Faculty/Presenter Disclosure

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1 Everything you want to know about helping people living with obesity (in 45 minutes ) An overview of the 5As Team approach to advancing obesity prevention, assessment and management in primary care Denise Campbell Scherer, MD, PhD, CCFP, FCFP Faculty/Presenter Disclosure Faculty/Presenter: Dr. Denise Campbell Scherer Relationships with commercial interests: Grants/Research Support: CIHR, MITACS, Alberta Innovates, Novo Nordisk Speakers Bureau/Honoraria: Not Applicable Consulting Fees: Not applicable Other: This presentation has received support from the Alberta College of Family Physicians in the form of a speaker fee and/or expenses. 1

2 ACFP 63 rd ASA Disclosure of Commercial Support This program has received financial support in the form of sponsorship from: Potential for conflict(s) of interest: Those speakers/faculty who have made COI disclosure are noted in the 63rd ASA Program and on the Salon A/B slide scroll. Mitigating Potential Bias ACFP: The ACFP s Sponsorship Guidelines apply to ASA Sponsorship. The ACFP abides by the College of Family Physicians of Canada s Understanding Mainpro+ Certification Guidelines, the Canadian Medical Association s Policy Guidelines for Physicians in Interactions With Industry and the Innovative Medicines Canada Code of Ethical Practices (2016). As a non profit organization, the ACFP complies with Canada Revenue Agency regulations. When deliberating acceptance of sponsorship, the ACFP considers and accepts sponsorship only from those whose products, services, policies, and values align with the ACFP vision, values, goals, and strategies priorities. ASA Planning Committee: Consideration was given by the 63 rd ASA Planning Committee to identify when Planning Committee members and speakers personal or professional interests may compete with or have actual, potential, or apparent influence over program content. Material/Learning Objectives and/or session description were developed and reviewed by a Planning Committee composed of experts/family physicians responsible for overseeing the program s needs assessment and subsequent content development to ensure accuracy and fair balance. The 63 rd ASA Planning Committee reviewed Sponsorship Agreements to identify any actual, potential or apparent influence over the program. Information/recommendations in the program are evidence and/or guidelines based, and opinions of the independent speakers will be identified as such. 2

3 Objectives & Outline Understand the complexity of obesity and its management Reflect on techniques for collaborative deliberation (including shared decision making and motivational interviewing) The challenge The patient voice Structure for consultation Key communications Strategies for collaborative deliberation Tools to help 3

4 Prevalence of Obesity in Canada Twells LK, et al. CMAJ Open

5 Energy in <=> Energy out Sleep Genetics Gut Flora Mood Stress Diet +/ +/ Exercise Energy in Energy out Energy Regulation is Complex! Sharma AM 2007 revised

6 Societal influences Individual psychology Food Production Food Consumption Individual activity Activity environment Biology Phases of obesity treatment Phase I (Weight Loss) Phase II (Weight Loss Maintenance) Weight When you stop treatment, the disease comes back! 3 6 months Indefinitely 6

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8 They were like, Okay, cut your calories and exercise, and that was their only thing Eat less and exercise more isn t the end all be all. I m looking for more concrete strategies. (Patient 11) My family physician has never ever talked about my weight. (Patient 5) My family physician would give me the standard, Eat less fat, eat less sugar (chuckle), exercise more, and that s not going to cut it (Patient 2) My doctor doesn t deal with the weight management as a completely separate issue. It s affecting my health, my recovery and my ability to exercise. She sees me once a month for a follow up appointment to check my prescriptions, how I m feeling, and my weight. So it s part of the bigger picture. (Patient 7) I love my new doctor because he actually says stuff to you, very nicely. He s very kind and gentle about it but he ll actually say, It ll help if you lose weight. And he encouraged me to come here and encouraged me to take more classes. (Patient 21) 8

9 Patient Physician Relationship (initiate, effective, knowledgeable, kind) Coordinated whole person approaches to address the multiple conditions and drivers of obesity Emergent Themes Existing services are providing support in meaningful ways Want supports that are personalized 9

10 Our patients voices 10

11 Coordinated and person centred care Weight management is inseparably tied to other physical, mental, and socio economic conditions presenting barriers 11

12 How do we do the work in our complex primary care world? Hint: It takes a team... 12

13 All Images are from the Canadian Obesity Network Image bank ~ all have consented for their use. Sorting out the Consultation Structure for Family Practice. What to do more of and what to do less to support people make changes towards health? OBJECTIVES 1) Identify key elements of the counselling approach that are impactful from the patient perspective and that work in primary care 2) Understand how the approach effects change in patients everyday life GOAL To develop an approach and identify suitable theoretical models and outcome measures for future testing METHOD(OLOGY) Collaborative, qualitative-explorative, pragmatic, dialogic interaction Video-recorded encounters, patient and provider interviews, journaling, follow-up interviews 13

14 27 Fostering Self Compassion Treat oneself gently when encountering failures. Common humanity: recognize failures are part of human nature Mindfulness: take a non judgemental and present perspective Skill that can be strengthened Remember all of the emotional elements of obesity (experiences, feelings etc.) 14

15 Therapeutic objective is not to solve obesity, but rather to live a meaningful, vibrant life even when symptoms are present. What are the persons values they hold most dear? Value based behaviour change Values NOT goals What is the functional thing that you would like to do? Why? Linking values to behaviours How will engaging in a health behaviour help you express and move toward your values? Patient example 15

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18 Connec ting Active Ingredients Trying out and adjusting Patient story: root cause and context integration Reframing views about self and obesity Journalling Compassion Relationship Listening Aligning expectations with evidence Action planning Whole person health approach 18

19 Sense-making and trying out over time Lisa: You, you know I would say what had the most impact on me was, was the session itself and the approach she took because I m now taking that approach with myself, so she showed me an approach that was about compassion, about being gentle with myself, about understanding that there s lots of different variables that are affecting things and about looking at the positive things that I m contributing to what I m doing right now so it feels, I d have to say overall that it just feels like a much gentler process [ ] Feeling much, much better about it. There s been a big shift around that for me so it s no longer about you know why can t I change this back? I keep trying to do all these things and so it s no longer about trying to change it back. Now the goal is about being the best I can in this body,, so I would say I m not beating myself up as much. I, I m, I still beat myself up and I m hoping I ll be able to let that go. I m not going down as far as I used to so I m generally speaking, my activity level is increasing and that s huge. [ ] after doing this for a month, I would be feeling like I want to do that for about a year cause then I d be on top of this stuff. I d really know what I was doing right and that would be (whisper) so helpful. That could possibly, I believe that that in truth could lead me back to work. Image: MAKING SENSE of the why and how ALINGING for manageability REFRAMING toward strength and meaning Transforming the narrative in collaboration supports people to make changes to improve health 19

20 Collaborative deliberation Making sense of causes, drivers, context Reframing views of obesity and self Prioritizing Trying out and adjusting Elwyn et al. Collaborative deliberation: A model for patient care

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23 Reflect on your lived experience in your environment What are the aspects of your setting that you see need to shift and how do you think this could work? What aspects of your personal practice do you see as needing to shift? 23

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27 EOSS Predicts mortality in NHANES III 27