Sudi Devanesen, MD, CCFP, MClSc, FCFP, Associate Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON
Macaran A. Baird, MD, MS, Professor and Head, Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis, MN
Janet Christie-Seely, MD, CCFP, FCFP, Professor, Department of Family Medicine, University of Ottawa, Ottawa, ON
Pauline Abrahams, MBChB, BSc, CCFP Member, Psychosocial-Spiritual Team, Tammy Latner Centre of Palliative Care, Mount Sinai Hospital, Toronto, ON
Posted: July 9, 2014 Format: PDF
A Patient-centred Approach to Obesity: Counselling Health Behaviour Change
Family physicians (FPs) commonly deal with patients’ concerns about weight, because of a direct request for advice on losing weight or because a medical assessment leads to concerns about a patient’s overall health risks. As with other chronic conditions such as diabetes or hypertension, some people are predisposed to obesity because of a genetic tendency; the incidence is also influenced by environmental factors. Attempts at weight loss are frustrating for both patients and physicians, because patients have difficulty sustaining long-term weight reduction. An estimated two-thirds of the weight loss achieved by individual patients is regained in the year after the initial loss.(1) A patient-centred approach to obesity takes into account such factors as stage of change, level of motivation, health beliefs, support system, family background and other family factors, and psychosocial stress. This approach may improve overall patient care.(2,3) Factors beyond diet, exercise, and medications must be considered. FPs need to find ways to avoid frustration and engender optimism in their patients. In addition, we must recognize the role families play in contributing to and perpetuating obesity in patients, especially children.
In today’s world, families are under increasing stress, from financial and time constraints, to family breakdown, substance abuse, and threats of violence. Family physicians are seeing an increase in psychosocial issues such as anxiety and stress-related disorders, often co-existing with and complicating medical problems such as diabetes or pneumonia. The psychosocial issues are often more difficult to diagnose and manage than are the medical problems—and all take place in the family context. Very often, the family is the key to dealing effectively with the whole spectrum of complaints, requiring a psychosocial assessment. In the crowded family medicine curriculum, this vital area of knowledge and skill is often ignored in favour of more clear-cut procedural skills.
To educate family physicians about dealing with families, a group of family medicine educators, practitioners and mental health professionals affiliated with the Department of Family and Community Medicine at the University Of Toronto founded the Working with Families Institute (WWFI) in 1985. The WWFI has developed various training experiences for trainees and practising physicians.