‘Pushing a very heavy wheelbarrow up a very steep hill’. This is how GP Dr Elizabeth Sturgiss describes the difficulty facing an overweight or obese patient as they struggle to lose weight. The difficulty in achieving real and lasting behavioural change, and finding practical ways to enable that change is the focus of her RACGP research.
It’s no secret that the incidence of obesity has been steadily increasing in Australia over the past 30 years. In fact, close to two thirds of today’s adult population is considered overweight. That is a concerning statistic, given that obesity is a leading cause of mortality in our community. But few of us would not be familiar with the seemingly Herculean task of losing excess weight – and keeping it off.
Of course, as the health professions seek to address the issue they, and we, are faced off against a barrage of junk food and alcohol advertising, weight loss reality shows promising miracle results and an endless array of cooking shows!
For Dr Sturgiss, the lightbulb moment was realising the role of the GP as a vital change agent. As the first point of contact in the health system, she sees them as being in an ideal position to raise and address this issue with their patients. However, she doesn’t underestimate the challenge:
‘… as patients leave your consultation room, everything in the environment is usually working against them, from the food that’s cheap and available, to how easy or hard it is to be active,’ she says.
While there is a wealth of health and diet information available within Australian guidelines, Dr Sturgiss saw a gap in terms of those resources being presented as a practical, integrated treatment program that could be easily adopted by patients.
‘I would offer (my patients) referrals to dietitians and exercise physiologists. But some people, for whatever reason, don’t want to do that, and I wondered if there was something that I could help them with,’ she says.
A 2013 RACGP Foundation grant enabled her to develop the Change Program, described as ‘a toolkit that can provide structure for a GP within their practice, looking at supporting people who are trying to improve their health through weight loss’. Themed around nutrition, physical activity and behavioural change supports, The Change Program toolkit includes a handbook providing GPs with guides on how to help patients manage their weight, plus a workbook for patients to bring to regular consultations. The kit also provides a template that links into clinical software, enabling GPs to enter information into the patient record quickly and conveniently.
Importantly, Dr Sturgiss says the Change Program also offers prompts for GPs on useful discussion points in the course of what might be a difficult consultation:
‘These things are really difficult to even discuss with a patient if you don’t have a toolkit or supports to help you do that. But this program… will allow GPs to bring up the issue and then give the patient a worksheet, and they can then go home, have a go and come back and talk about it. As a GP, if we have tools that can support us in helping patients, then that makes the subject easier to bring up.’
Now being piloted in five GP practices across Canberra, even at this early stage Dr Sturgiss is pleased with the positive feedback from patients. She is convinced the quality of the GP patient relationship holds the key to its ongoing success:
‘We’re not going to find a program that we can just fling up and have it work for everybody,’ she says. ‘The Change Program is likely to work in a situation where a GP and a patient have a good therapeutic relationship and it’s something that they want to work on together. It gives them more structure around what they might do together.’
The Change Program is a recognition that one of the keys to a leaner, healthier Australia lies in the partnership between the patient and their own GP.
We're always looking for partners who want to create a healthier Australia. To find out more about the RACGP Foundation's work, or how you can partner with us to create a healthier Australia, visit foundation.racgp.org.au/foundation
All quotes taken from the article ‘Path To Change’ Good Practice Jan-Feb issue 1-2 2016
Independent Practitioner Network Pty Ltd (IPN)
RACGP/IPN Medical Centres Research Grant 2013