Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study

Abstract

Objective The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. Methods We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new ‘EOSS-2 Risk Tool’, using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. Results Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). Conclusion The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.

Development and internal validation of the Edmonton Obesity Staging System-2 Risk screening Tool (EOSS-2 Risk Tool) for weight-related health complications: a case-control study in a representative sample of Australian adults with overweight and obesity

“…The β coefficients for the final model and the scores allocated to each risk factor category were then computed (table 3). To create the final paper-based version of the EOSS-2 Risk Tool, we included the three definitional variables and variables with significant correlation to EOSS≥2 (assigned a maximum score of 25 each) along with the three risk factors in the final diagnostic model 11…”

“…We recently published the first evidence of a nationwide pilot study supporting the clinical usefulness of the EOSS-2 Risk Tool (including a paper-based version) for activating weight management discussions in general practice, although further research is required to assess its scalability in Australia's healthcare system. 11 Despite their variable application in Australian general practice, both the AUSDRISK and CVD risk tools are considered clinically useful for patient engagement and education, as well as assessment and management of risk followed by appropriate diagnostic tests. [22][23][24] The EOSS-2 Risk Tool could also be used by other healthcare professionals involved in multidisciplinary clinical obesity services in both public hospitals and private settings such as nurses, dietitians, clinical psychologists, exercise physiologists and physiotherapists.…”

“…It may also help GPs initiate a discussion about the health benefits of weight loss with patients, with or without mentioning obesity, resulting in improvements in their quality of care and health outcomes. 11 Thus, we aimed to report the development and internal validation a simple screening tool ('EOSS-2 Risk Tool') to estimate the risk of clinically significant weight-related complications according to a diagnostic definition of EOSS≥2. 3…”

“…A brief diagnostic screening tool for predicting EOSS≥2 in patients with excess weight could provide GPs with a structured framework for further investigations to confirm a timely diagnosis in those who screen positive. It may also help GPs initiate a discussion about the health benefits of weight loss with patients, with or without mentioning obesity, resulting in improvements in their quality of care and health outcomes 11. Thus, we aimed to report the development and internal validation a simple screening tool (‘EOSS-2 Risk Tool’) to estimate the risk of clinically significant weight-related complications according to a diagnostic definition of EOSS≥2 3…”

“…based on nine self-reported risk factors11 relevant to the Australian population. A score of 25 or more was assigned to six out of nine risk factors to Structural zeros were either due to the definitional variables (variables or levels of variables that were used to define EOSS≥2) or those variables that had significant correlation to EOSS≥2.…”