Current Challenges and Strategies for Managing Obesity in Primary Care
Jasmine
Welcome to tonight's webinar, Supporting Patients at Risk, Overweight and Obesity Management in Primary Care and New South Wales Health Prevention Services. Our speakers for this evening are Dr Miriam Grotowski and Dee Upton. My name is Jasmine and I am your RACGP representative for this evening. Before we get started, I would like to make an acknowledgement of country. We recognise the traditional custodians of the land and sea on which we live and work, and we pay our respects to Elders past, present, and emerging. I would also like to acknowledge any Aboriginal and Torres Strait Islander colleagues that have joined us online this evening. Let me introduce you to our presenters for this evening. Dr Miriam Grotowski is an accomplished medical professional with a rich history of dedication to both rural medical practice and medical education spanning more than 30 years. Dr Grotowski also works as a general practitioner in Tamworth and has a Diploma in Psychiatry in eating disorders, having worked in this space for over 25 years. Dee Upton is an accredited exercise physiologist with over 15 years’ experience across New South Wales health, spanning clinical practice, prevention, healthy aging and statewide program leadership. With clinical experience across acute, outpatient and community settings, Dee has worked with older people and people with chronic disease. Their work brings together clinical experience, population health and system level program design with a strong focus on equity, safety and evidence-based care. Dee currently manages statewide prevention programs, including healthy aging and Aboriginal healthy eating and active living initiatives, supporting culturally safe, community led approaches aligned with New South Wales health priorities. Now we can get started with a poll.
Dr Miriam Grotowski
Thanks so much, Jasmine, for that introduction and welcome everybody, really great to see so many of you joining us today. I just thought I would start by getting you thinking, how confident do you feel supporting patients at risk of being overweight or obese? If you could answer that, while you are answering that and Jasmine is collating your responses, we are going to look at the learning outcomes for today. The learning outcomes by the end of this online activity, you will be able to review the evidence that tailored health coaching can support people to change health behaviours and reduce chronic disease risk, develop successful strategies to integrate overweight and obesity care into your general practice, that is patient led, leveraging care pathways and being supported, and describe how the Get Healthy service and other New South Wales health prevention programs can enhance your clinical care at different stages of the life course and also how to refer. Now you should have had a bit of time to get your poll in, a little box will have come up on your screen. Hopefully you have been able to tell us how confident you feel supporting patients at risk of being overweight or obese, and we might stop the poll now, I think, Jasmine, and just see what has come of that poll. It is interesting, is not it? The majority of you or 70% have come up as somewhat confident and we are hoping that by the end of tonight, you are feeling more confident. It is absolutely fantastic. We have got some very confident people with us tonight and maybe you will be able to leverage or give us some ideas through the chat or Q&A function today, but we might move on to the next section. I am going to hand over to you now, Dee.
Dee Upton
Thanks, Miriam, and if we can jump on to the next slide. I would like to acknowledge that I am joining us today from the lands of the Gadigal people of the Eora nation. In this section, we are going to look at the health data and the relevance of health coaching. In 2024, overweight and obesity became the biggest health risk in Australia, overtaking tobacco. By 2031, it is expected that one in four people across New South Wales will have two or more chronic diseases. I am not going to go through all the detail on this slide. This has been recorded and the deck is going to be shared with everybody, but I think the key points that we should take from this is that chronic disease is increasing across Australia, and most importantly, that this increase is even greater across our priority populations. If we go to next slide, please, Jasmine.
Now let us look at the risk factors in New South Wales. Childhood overweight and obesity have stayed about the same over the past 10 years. In adults, overweight and obesity has increased. Now, three in five are above a healthy weight. While older adults have the highest rates, the fastest increases are in young adults and adolescents. Fewer people are meeting the recommended guidelines for eating fruit and vegetables compared to 10 years ago. However, the good news is that adult physical activity has improved with two in three meeting the guidelines. However, physical activity has dropped significantly among children and young people and this decline has and increase in sedentary behaviour is especially high in adolescents. And next slide please, thanks Jasmine.
Health coaching is proven to be effective in improving health behaviours. As GPs, you are expected to diagnose, manage conditions and support lifestyle changes, often in very limited time. We know that is challenging. Today, I will show you how New South Wales Health can support you. Our free programs, Go4Fun and the Get Healthy Service help extend your care beyond the consultation. Evidence shows that virtual coaching can be just as effective as face-to-face support. They can turn your clinical advice into practical, sustainable behaviour change. These health coaching services can complement your care and then help improve outcomes without adding to your workload. All our programs use a consistent model. They are personalised, they are evidence-based support delivered by qualified health coaches. They help patients build knowledge, skills and confidence to improve healthy eating and physical activity. These services are free, they are tailored and evidence-based, helping patients to eat well, be physically active, adopt healthier lifestyles, manage chronic conditions like type 2 diabetes, and reduce their risk of lifestyle-related diseases.
Dr Miriam Grotowski
Thanks for all of that, Dee, and I think setting the scene makes a difference when we are trying to consider how we might help that patient that comes to our rooms when we are in practice, and why does this really matter? The goal is not for us to solve obesity in one consultation, and we are seeing that there are more and more of our patients and those that come to see us that will be affected in one way or another, whether it is someone themselves having obesity or overweight or someone in their family or in their household experiencing that. Remembering the goal is not to solve this in one consultation, but to create a safe next step. Any weight loss reduces risk and even keeping people from gaining weight can make a big difference because the evidence shows us that trying to make a difference to someone's weight or obesity can actually reduce the risk of pre-diabetes. In fact, losing just one kilo over 12 months can reduce the risk of developing type 2 diabetes by up to 16%. There are huge ways that we can make a difference by small incremental factors, and we are going to look at that through the case of Sarah. We might move on to Sarah.
Sarah comes to see you. She is typical of many of the patients that present to us in general practice. She is a 47-year-old female and in fact she has come in because of her blood pressure. She needs a repeat script. You know Sarah and you know that she has a history of hypertension. She is pre-diabetic. She has got osteoarthritis of her knees and she has in the past talked to you about her poor sleep. She is very busy, caring for her elderly parents as many of our patients do have other responsibilities, and you know that in her past, she has had multiple attempts at trying to lose weight by dieting. Today, you have done a preliminary examination and you have demonstrated that she has a body mass index of 37 and that her blood pressure is elevated at 145/89. Sarah has many of the things that we see day to day in general practice, how confident do you feel managing a patient like Sarah? We might move to that slide. Thanks.
How confident. If she came before you, what would you do next? Do know exactly the steps that you take? Is it pretty clear cut? Sarah has come to see you about her blood pressure. She really just wants a repeat script. Would you make a comment about her body mass index? Would you say anything about the link between her blood pressure and her weight? How confident do you feel managing a patient like Sarah? Just give you another minute or so. How are we going, Jasmine?
Jasmine
It is looking good.
Dr Miriam Grotowski
Okay. Thank you. That is good. Once again, we have got you round about the same as the previous poll is somewhat confident. We got a few more of you a bit more confident in managing someone like Sarah. We are up to the 80% and very confident. In fact, 95% of you know exactly what you are going to do with Sarah today and I am wondering if it is going to correlate with what we are going to recommend that you do with Sarah, but let us have a look now we might progress with Sarah. Next slide, thank you.
What the evidence tells us is that whilst many of us feel confident in managing someone like Sarah, the phrases that our patients have heard us say with respect to bringing up issues around weight or obesity have been comments such as those that are on the slide that you are looking at. Things like you really need to lose some weight or you should cut carbs and exercise more. Phrases like these, which many of us may have actually said over the times, can actually cause our patients to become quite defensive and shut down. Often, in starting a conversation about what to do for someone like Sarah, using such phrases will actually only cause a withdrawal by someone like Sarah and yet the evidence tells us that many GPs actually launch into this with absolute good intent. I know myself I am not perfect in the way that I might bring up this conversation. We recognise that correlation between being overweight, carrying the exercise and the effect that it is having on her blood pressure, on her osteoarthritis, but how do we bring that up with our patient? Let us have a look at the next slide, please.
There are lots of reasons that we tend to shy away of directly talking about Sarah's weight. We would often use a conversation about her blood pressure, a conversation about her osteoarthritis, rather than talk about the things that we could do to support Sarah in managing her health and managing her weight. The literature tells us things such as fear of offending Sarah, barriers. Many of us, and I, work in general practice myself, I know about the time pressures, the thought of raising that question with Sarah, of even bringing up the issue we worry about almost pulling a thread and having something unravel before us that we cannot put together, back together before the end of a consult. Maybe you have experienced previous failed attempts with someone other than Sarah or maybe even Sarah herself. You might feel that you are alone and you do not have enough time to do it, and in fact, managing obesity itself is quite complex. How would we go about doing it? Next slide.
These barriers are often cited, they are very real, and yet what we know when we look at this diagram is that the picture that is on, I am going to say this incorrectly, but I think it is on your left, which looks a bit like a pyramid. The base of that pyramid is coloured green, and it mentions that low to moderate intensity lifestyle interventions are actually the foundation or the base of what we can do to impact weight loss and improve patients' health outcomes. The weight loss reported might seem small, but in fact, small losses that are sustained are achievable, can improve type 2 diabetes outcomes, reduce blood pressure, improve patients' triglycerides and affect their liver in a positive way. I bring this up because this is not perhaps a diagram that is not unfamiliar for many of you and many of our patients are pushing us to go to the higher components of this pyramid, but we are talking today about the lifestyle interventions and they really are the mainstay of what we do irrespective of if we move with our patients further up the pyramid, we are still going to be looking at the need to do lifestyle interventions and that is what our focus will be on today. Whilst not disregarding the effect of the other interventions. The intervention that all of us have at our fingertips is this lifestyle intervention we can do with every single patient in every single consult in a minor way just by raising the conversation. Let us see what that would look like.
Best practice is to do what we do in so many other ways in general practice. We are used to lifestyle interventions in areas such as smoking cessation and GPs have been shown to do that really effectively. We heard Dee earlier say that being overweight or obese has overtaking smoking as having an impact on health. Using strategies that are very, very familiar to many of you, but applying them now to weight loss strategies. Let us have a look at what best practice says. It talks to asking permission. Things like, would it be okay if we talked about how weight might be affecting your blood pressure and your knee pain, Sarah? Or normalising it. Many patients find weight affects several health issues. Is that something you would be comfortable discussing today? Often having lines that you can practice, see what fits in your own style can really help you start that conversation. If Sarah says yes to that, we will then explore with Sarah what is going on. Let us ask Sarah what her experience has been like. That way we might find out that Sarah has had negative experiences over the years and we might be able to tackle some of the fears she has in exploring her weight today. We might ask her what she is previously tried and what has been successful for her and what has been the biggest challenge. A really good question and I found this really effective is to ask people, what would success look like for you? Because what I think success might look like for my patient might be vastly different. They may wish to stop gaining weight. They might wish to get into a particular item of clothing that they are looking forward to wearing again, and therefore, what would it look like for them to get into that dress, to get into those trousers? Making it personalised can make a huge difference to the patient carrying through with that goal. Once we have explored, let us validate the complexity. I do not think we can talk about being overweight or obese, without actually really being honest about the fact that this is really difficult. Our patients often feel extremely judged and vulnerable in this space and reassuring them that this is not about lack of willpower, that many people who are overweight, their body is absolutely defending that weight. I often talk to patients about how very difficult it is to change that process that is going on in their body and comparing themselves to others is not going to be helpful, we are talking about them, and that actually maintaining any successful weight loss can be really difficult without ongoing supports. Letting our patients know that we are there to support them and that we can point them in the direction of supports that are available, readily available, freely available out there that we will focus on tonight. The other thing that can be really helpful is focusing on health gains. What is the point of doing this for Sarah today? We might be able to improve her knee pain, her sleep might improve, which might make her caring responsibilities easier. We may affect her blood pressure control, will certainly have an impact on her blood sugar levels and possibly her energy, and this can happen with even modest weight reductions, like we heard, even as something as small as one kilo can make a huge difference. This is something that becomes achievable. Thank you.
We have just given our best shot. We have done some motivational interviewing. We have advised Sarah what to do, and Sarah says, like many of our patients do, I am exhausted. I have lost weight before, but I always regain it. I think reassuring Sarah that this is extremely common. It does not mean that she has failed. Obesity is a chronic condition, not a character flaw. As I have said before, you can draw on what you know about smoking cessation. That often it takes many attempts before people are successful, but what did work before and what can we build on this time with Sarah? There are many options that we can try, nutritional supports, sleep assessments, other things that could help Sarah, but what about something like health coaching? What about programs that you might know about? That is what we will explore today about free and readily available programs that have success and evidence behind them. The other thing you might be able to do for Sarah is make some links to her caring responsibilities and how we hope to help support her with that. Basically, how can we help Sarah today whilst recognising the frustrations that she feels and I think it is about being honest and stating that you will be there on this journey. This is the first step in a journey. This is not solving this in one consultation today. Next slide.
Starting the conversation about weight, just some practical tips before we move on to actually seeing the way that we can use some evidence-based programs. Practical tips include, helpful language, language to avoid. Helpful language, would it be okay, as we have said, to talk about your weight and your health. Acknowledge barriers that might exist. Talk about it as a chronic condition. Things to avoid that we have talked about today include. Next slide. Things like you need to lose weight, you are not compliant and that is why it is not happening. You have failed previous attempts, that language is quite judgmental and can really put our patients off joining us in the journey, and one of the things that the literature tells us and certainly some of the patients that I have worked with have talked about is saying something is simple. It is as simple as input versus output, can really be a reductionist way to talk to our patients about the complexity of weight gain and obesity, and often we will put our patients off wanting to come on this journey with us because we seem to be minimising how difficult this can be for some people and how complex it is.
Practical tips include, let us get permission from our patients first because sometimes it is not the right day. Just like it is not with smoking sometimes. Are you happy to talk about this today? If Sarah says no, you might say, “perhaps when you are ready, know that I am here and I have got some strategies that might be able to help you along the way or would it be all right if I ask you the next time you come in?” Be careful because one of our jobs as GPs is often to give advice. This is one of the areas where we can offer support and encouragement and suggestions, but be very careful about just handing out advice. Ask Sarah what has worked before, what her goals are, what she would like some support with, and maybe today just move forward with one step. What is that one step that Sarah would like to do? We are about to hear about something that is really useful, which is we could talk to Sarah about New South Wales Health Resources, the Get Healthy service, which offers some personalised and targeted supports for Sarah that is free. Dee is now going to explain that better for us. Thanks, Dee.
Dee Upton
Thanks, Miriam. I think that was really helpful to understand a little bit more of how best we can have those conversations. My job here now is to support you in your referrals and understand what is available to support you to enhance those conversations with your patients like Sarah as well. Across New South Wales and New South Wales, New South Wales Health delivers a range of evidence-based prevention programs across the life course. We work in partnership with the 15 local health districts across New South Wales and we also work across government to improve the food and physical environments. Our work focuses on prevention, early intervention and supporting people to live healthier lives. Our shared goal is to keep people well, prevent chronic disease and reduce health inequities. Our prevention programs include statewide virtual coaching for pregnant people, the Get Healthy in Pregnancy, for children and families Go4Fun, and for adults and older adults Get Healthy service. We also look after programs in early childhood settings called Munch and Move, in schools, Live Life Well at School and healthy canteens and these are in an effort to build healthy habits early in life. We also support community-based programs, particularly those for Aboriginal people, in particular Challenge to Change. Today though, we are going to focus on our statewide health coaching services, Go4Fun and Get Healthy service, including Get Healthy in Pregnancy. These are free, evidence-based services that I am hoping many of you already know and refer your patients to. Let us look at how health coaching can complement your clinical care. These services are delivered by phone and online, flexible for people like Sarah. They are designed to support people at risk of chronic disease and they focus on small achievable behaviour change that lasts. New South Wales Health coaching programmes include Go4Fun and Get Healthy Service. Go4Fun is for families with primary school aged children. It includes access to an app with recipes and games. This would be relevant if Sarah is also supporting children in her care. Get Healthy Service is for adults 16 and older with or at risk of chronic conditions. The Get Healthy Service includes diabetes prevention focus and it also includes support for older people. Get Healthy Service receives approximately 17,000 referrals each year and has demonstrated improvements in weight and healthy behaviours. Get Healthy Service includes Get Healthy in Pregnancy, which provides support before, during pregnancy and throughout early parenthood. Get Healthy Service can extend care beyond the consultation. It reinforces the lifestyle advice that Miriam spoke about earlier. It can provide ongoing follow-up and coaching, and it can also create a team-based approach to Sarah’s care. The wraparound support makes it easier to stay on track long-term. There are easy referral options for GPs. It can be done by the phone, on our website, and through GP practice software. We will show you exactly how to refer a little later on. How do New South Wales Health Coaching Programs support your patients? These programs are free, flexible and effective and they offer accessible and culturally safe care. Our services provide Aboriginal health coaches, translators and national relay service support. The services also provide bilingual coaches and translated resources. For Sarah, if English was not her first language or she needed extra support, the services remain easy and accessible. Our services offer convenient, flexible delivery by qualified health coaches. The virtual health coaching is delivered over the phone and online, so no travel is required. They are delivered by qualified health coaches, ideal for Sarah as a busy carer, fitting support around her schedule. Patients receive access to information and education. The services include activities and online learning modules, and there are goal tracking tools. All of this can keep patients engaged and motivated, and this can help Sarah move beyond past dieting attempts to structured guided change. There is also ongoing support and accountability, the regular coaching sessions at times that suit the patient. There is continuous encouragement to stay on track, and this gives Sarah consistent follow-up in between GP visits. The service provides patient-centred care. Coaching is tailored to individual needs and goals. The coaching focuses on what matters most to the patient. For Sarah, as Miriam mentioned earlier, this could be for weight management. It could be for support with her diabetes risk. Sarah may be interested in having support with her sleep and stress as a carer, or she may want some support from an exercise physiologist to prescribe some safe physical activity with her knee osteoarthritis. Our health coaching provides support through challenges as well. Coaches can help patients navigate setbacks, help build confidence and maintain long-term progress. This is important for Sarah given her history of repeated dieting attempts. For patients like Sarah, health coaching provides the ongoing practical support that turns clinical advice into real sustainable change.
Dr Miriam Grotowski
How can health coaching fit into your clinical care? Someone like Sarah, there are several ways that we could do it. Maybe we come to Sarah through her carer role and talk about some health programs that are there for her aging parents, but basically when you are using health coaching, it is complimenting. not replacing your clinical care. It is alongside us as GPs. Our role is to identify suitable patients and to refer them to the service. That service will then provide structured coaching as we have just heard Dee say. It will include goal setting, perhaps barrier identification, and importantly give regular follow-up. It is complementing that continuity of care that we as GPs provide. It benefits us as GPs because our patients receive ongoing support and sustained change, so that helps us do our job. Wins for patients often help us feel enthused and engaged and wanting to do this more. Progress updates support follow-up care with the patient and with the patient's consent, we can get that information. Having that care in between the visits where we are seeing them will reduce our workload. We are about to see a video now where there is a GP who regularly refers to the Get Healthy service talking about it. This is Dr Bijay Pandey from the Aboriginal Medical Service in Wellington, New South Wales.
[Video played]
What we have heard from Dr Bijay is just how effective it can be from a primary care practitioner's perspective. He has found it really useful for his patients. I just want to give a bit of a shout out to Wellington because in the past, Wellington has absolutely championed whole of town responses to weight loss and to developing healthier habits for their town. There was the Wellington challenge, some of you may remember, where the whole of the community had the opportunity to partake in a weight loss challenge over 12 weeks. In that town, individuals lost on average 2.3 kg, their waste reduced by 3.7 cm, and this was maintained at nine months. Again, a whole of population evidence that making small incremental changes can be A, sustainable, B, achievable, and C, something that we as primary care providers can actually stimulate. Go Dr Bijay and go Wellington, you are really good example of what can happen.
Dee Upton
The next section is who can be referred to the health coaching services. In a nutshell, health coaching is suitable for everyone. Go4Fun and Get Healthy service support all patients, regardless of the current health status. The coaching is tailored to the individual risk. For patients like Sarah, support is personalised whether she would like to start small or she is managing multiple conditions. All of our programs and our services, including Go4Fun and Get Healthy Service, are tailored for Aboriginal people. They are also tailored for people living in regional and remote areas of New South Wales and are tailored and provide support for culturally and linguistically diverse communities, and this ensures that the care that is provided through Go4Fun and Get Healthy Service is accessible, inclusive and appropriate. Referrals to Get Healthy Service are highly encouraged for your patients that are at risk of type 2 diabetes, for those with or at risk of cardiovascular disease and for those with or at risk of cancer. For Sarah, with pre-diabetes, hypertension, and a BMI of 37, she is a priority patient who would benefit from health coaching and should be referred for support through Get Healthy Service. Tailored support is also available for older people with Get Healthy Service, for pregnant people with Get Healthy in Pregnancy, and of course for those with existing conditions like gestational diabetes. The health coaching helps patients manage health across different life stages. However, GPs are essential to confirm patient suitability. As a GP, when you are completing a referral, you are required to sign the referral form to say the patient is safe to participate. It is extremely important that you recognise the patients that there is no conditions where physical activity is contraindicated. This ensures that the coaching that is provided to your patients is safe and aligned with your clinical care. These programs, Go4Fun and Get Healthy service are designed to support everyone, but they are especially valuable for higher risk patients like Sarah, providing tailored safe support to improve long-term health.
I know this is the moment that everybody has been waiting for. How do I refer my patients? There are easy and flexible referral options in place, both for Get Healthy service, Get Healthy in Pregnancy, and for Go4Fun for children and families. These are easy and flexible and designed to be simple and fit into your workflow. Clinical referral or self-referral options are available for both programs. As clinicians, you can refer over the phone, including a dedicated clinician line for Get Healthy service. You can refer by using our online forms on our websites. The links are available on screen. Also, if you are a little bit old school, you can use our paper-based forms. They are also available for referrals for both programs. You can refer via our GP practice software. Get Healthy Service now also collects clinical measures such as HbA1cs and this will enhance report backs to GPs that refer patients and it will also support monitoring of patient outcomes and service impact. Referring is quick and flexible with multiple options to suit your workflow. We are continuing to improve integration and constantly action and feedback to support your care. Please give us more feedback and feel free to contact us directly. The two email addresses on screen, we can throw them in the chat as well if you cannot, no pressure. Also, you can add any suggestions to the chat on how you feel we can support GP referrals. Thank you.
Our programs, our communications, our resources and our social marketing all use behaviour change theory to support lasting lifestyle change. On the link here in front on the screen, we have got our link to a healthy living website. I encourage you to visit our healthy living website. It is our front door and provides easy access to all our resources. I encourage you to share the link on screen with your practice managers, the nurses that you work with and your colleagues. The website includes access to the free New South Wales Health Programs, Get Healthy Service and Go4Fun, and a plethora of other services that we have available across the life course. Healthy You, Healthy Mob resources and supports are also available on the Healthy Living website, along with practical tools to support patients. All of our communications are delivered through trusted stakeholders and trusted voices via our website and our social media channels and these include via clinicians and community leaders. Our resources are evidence-based, they are easy to access and they are designed to support both clinicians and patients with practical tools for healthy living. As I said, you can get access to our Get Healthy service and Go4Fun health coaching via the Healthy Living website. We have also included the direct links to those websites for ease of access. Any of those that are available, please share with your colleagues and please refer your patients.
Dr Miriam Grotowski
Thanks, Dee. What are our take home messages? We have come to the end of our presentation, but we are certainly happy to take some questions. In summary, prevention matters. What we have been talking about is trying to reduce the impact that being overweight or obese is having on our patients and on our health system. Prevention matters, and we, in general practice, are so well placed to make suggestions and incremental changes for our patients to make a difference. Health coaching, as we have heard today, is effective and it complements the clinical care we already provide. We know that we are seeing patients over time in a continuous way to develop relationships where we are trusted professionals. The information and suggestions we make to impact our patients' health are very, very important. Health coaching, when it is suggested by you as a trusted GP is going to have so much more an impact. It is, we just heard today something that you can make the suggestion, hand it over to the Get Healthy program and they will take over the responsibility for the delivery from there on. New South Wales, as we have seen, has this suite of programs. The patient in front of you may not be Sarah. It might be a young mum who is pregnant. It might be an elderly patient at risk of osteoporosis or falls. The suite of programs will enable you to tailor the program to the patient that is before you and make a difference. Remember that they are evidence-based and free. Okay, so now we are over to you, and I believe that Tahlia has been looking at some questions that have been coming through. We might hand over. We have some time for some questions.
Tahlia Reynolds
Just while we are getting started, I might start you off with the first question, which is how do you manage a patient who refuses lifestyle interventions but wants medication?
Dr Miriam Grotowski
A really good question, Tahlia, and it is probably on the lips of many of the GPs that are joining us today because there is such an emphasis in our community and so much chat about the medications and can I just have the medications. My answer to that is that irrespective of what other measures you use to support patients' weight loss and attainment of healthier bodies and healthier outcomes, that life coaching, healthy approaches to the way that we eat, the exercise that we do in our day is actually the mainstay. The other bits that you might add, be they medications, be they surgery, or be they other interventions, still require our patients to make healthy changes to their lifestyle. This includes all the things we have been talking about that are managed by the Get Healthy programs around physical activity, healthy food choices, and general lifestyle changes that sustain that approach to weight loss. It is really important to remember even the desire to achieve a fast goal, what we know and the evidence tells us that without sustained lifestyle change that is learnt through coaching and support such as these programs, without physical activity, without changing the way that you are eating, those benefits will not be maintained. What we are talking about here is making lifestyle changes that are sustainable and ongoing and to do that support programs such as the Get Healthy service are exactly what we need to be working on with our patients.
Tahlia Reynolds
Someone has made a comment that says, I would say it amplifies our work rather than complements it. I might just let you both respond to that because I agree.
Dr Miriam Grotowski
Dee, did you want to start with that one?
Dee Upton
Sure, thanks Miriam. No, it is a great comment. I think that most definitely the goal of our health coaching services is to complement your care and definitely amplify your work. The coaching does not do any clinical work. It supports your clinical care and provides that behaviour change and motivational support to your patients to continue on the advice that you have provided to them.
Dr Miriam Grotowski
Absolutely, and I think, what it can do is give those gentle nudges and gentle supports in a timely manner in the intervals between you seeing your patients. We are giving that clinical care and we are giving that continuity of care over time, but in between that and alongside with the care and the support that you are providing, these health coaches doing the things that we do not realistically have time to do. We know and the evidence tells us it is actually impactful. We know that it does work.
Tahlia Reynolds
We have got a question that says, is there an app for the service? I might answer this one for the Get Healthy and then also share for the Go4Fun. At the moment, we do not have an app for Get Healthy, but we do have a participant web portal where they can log in, access resources, change appointments, chat with their health coaches that can support as an add-on service for their programs. The Go4Fun enhanced service offerings that has just been released also does have a goal setting app, which is a really new enhancement that we are really excited to see how this supports the coaching experience.
The next one we have got there is, love the opportunity programs provided for including GP in feedback about progress. Just for reference, Dr Miriam and Dee, there was a question around what is the correspondence that is shared as part of the program. We just highlighted that there is regular contact sent from the program to acknowledge the referral when somebody is referred, when they enrol, at completion and also some communication if they do drop out as a way to re-engage and support them because we are really, like you said, complementing and working together to support individuals to achieve those long-term outcomes.
Dr Miriam Grotowski
I think it shows almost a level of trustworthiness with the program. We referred a patient to the program and then we are actually getting feedback about how that is going with the patient permission. We are part of the same loop, so I agree, I think it makes a big difference and I think it improves the credibility.
Tahlia Reynolds
There is one final question in here at the moment while everybody's still thinking about the other ones and it is about ongoing support after the 10 sessions are over. Because this is a program one, I might answer this one as well. In really good news, we know that sometimes the number of calls that were offered at that first experience might not be enough for them to achieve the goals that they wanted to achieve. We know obesity is a complex condition and there is a lot of factors that can be involved. We offer ongoing support where patients can re-enrol if they need additional time to achieve their behaviour change goals. They also have some lower intervention support after the program. A Get Healthy, Stay Healthy program offers SMS support for about six months after, and we also re-engage with participants following completion just to check in and see how they are going, and sometimes congratulate or offer that ongoing support.
Dr Miriam Grotowski
Again, that is evidence based to be effective, is that ongoing support and sustained changes, which is really important. Just noticed that there is a question around the qualifying BMI, but my understanding is we are not just talking about obesity and overweight, but also healthy lifestyle and healthy choices with regards to food. What we do know is even though some people might be within the healthy weight range, their actual eating habits or their exercise habits are not what we would consider to be healthy and not helping to reduce risks of progression in disease. I understand that you would be able to refer up people for support around lifestyle interventions to benefit them in both those areas, irrespective of their weight. Is that correct?
Dee Upton
Most definitely. It is about maintaining a healthy weight as well, Miriam. It is just as important as weight loss is maintaining the healthy components. I did see another one as well that I know you have answered it in the chat, but I am really interested to delve into it a little bit. There is one is should I try the service and should I try it out for myself before I refer patients? Most definitely. I think it is really important. I actually have Aboriginal staff on my team. We recently engaged with the Aboriginal health coaches that work a part of Get Healthy Service and Go4Fun. It was really enlightening to share the journeys and the stories from Aboriginal participants, from the Aboriginal health coach to our Aboriginal staff, to enable them to really speak on behalf of the program. It also gave them a different perspective, a perspective that I would not be able to share. I believe it would be the exact same process for a GP that you would go in with expectations that would be very different to mine, very different to Tahlia's and even Miriam, you and I would have very different expectations of what we would expect from the service. I think for you to enable yourself to try out the service and understand what exactly your patient will receive through it, I think is a massive value add and will really build your confidence and your trust in what we have to offer as well. It is a really good question, and I think we should definitely share that.
Dr Miriam Grotowski
On that same light, I will share with you, I encouraged a patient who is the mother of children that are struggling with healthy weight and struggling with healthy choices with food. She enrolled in the program and she actually enrolled in the program in my room when we were there so that we did it together, and she has been giving me feedback. Two of the things that she commented on that I thought were really relevant and I have mentioned it to other patients, but it is worth mentioning tonight, is she felt completely non-judged. One of the interesting things she has found in her journey with managing her children has been being judged for the choices her children are making and for the way her children look. She felt completely non judged and found a very non-judgemental program. She has found that regular support to be game changing, as she said. Someone that she can talk to, that she can share her frustrations with, get little tips and tricks and make some small changes that are celebrated as she has just found absolutely has engaged her in a way that she has not been able to be engaged in, in the past. Just a really positive reinforcement of it. She is a really incredible mom who is doing an incredible job in really difficult circumstances. This has been an adjunct well and truly.
Tahlia Reynolds
Nice to hear these real stories. We have got another comment rather than question, but moves that support integration of care versus more fragmentation, hooray.
Dr Miriam Grotowski
Nice. There is a lovely comment there. Patients can absolutely self-refer. They do not require a GP referral at all. Patients definitely can self-refer. You can have the information up in your waiting room while people are waiting to come in and see you not that they ever wait in a general practice, but while they are waiting, they can actually enrol if that is something that engages them. Maybe you have started the conversation in one consult and it is the next time that patient comes into your waiting room that they think, oh, that is right, I was going to do that. While I am waiting here for Dr X, I could do that. Absolutely patients can self-refer.
Tahlia Reynolds
Do you have clinic posters? I will answer this one as well. There is a number of orderable resources that are available on the Get Healthy page. We can also share some links post this session as well, which includes the ordering forms where these can be ordered for your clinics and other things. There are a range of resources for different purposes here. Can we get them? Yes, we will also share the resource order form as part of the resource package that we share following this session.
Dr Miriam Grotowski
Just while we are getting ready to tie up, I did just want to ask people to perhaps think about what you have heard today and to think about our presentation and to commit to one small practical change that you will commit to trying with your patients in the next week. Maybe it is reinforcing something that you do that you have been reminded to continue to do, or maybe there is a new strategy that you have heard today. Maybe it is the first time you have heard about the Get Healthy service and you will give it a go, but have a little think and commit to one small practical change that you will make going forwards after today.