For the practical management of obesity, international guidelines propose the “5A” model, an evidence-based framework for behavioral interventions that was originally developed for smoking cessation. This brief intervention (lasting approx. 20 minutes) can be carried out during a doctor’s appointment.
The professional organization Obesity Canada, a network of researchers, health professionals and public advocates, published an evidence-based, patient-centered clinical practice guideline for obesity in adults in 2020 [1]. An important message of the guideline is that obesity is a complex disease that is multifactorial and therefore requires a holistic approach. In line with the biopsychosocial model of health, the treatment goal is not exclusively weight reduction, but rather an improvement in the general state of health and quality of life of the affected patients.
Canadian and Irish guidelines recommend “5A” strategy
The basic idea of the Canadian guideline was taken up by an interdisciplinary, multi-professional collective of 70 experts in Ireland in 2022 and they adapted the guideline for use in the context of the European and Irish healthcare system. The adapted Irish guideline was published under the title “Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland” in the journal Obesity Facts [2].
The steps subsumed under the acronym “5A” have proven to be effective in helping smokers to change their behavior in everyday life [3,4]. In a consensus paper on treatment principles for obesity published in 2023, the individual components of brief intervention are described as follows [3]:
“Ask” – address the issue: The first step is to clarify whether patients are willing to address their own weight situation. This is by no means a matter of course, because due to discrimination, frustration, feelings of guilt or negative experiences in the personal or medical environment, those affected sometimes react with disinterest or rejection when they are approached about the need to lose weight. In order for the brief intervention to be successful, it is important that the person concerned is willing to change their behavior. Patients who are not yet willing or able to start weight-loss therapy should be made aware of counseling and support services; if necessary, it may be useful to arrange a further counseling appointment. Information material on the benefits of weight reduction, healthy eating and physical activity should also be provided. An important factor is that the treatment of those affected and their environment should be respectful, empathetic and free of criticism and prejudice.
“Assess” – Determine: This stage includes a comprehensive general and specific medical history, the diagnosis of the metabolic situation and the associated health risks, as well as documentation of the patient’s history of obesity, including attempts to lose weight. It is suggested that the patient’s subjective perception of their health and their goals in this regard be recorded in parallel. Finally, the aim is to identify the causes of obesity and the factors that have hindered previous efforts to change lifestyle.
“Advise: In this step, people who are overweight or obese are educated about their personal health risk and informed that even moderate weight loss can noticeably improve their state of health, focusing on the patient’s individual values. Patients should also be informed about the various treatment options. The associated advantages, disadvantages and risks and the contribution patients need to make to the success of the treatment must be made clear.
“Agree – agree: In the sense of a “shared decision-making” process, patients should be involved in setting treatment goals and in planning the measures to achieve these goals. Planned interventions should be discussed and the consent of the person concerned obtained. At this point, it is important that the agreed goals are realistic, and patients should be advised accordingly.
“Assist” – support: Overcoming established behavioral patterns and integrating new eating and exercise habits into everyday life is an interdisciplinary challenge that requires the support of all professionals involved. Patients should also be advised as to what barriers stand in the way of lifestyle change and how these can be overcome. Partners or caregivers should be involved in the care in a supportive manner wherever possible.
Literature:
- Wharton S, et al.: Obesity in adults: a clinical practice guideline. CMAJ 2020 Aug 4; 192(31): E875–E891.
- Breen C, et al.: Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland. Obes Facts 2022; 15(6): 736–752.
- Brix JM, et al.: Übergewicht und Adipositas bei Erwachsenen: allgemeine Behandlungsgrundsätze und konservatives Management [Overweight and obesity in adults: general principles of treatment and conservative management]. Wien Klin Wochenschr 2023; 135(Suppl 6): 706–720.
- Plourde G, Prud’homme D: Managing obesity in adults in primary care. CMAJ 2012; 184(9): 1039–1044.
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