Conversations about health and weight must not be delayed

CONVERSATIONS with patients about weight – often put off due to lack of time, resources or even confidence – have the potential to be life changing.

Obesity is continuing to climb in Australia, with two-thirds of Australian adults considered above a healthy weight, and more than nine out of ten Australian adults and children not eating a healthy diet.

With obesity now identified as a risk factor for severe disease and increased mortality for COVID-19, and the past 2 years seeing factors contributing to weight gain – fast food consumption, increased snacking, reduced physical activity – exacerbated by lockdowns, these conversations have become more important than ever.

Now and into the future, as health professionals and primary care providers, we have a key role to play in providing healthy lifestyle information and support and intervening early with patients who have, or are at risk of, overweight or obesity, to prevent further illness.

Intervening early to prevent future disease

Unhealthy weight, defined by high body mass index (BMI), is the biggest contributor to the burden of disease in Australia after tobacco smoking, and is strongly associated with several chronic diseases including heart disease, type 2 diabetes and certain types of cancer.

Unlike many other serious illnesses, weight-related chronic disease can be prevented, or progress delayed, with early intervention and support to make healthy lifestyle changes.

Yet the diverse range of public opinions on healthy eating, weight and dieting can make finding a trustworthy source of advice a minefield, and many patients can feel uncomfortable bringing up the topic themselves.

This is where health professionals come in.

Health professionals understand that the causes of unhealthy weight gain are complex and a personal approach to lifestyle changes is needed. Health professionals are also highly trusted by their patients as reliable sources, and research has shown many patients want advice on healthy eating and weight management from their health professional, including their primary care provider. In addition, advice from a health care professional is a strong predictor of patients’ efforts toward weight management and weight loss outcomes (here and here).

Our own national survey of adults aged 18–65 years – Shape of Australia 2021 – showed just under three-quarters (73%) of adults are at least a little concerned about their body weight, almost half are currently trying to reduce their weight (47.6%), and of those above a healthy weight, almost one-third (31.2%) wanted their doctor to initiate a conversation with them about it.

Health care professionals are in a unique position to drastically improve our patients’ lives by providing them with the knowledge and skills they need to start living a healthy life and reduce their risk of serious illness.

What needs to be recognised, however, is the role of health professionals in starting these conversations. A large international study has shown that, for a patient struggling with excess weight, it takes on average 6 years for them to raise it with their health care professional.

A simple, timely intervention by a health professional can significantly reduce this delay, potentially preventing future unhealthy weight gain and related chronic disease.

An effective intervention

Starting the conversation can be difficult due to not wanting to offend the patient, concerns the patient is not ready, lack of resources and even the health professionals’ concerns about their own weight, but, with practice, many of these barriers can be overcome.

Successful interventions can be as short as 3–5 minutes and, in the first instance, will sometimes only include raising with the patient the idea of making a change towards a healthy diet or being more active and making the offer to discuss it further at a later consult when the patient is ready.

Training and regular practice can help greatly to overcome initial barriers or feelings of discomfort to engage patients in a weight-related conversation and to assist them to make changes. Through training, health professionals can also gain techniques and skills, such as motivational interviewing (and here), which can help make these conversations more impactful.

Equipping yourself for an effective intervention

Many health professionals aren’t provided training on motivational interviewing and behavioural change (here and here) – a gap that was identified by Cancer Council Victoria 6 years ago.

Since then, Cancer Council Victoria, in collaboration with Health and Wellbeing Training Consultants has been offering training on talking with patients about health and weight, to increase practitioner confidence to initiate early and brief weight intervention plans with patients who have, or are at risk of, overweight or obesity.

The training covers the National Health and Medical Research Council guidelines, motivational interviewing techniques, use of language and terminology regarding weight stigma, and available resources and support for patients and health professionals.

The training is now offered via two separate pathways:

• online – a one-hour online training module (Royal Australian College of General Practitioners [RACGP] continuing professional development [CPD] activity); and
• face-to-face – a full day intensive course (6 hours learning; RACGP-accredited CPD activity).

To enrol (fees apply), visit: cancervic.org.au/healthyweight/gps-and-health-professionals

Alison McAleese is an Accredited Practising Dietitian and Campaign Manager of Cancer Council Victoria’s LiveLighter program. Alison has a background in community health including patient education for chronic disease and weight management. She has designed and delivered health professional education on talking to patients about health and weight over the past 6 years at Cancer Council Victoria.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.