Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health

Abstract

SummaryObesity is a complex, chronic disease, frequently associated with multiple comorbidities. Its management is hampered by a lack of translation of evidence on chronicity and pathophysiology into clinical practice. Also, it is not well understood how to support effective provider–patient communication that adequately addresses patients’ personal root causes and barriers and helps them feel capable to take action for their health. This study examined interpersonal processes during clinical consultations, their impacts, and outcomes with the aim to develop an approach to personalized obesity assessment and care planning. We used a qualitative, explorative design with 20 participants with obesity, sampling for maximum variation, to examine video‐recorded consultations, patient interviews at three time points, provider interviews and patient journals. Analysis was grounded in a dialogic interactional perspective and found eight key processes that supported patients in making changes to improve health: compassion and listening; making sense of root causes and contextual factors in the patient's story; recognizing strengths; reframing misconceptions about obesity; focusing on whole‐person health; action planning; fostering reflection and experimenting. Patient outcomes include activation, improved physical and psychological health. The proposed approach fosters emphatic care relationships and sensible care plans that support patients in making manageable changes to improve health.

Obesity in adults: a clinical practice guideline

“…Health care providers should ask the patient permission to discuss obesity, and if the patient permits, then a discussion on treatment can begin. 50,51 Step 2: Assessment Primary care clinicians should promote a holistic approach to health with a focus on health behaviours in all patients and address the root causes of weight gain with care to avoid stigmatizing and overly simplistic narratives.…”

“…53 Root causes of obesity include biological factors such as genetics, epigenetics, neurohormonal mechanisms, associated chronic diseases and obesogenic medications, sociocultural practices and beliefs, social determinants of health, built en vironment, individual life experiences like adverse childhood experiences, and psychological factors such as mood, anxiety, binge-eating disorder, attention-deficit/hyperactivity disorder, self-worth and identity. 50 Working with people to understand their context and culture, and integrate their root causes, allows for the development of personalized plans. These plans can be integrated into long-term therapeutic relationships with chronic disease follow-up of obesity and related comorbidities, including addressing the root causes of obesity such as existing conditions and obesogenic medications.…”

L’obésité chez l’adulte : ligne directrice de pratique clinique

“…Les professionnels de la santé ne devraient pas tenir pour acquis que tous les patients vivant avec l'obésité sont prêts à s'attaquer à ce problème; ils devraient demander au patient l'autorisation d'en discuter et si le patient les y autorise, la conver sation au sujet d'un traitement peut commencer 50,51 .…”

“…Les causes de l'obésité sont multiples : facteurs biologiques, tels que mécanismes génétiques, épigénétiques et neurohormonaux, certaines maladies chroniques associées, médicaments obé sogènes, croyances et pratiques socioculturelles, déterminants sociaux de la santé, environnement, vécu des individus, p. ex., trau matismes de l'enfance, et facteurs psychologiques, tels que trou bles de l'humeur, anxiété, hyperphagie boulimique, trouble du déficit d'attention, piètre estime de soi et problèmes identitaires 50 55,56 . Elle ne devrait cependant pas être utilisée isolément pour la gestion de l'obésité, car le maintien à long terme de la perte de poids peut être difficile en raison de mécanismes neurologiques compensatoires qui mènent à une augmentation de l'apport calorique en accroissant la sensation de faim, causant ainsi un gain pondéral 57,58 .…”

Transforming Health Experience and Action through Shifting the Narrative on Obesity in Primary Care Encounters

“…We sought to answer this question in a larger research project that used a qualitative, inductive, and collaborative approach to understanding clinician-patient encounters. The larger project identified interpersonal processes that translated into patient-important impacts and tangible outcomes in the weeks after the consultation (Luig, Anderson, Sharma, & Campbell-Scherer, 2018), resulting in an adaptation of the collaborative deliberation model for care communication for the obesity context (Luig, Elwyn, Anderson, & Campbell-Scherer, 2018).…”