4 Key weight management tips for GPs

Person on weight scales image


By Melanie McGrice, AdvAPD - www.melaniemcgrice.com.au

Weight management is a topic that is discussed regularly amongst all health professionals, however a recent survey found that 60% of GPs admit to only initiating a discussion about weight when their patients were more than 11kg overweight and another 14% wait until patients were more than 20kg overweight. (1) Yet excess weight is often in the background of other more complex or chronic conditions and its management could be the difference between prevention or progression. 

Patients turn to health professionals not only for help and advice, but also for prudent strategies, updated progress reports and to explain the effect on their health. It is therefore crucial that GPs, who are generally the first responders at the front line of intervention, be confident and effective when guiding their patients through their weight management journeys.

Although the field of weight management is as large as it is complex there are a few things that GP’s should keep front of mind. My top four weight management tips for GPs are:

1. 5-10% weight loss can be clinically significant

There is a wealth of evidence that shows that moderate weight loss of 5-10% of overall body weight can be clinically significant in improving a range of metabolic and cardiovascular conditions. Van Gaal showed that sustained moderate weight loss lowers blood pressure, improves glucose control and improves dyslipidaemia as well as inflammatory, haemostatic, and fibrinolytic factors. In addition, it is associated with the prevention of progression to Type 2 diabetes in at risk subjects.(2) 

For individuals who are well above their healthy weight, it can be daunting to imagine how they will be able to lose such a large amount of weight. However, breaking it down into smaller shorter term goals of 5-10% can be more empowering while still enabling a range of beneficial and tangible health outcomes.

2. Fast weight loss can be a good thing

Only a few short years ago, losing weight quickly was frowned upon by health professionals, however new research shows that losing weight quickly is a better option.(3) Rapid weight loss can increase motivation and help to achieve more sustainable results while not increasing the risk of weight regain. The one condition is that nutritional requirements need to be met. Therefore fad diets that promise quick weight loss but eliminate core food groups should be avoided. 

Dietitians can instruct patients regarding safer alternatives that can illicit faster weight loss in a controlled manner, such as the use of a kilojoule restricted meal plan or Very Low Energy Diets (VLED’s). 

3. One size doesn’t fit all

There is no one quick fix that will solve weight management concerns for everyone. The factors affecting weight management are varied, complex and can be very specific and personal. Although some ‘diets’ may have some medical basis (such as intermittent fasting or a low carbohydrate diet), it may not be applicable for every individual due to their social, mental, medical and/or physical health. Maintaining weight loss can also be as challenging (if not more so) than gaining or losing weight and so GP’s need to be able to provide advice to prevent weight cycling. 

It is also important to use clinical judgement and to take into consideration internal (genetics, hormones, physical ability, medical conditions etc) as well as external (living arrangements, motivation level, cooking skills etc) factors when providing advice to clients. 

4. Prevention is the best

There is a wealth of evidence that supports good health and nutrition particularly in the first 1000 days of life for the vitality of future generations.(4) Women who gain excessive weight during their pregnancy, not only increase their risk of weight-related lifestyle conditions such as diabetes, hypercholesterolemia and hypertension, but also may affect their offspring’s genetics regarding body composition and metabolism predisposing them to also become overweight. Additionally, women may find it harder for them to return to their pre-pregnancy weight resulting in a higher starting weight for future pregnancies. If the child grows up overweight or obese, and becomes pregnant, the cycle begins again. Weight, nutrition, stress and other environmental factors can play a role in epigenetics however the more knowledge women of child-bearing age obtain, the more likely they will be to prevent the perpetuation of the obesity cycle.

As a GP is at the front line it can be difficult to assess and review all weight management cases and so a referral to an Accrediting Practising Dietitian can be of great benefit. Consultation with a Dietitian will allow for a thorough dietary assessment taking into consideration their social, mental and clinical histories in order to provide individually-tailored strategies to help achieve their goals. 

Further information on weight management can be found on the following video clips/links:  

1. Fad diets
2. Maintaining weight loss
3. The effect of hormones on weight 
4. The Pregnancy Weight Plan

References

1. Survey conducted at GPCE Sydney (Survey Monkey May 2015 n=62) by Omega Pharma
2. Van Gaal LF, Mertens IL, Ballaux D (2005); ‘What is the relationship between risk factor reduction and degree of weight loss?’ Eur Heart J Supp; 7;L21-L26
3. Purcell K, Sumithran P, Prendergast L, Bouniu C, Delbridge E, Proietto J (2014): ‘The effect of rate of weight loss on long-term management: a randomised controlled trial’: Lancet Diabetes Endocrin; 2 (12); 954-962
4. Gillman MW, Ludwig LW (2013); ‘How early should obesity prevention start?’ N Engl J Med; 369; 2173-2175