Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

Abstract

Abstract. Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n = 49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and costeffectiveness in Australia.

A systematic review of patient barriers and facilitators for implementing lifestyle interventions targeting weight loss in primary care

“…The role of the GP was addressed by 21 studies; 11 studies described barriers 28,35,37–39,42–45,50,52 and 17 described facilitators 26,28–30,32,35,39–43,45–47,49,50,52 . The most commonly described barriers were GPs not being involved with the problem, feeling like they were wasting the GP's time, and lacking of empathy from the GP.…”

“…The theme of the “role of program staff” focuses on HCPs directly involved in the lifestyle intervention program, of which 15 studies reported on. Eight studies described barriers, 26,32,33,35,37,39,43,50 and 11 described facilitators 27,35,38,39,42,43,45,47,49–51 . The two most commonly reported barriers were a lack of active follow‐up and program staff being difficult to reach for participants.…”

“…Twenty‐six studies reported on the program structure of the lifestyle intervention, of which 19 reported on barriers, 27–29,31–35,37–41,43,45,46,48–50 including disliking certain aspects of the group sessions, feeling that the individual is not the target population, a lack of personalized approach, the program being too much effort, program tools are difficult to use, and the program having too much time between follow‐ups; 25 studies reported on facilitators 25–29,31–36,38–43,45–52 . The most commonly reported facilitators were a program with a personalized approach, liking certain aspects of group sessions, liking certain aspects of the program, monitoring of health and weight status, and programming tools that were seen as helpful and flexibility in scheduling the sessions.…”

“…The theme "psychological factors" contains several factors of individuals, such as motivation, confidence, and stress. It was reported by 23 studies, of which 23 identified barriers [25][26][27][28][29][30]32,33,35,[38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 12 identified facilitators. 25,[28][29][30]33,40,41,43,[46][47][48]51 These include barriers such as the motivation and self-confidence of the individual, the lack of trust in the intervention, poor knowledge of health risks associated with their weight, and stress perceived by the individual.…”

Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs

“…It is therefore vital to consider behavioural, social and environmental influences that impact obesity (Australian Institute of Health and Welfare, 2018) Yet, many organisations implementing prevention activities tend to favour behaviour change programs focusing on risk factors such as poor nutrition and inadequate physical activity levels, to address overweight/obesity (Dalle Grave et al, 2013;Swinburn, Caterson, Seidell, & James, 2004). These types of programs can be difficult to sustain in the long-term, and have been found to have limited success (Committee on Evaluating Progress of Obesity Prevention et al, 2013;Gray et al, 2017;Khanal et al, 2016). In addition there is a tendency for organisations to work in a siloed manner, limiting their interaction with other groups or sectors to affect change, often competing for minimal and/or the same funding (Bevc, Retrum, & Varda, 2015;Butcher et al, 2014;Nader et al, 2012;Reicks, Trofholz, Stang, & Laska, 2014).…”