a new model of weight loss clinic in general practice...
TRANSCRIPT
A New Model of Weight Loss Clinic in General Practice Using Multidisciplinary Approach in Group Sessions
Dr. Tri Tuyen CaoMBBS, FRACGPSpecial interest in Obesity Specialist Certification of Obesity Professional Education ‐ SCOPEWorld Obesity Federation (formerly IASO)
•MBBS, Adelaide University, 1995•FRACGP 2004•Special interest in Obesity Management•Emergency GP Consultant, Noarlunga Hospital since 2000•Work at Montague Farm Medical Centre since 2007
Montague Farm Medical Centre • Established 1997• 8 GPs (4 males and 4 females)• RACGP SA Practice of the year 2011• Practice Manager of the year 2012• Quality in Primary Health Care Award 2012
Tri Tuyen Cao
Background
The prevalence and degree of obesity in increasing in Australia.
GPs are in the best position to manage obesity.
Multidisciplinary approach: GPs don’t have to cover all aspects of obesity.
Group session: leverage time available for patients.
GPs are in the best position to manage obesity
In general, GPs don’t take an active role:
In Australia, there are limited previous studies in weight loss programs at GP level, in both multidisciplinary approach and in group sessions.
Obesity Management in GP
Lack of time Inadequate Medicare re‐imbursement
Lack of skills and knowledge
Easy to access unlimited visits lifetime management one of the most trust health professionals know the patients and families well access and coordinate a multidisciplinary team approach
1. Individual consultations
2. Individual consultations in one morning session
3. 8-week program in group sessions & multidisciplinary approach
Development of Multidisciplinary Weight Loss Clinic in GP
8-week weight loss programTuesday evening 4:30-8:30 pm20-25 patientsScheduled follow up 6,12,18,24 monthsEach week
– 10 minutes weigh in and measure by nurse / receptionist– 10 minutes GP consult, item 23– 30 minutes group education (time donated by local allied health)– Total patients time 50 minutes
The LivingLite Clinic, MFMC
Our Team
• Dr Tri Cao – GP specialised in weight management• Megan Wachowicz – Dietician• Miguel Quintero – Lifestyle Advisor• Elvira Kovacs – Psychologist• Chris Ftinogiannis – Exercise Physiologist• Kylie Henderson – Coordinator• Practice Nurse
Method Recruitment
Invitation letter to patients ≥18 y.o, and BMI≥30, or prescribed Phentermine in previous 12 months
Waiting room flyers Self referral or from GP within the clinic
8-week program In group sessions Multidisciplinary approach
Weekly text message Clinic reminders Motivational quotes
Goals of the 8-week program
1. To lose weight
2. To find your key behaviour factor
3. To establish new healthy habits
Week Description Presenters1 Welcome and overview of the program
Weigh‐in and measurements Goal setting: “What, Why, How”
General practitioner
2 Meal Planning Workshop Diet and its role in weight control Planning meals for the next week with the guidance of the dietician.
Dietician
3 Lifestyle changes for healthy weight loss Holistic approach to healthy weight loss and lifestyle changes Planning of next week schedules including “me‐time”
Lifestyle adviser
4 Physical activity for healthy weight loss and fitness Planning of next week incidental exercise and work out
Exercise physiologist
5 Dealing with stress and setbacks, emotional awareness, non‐hungry eatingHow to recognise and overcome the challenges Meet “your inner self” and review “Why” goal
Mental health clinician
6 Panel Review: Myths and Facts in weight loss Time for questions and answers
GP, dietician, psychologist, exercise physiologist, lifestyle adviser
7 Learning from other stories and reviewing your journey Show and tell: hidden fat and sugar Time to share tricks and traps in the journey, stories and experiences
Lifestyle adviser, GP
8 Moving forward Evaluation, review of the program Group Fitness Where to go from here, planning of next 3 month journey
Gym Owner
Schedules of educational meetings
Goal settingWhat Goal: aim to lose 5-10% of current body weight and maintain the current muscle mass
Why Goal1. What are the benefits of achieving my weight goal?2. Why is it so important to me?
How Goal: clear one road block at a time1. Food-Mood-Physical Activity Diary 2. Pedometer3. New habit
How Bioelectric Impedance Analysis works
‐Muscles, blood vessels and bones are body tissues having a high water content that conduct electricity easily.‐ Body fat is tissue that has little electric conductivity. ‐BIA scales send an extremely weak electrical current through your body to determine the amount of total body water. ‐These allow an estimated calculation of body fat percentage.
Why not measure BMI, why body fat percentage
• Body fat percentage measured by bio‐impedance analysis(BIA) scales
• Fat loss is healthy weight loss
Normal BMI (healthy)
High BMI (obese)
Who has the healthy BMI?
Finding Your Key Behaviour FactorStory of young boy and the world map puzzle
Obesity System Causal Map
Baseline Characteristics of PatientsNo. of patients enrolled
Clinic start date Baseline (Median)Age (years)
BMI (kg/m2) Weight (kg) Body fat (%) Waist circumference (cm)
Clinic 1 29 11/10/2011 45.0 34.7 95.2 37.1 109.0
Clinic 2 29 07/02/2012 51.0 37.6 104.5 43.6 114.0
Clinic 3 25 01/05/2012 52.0 32.6 81.9 34.0 103.0
Clinic 4 26 24/07/2012 49.5 34.1 91.1 35.2 102.0
Clinic 5 26 09/10/2012 50.0 31.9 87.8 33.1 98.0
Clinic 6 28 05/02/2013 49.0 36.1 94.2 41.9 104.5
Clinic 7 20 07/05/2013 42.5 34.7 96.5 41.8 108.0
Clinic 8 12 23/07/2013 49.5 35.06 97.1 45.3 105.0
Clinic 9 22 15/10/2013 40.0 34.96 95.0 40.8 105.0
Total 217Max 52.0 37.6 104.5 45.3 114.0Min 40.0 31.9 81.9 33.1 98.0Average 47.6 34.6 93.7 39.2 105.4Median 49.5 34.7 95.0 40.8 105.0
Results
Results
Clinic Number Patients Number achieving weight goal loss
Number achieving “Why” goal
Number achieving “How” goal (i.e. finding behaviour key)
Number achieving “How” goal (i.e. establish new habits)
1 15 6 9 10 15
2 14 10 9 12 12
3 20 11 13 14 16
4 13 8 6 9 13
5 6 3 1 4
6 18 11 10 12 14
7 19 12 11 12 16
8 14 11 12 10 13
9 10 5 6 6 7
Total 129 77 76 86 110
Percentage 60% 59% 67% 85%
Patients feedback at 8 week: Did you achieve your goals?
DiscussionThe decreases in weight, body fat and waist circumference achieved via our multidisciplinary group clinic model are encouraging.
The long‐term efficacy and generalisabilty of this model deserves further study and we are continuing follow up of all clinic groups.
Using a multidisciplinary approach can leverage the knowledge and energy of allied health colleagues and GPs don’t have to cover all aspects of obesity on their own.
A group session model can maximise time available as we don’t have to repeat information to every patient.
Many patients attended in groups of friends and family members and this creates a momentum within families and the community.
Whilst the allied health professionals’ time is donated, the referrals arising from their involvement makes it worthwhile.
Unexpected benefits arising out of the program include improvement of health parameters in the families of patients as well as healthier habits developing amongst our staff.
Visit our poster: No 14
Building Your Weight Loss Clinic in General Practice Using Multidisciplinary Approach in Group Sessions
