Multidisciplinary Weight Loss Clinic in General Practice. Dr Tri Tuyen Cao MBBS, FRACGP Professor Garry Egger PhD, MPH, MAPS

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1 Multidisciplinary Weight Loss Clinic in General Practice Dr Tri Tuyen Cao MBBS, FRACGP Professor Garry Egger PhD, MPH, MAPS

2 Weight Related Problems The prevalence and degree of obesity is increasing in Australia: In 2000 over 67% of Australian men 55% of Australian women were classified as overweight or obese. Obesity is associated with over 35 different diseases. Obesity is: A multi faceted chronic condition Requires a multidisciplinary approach of a GP, Psychologist, Dietitian, Exercise Physiologist, Lifestyle Advisor

3 Obesity Management in GP GPs are in the best position to manage obesity easy to access unlimited visits In lifetime general, management GPs don t take an active role: Lack one of the time most trusted health professionals Inadequate know the patients Medicare and re-imbursement families well access and coordinate a multidisciplinary team approach In Lack Australia, of skills there and knowledge are limited previous studies in weight loss programs at GP level, in both multidisciplinary approach and in group sessions.

4 Development of Multidisciplinary Weight Loss Clinic in GP 1. Individual consultations 2. Individual consultations in one morning session 3. 8-week program in group sessions & multidisciplinary approach

5 This Study The Study A practical evaluation of four 8-week Weight Loss Programs in 12 months at Montague Farm Medical Centre: in group sessions with multi-disciplinary approach The Aim To develop and to test a new model of a weight loss clinic in General Practice

6 Method - Sample Selection of participants invitation letter to patients with BMI >30 had phentermine scripts in the last 12 months referred by GPs within the clinic response to pamphlets distributed in the practice waiting room

7 Baseline Characteristics of Participants all groups Max Median Min age Age BMI weight Weight 108 patients, 15 males 93 females. 10 diabetes, 9 on Phentermine

8 Method - Clinic Model Enrolment was from Oct 2011 to July 2012; four groups met once weekly for eight weeks. Group instruction led by multidisciplinary team of a GP, dietician, psychologist, lifestyle advisor (Do it for Life), exercise physiologist, laughter yoga teacher. Weekly measurements using Bioelectric Impedance Analysis (BIA) scales by nurses Weekly review and monitoring by GP

9 Weekly Measurement Using Bioelectric Impedance Analysis Scales Weight (kg) Body Fat Percentage (%) Body Fat Mass (kg) Body Water Percentage (%) Waist Circumference Blood Pressure

10 Method - How Patients Lose Weight Goal setting: what, why, how Identify, practise to establish new healthy habits in 8 weeks Motivational Tools Weekly measurement using BIA Diary of food, mood and physical activities Four S s fitness test (Size, Stamina, Strength, Suppleness) Text message to reinforce discussed topic and remind meeting

11 Results no of patients from enrolled clinic start date no of patients after 8wk 8 week weight lost (kg) from baseline no of patients after 6 mon 6 month weight lost (kg) from baseline max min median max min median Clinic-1 24 Oct Clinic-2 30 Feb Clinic-3 28 May Clinic-4 26 Jul total

12 Results: Clinic 1 & weeks 6 months median waist circ reduction (cm) 4 7 median estimated fat lost(kg) median weight lost (kg)

13 Other Measurements 3 months after the first program: - Liver function test return to normal (1 fatty liver patient, lost 2.7 kg) - HbA1c reduction (5 diabetic patients) Patient 1: 10.2 to 8.2, lost 0.6 kg Patient 11: 5.9 to 5.6, lost 6.1 kg Patient 13: 9.4 to 7.9, gain 0.3 kg Patient 16: 5.9 to 5.4, lost 4.2 kg Patient 24: 6.9 to 6.7, lost 1.3 kg

14 New Healthy Habits Exercising daily Regular walking Planning the next day Meal planning Keeping a food diary Counting and recording calorie intake Drinking more water Reducing calorie drink (alcohol, soft drink, fruit juice) Cutting down chocolate & sweets

15 Discussion Multi-disciplinary approach for multi-faceted problem of obesity, GPs don t have to cover everything Group sessions: time efficient create a momentum in the community and at family level Individual consultation: Cost effective: MBS item 3 or 23 per patient x 8 Customized program for each patient

16 After the Study Regular 8-week programs every quarter Program 5: in Oct 2012 Continuing to improve and update the program Liaised with local council lifestyle programs Scheduled follow up at 6, 12, 18 and 24 months Surveying healthy habits Monitoring measurements

17 Acknowledgements Montague Farm Medical Centre RACGP South Australia Practice of the Year 2011 Dr Oliver Frank Discipline of General Practice, University of Adelaide Do It For Life

18 Questions and Feedback Dr. Tri Tuyen Cao Montague Farm Medical Centre 8/2 Montague road, Pooraka SA Work: Mobile:

Pre-Assessment Survey

Date: Participant ID: Tripler/Schofield Barracks MTF: Pre-Assessment Survey Directions: Please use a blue or black pen to complete this survey. Be sure to darken bubbles completely. Do not use checks or