Weight Management Goals

Your role as a clinician is to assist the patient in setting and achieving weight management goals if this is something that they are interested in. Clinicians tend to have skills in recognising and addressing barriers and facilitators that patients may have to adopting or adhering to certain behaviours. The skills are transferable and you can use them to support their health behaviour change to help achieve their weight goals.

Weight Loss Motivation

Motivational interviewing can also be used in your approach. If you are actively assisting your patient with weight management it is important to arrange regular reviews for the first 3 months and to plan for continuing monitoring for at least 12 months, with additional support or intervention as required.

It may also be appropriate to recognise that the best way to “assist” your patient with their weight loss goals after your initial discussion is to refer them on to another health professional who may have more experience in supporting and monitoring active weight loss.

Referral to Support Weight Management

In many cases, medical referral will be warranted to support weight management. This is particularly likely in patients who have additional complex medical, psychological or physical co-morbidities and/or obesity class 3 (BMI >40 kg/m2). The following are some potential indications for medical referral for either weight management or clearance for an intensive dietary intervention:

• Weight > 150kgs due to the increased risk of medical conditions and greater specificity of dietary or pharmacological interventions required
• Type I diabetes
• Type II diabetes requiring insulin or other medication apart from Metformin
• Warfarin use
• Stroke or cardiac event in the previous six months
• Unstable cardiovascular condition
• Fluid intake restriction
• Renal disease or problems
• Taking drugs that contribute to weight gain as a review of drug regimens may be helpful
• Consideration of pharmacotherapy as not losing weight through lifestyle interventions or to assist with weight maintenance following a weight loss program
• Consideration of bariatric surgery for complex patients with severe obesity-related co-morbidity (Week 5)
• Excessive weight loss during a weight management program – for example losing greater than 20% of baseline weight in 6 months or greater than 30% in 12 months. Such individuals may require assessment of clinical symptoms that could indicate safety or health issues.

Dietitian Referral Criteria

Dietitians are highly skilled in nutrition assessment, nutrition diagnosis and nutrition intervention. Dietetic referral may be appropriate if a more detailed assessment of the person’s macro and micronutrient intake as well as a more individualised dietary plan is required. This could be in cases where:

• The patient has a more complex diet including food allergies or dietary preference such as vegan
• The patient has co-morbidities such as diabetes which may require more specialised nutrition input
• The patient has behaviours that could indicate an eating disorder

Psychologist Referral Criteria

There are several scenarios where referral to a psychologist might be considered:

• Mental health issues such as depression and anxiety are common in people with obesity. A psychologist may help address any mental health issues ideally before a weight management program is commenced
• It may become apparent that the person has disordered eating patterns such as binge-eating, bulimia, anorexia. These may be helped by a psychologist with expertise in eating disorders
• A major aspect of effective weight management involves understanding and managing thoughts, perceptions and behaviours that can interfere with weight management efforts. If the patient is having difficulty losing weight or preventing weight regain and psychosocial factors appear to be playing a key role, then referral to a psychologist may be warranted
• Some individuals undertaking a weight management program may develop excessive or extreme exercise behaviours which can be associated with an eating disorder

Psychological Evaluation

The psychologist can provide a more thorough evaluation of psychological factors relevant to obesity, eating behaviour, physical activity and patient engagement and targeted management such as cognitive behavioural therapy.