Assessment

Importance of Assessment

A careful and detailed assessment forms the basis of a good weight management programme. All patients will have a different clinical presentation and it is important to unravel specific difficulties in relation to weight control so that treatment can be tailored accordingly. A thorough evaluation should be undertaken with each patient, regardless of how long they have been with the practice.

 

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Listening to the Patient

Having raised the issue of body weight it is important to work with the patient in a way in which they will feel supported and understood. This requires the practitioner to listen carefully to the patient's description of what being overweight means to them, what they feel has contributed to their obesity and whether they feel ready to begin a treatment programme. It is likely that many patients will already have had a number of attempts at losing weight and it is important to acknowledge and affirm past efforts.

Waist circumference

The measurement of waist circumference provides information about the distribution of body fat and is a measure of risk for conditions such as coronary heart disease (CHD). It is now well known that people who carry their excess fat centrally (within the abdominal cavity) are more likely to suffer the consequences of being overweight.2, site 3

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Screening for other diseases

It is well documented that obesity increases the risk of other conditions such as hypertension, hyperlipidaemia, diabetes, skeletal disorders and respiratory disease. In addition, the elimination of other conditions such as hypothyroidism (which can lead to weight gain) is important. A thorough assessment should therefore include the following:

 

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Identifying potential difficulties or barriers to change

Since changes in a patients' lifestyle are the mainstay of obesity treatment, care needs to be taken to ensure that the patient has thoroughly considered both the pros and cons of change for them at this time. Potential difficulties to success need to be identified from the outset and steps taken to overcome them. The maintenance of a 'food and activity' diary will raise patients' awareness of their own behaviour with regard to eating and exercise, the first and most important step towards changing things.

Patient Expectations

The expectations that patients have about achieving weight loss are influenced by their past experience, what they read/see in the media, and others around them including healthcare professionals. Expectations are often greatly inflated beyond what is achievable from a physiological and psychological perspective. In addition to patient expectations, healthcare professionals need to ensure that they do not place unreasonable demands on their patients with regard to achieving weight loss. It is not uncommon to have obese patients report that their place on a surgical waiting list has been suspended until they can lose 4–5 stones in weight, yet they are expected to achieve this without any support being offered?

 

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References

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