Article Figures & Tables
Tables
Impact Representative quote* Increased self-awareness "I think it gives me a different perspective … because sometimes we're so used to doing what we do, we do it every day that we don't self evaluate, we don't self reflect so this, it allows me to do that. It kind of forces me to do that." (dietitian 4)
"I think it's definitely given me a more rounded perspective in particular towards, like, weight, weight bias, that sort of thing … but is it something that am I going to remember everything that we talked about? Not a hundred percent right but I think it's definitely useful information." (dietitian 1)
"[Provider X] mentioned she was very surprised about her score (on an weight-bias test) - was surprised she has so much bias. She has the training so was wondering if it wasn't something more personal coming from someplace else." [All nod] (field notes, session 1)Reframing obesity as chronic disease "You know doing the sessions here, I have come to realize that no I have not … I'm beginning to realize or at least see it more of a chronic disease." (dietitian 4)
"I'll start off by telling them obesity is a chronic disease so setting some expectations right away versus saying 'Well, how much weight would you like to lose?'" (nurse 3)
"Well I think there's definitely pieces that stand out. … I'm talking to people it triggers, like, 'Oh I heard this,' you know maybe I should do that. So definitely that asking part of it, and that it's a chronic disease, and that stopping the weight gain, that's a big one." (dietitian 2)Change to vocabulary "I've learned enough to ask 'Is that something that we can discuss, is that something you want to look at?' and stuff like that which, which was something that I wouldn't have done before the asking. You know … I would definitely lead in softly type of thing, but that, that's not the vocabulary that I would have used, so certainly more awareness there." (mental health worker 5) Increased confidence "I think, I feel more confident with some of the learning that I've done, even with just the presentations of actually taking on these clients and referring them on to [an external program], whereas I can do probably better follow-up since I've done this." (nurse 27)
"I'm getting comfortable in, in asking and going over them [the 5As]." (nurse 3)
"I'm not afraid to discuss weight and I think that, you know, that I've learned enough to ask is, you know, is that something that we can discuss … which was something that I wouldn't have done before." (mental health worker 5)Buy-in to 5As Team concepts "I really, I love the concept of the 5As. I think it's packaged well. I think that the Canadian Obesity Network has done a, a brilliant job in creating a template which we can use." (dietitian 3)
"You know, education is always empowerment right and it always gives us the opportunity to improve our practice so I think in that way it will. Absolutely, you know when you learn something new and you have that kind of ah-ha moment, then it changes, you know it changes things forever so in that way I think it's helpful." (mental health worker 5)
"I do. I, you know, I bring it back [to] what I've learned and I say … this is an approach we can try." (nurse 28)*Quotes were edited to improve readability.
Impact Representative quote* Increased "Ask" "I think I talk about weight more initiated by me I would say now." (nurse 7)
"I tried it [asking about weight] twice now because of the sessions because if they come in for something other than that like diabetes for example but they have a weight issue, then yes I do try and ask them." (dietitian 4)
"I think that that's something [asking permission to talk about weight] that maybe I'm doing much more diligently than I have in the past because of being involved in, in this group." (mental health worker 3)Agenda shift "I really promote kind of getting away from the numbers and focusing on health and I never weigh them initially so I'll ask them if that's something they want, like, 'Do you want to focus on numbers?' because some people do, they just want to know the numbers and it's going down but it's not anything, like, I never promote it or I never just automatically do it anymore, whereas before I would, as we're walking to the room at the back, we would stop and do height and weight so that's something I never do anymore and it's completely up to the patient if [he or she] wants that or not." (dietitian 6)
"I think it's really good, it's helped me kind of sit back and have a little bit more structure to my appointments and come in with more of an open mind to see what the patient wants from me more as you know me coming in and telling them what they need to change or what they should do." (nurse 4)
"I think the biggest thing to remember is to just be patient focused because I think we all have our own motives and our own desires for what we want our patients to do but it needs to be what they want to do." (nurse 11)Increased attentiveness to patients' feelings "I'm more aware of asking them if they want to change, what are, how are they feeling which I probably never would have before." (nurse 19)
"You know how it's going to impact my practice, I guess just increased awareness and sensitivity for people." (mental health worker 5)Fostering rapport "I think it's just going to have to depend on the patient because some patients are, I don't know, they like a gentler approach than others and you just have to know your patient. ... If they're nervous and uncomfortable, you know I think sometimes they just want to be heard and so just giving them the time and I think nurses have that time." (nurse 11)
"Well I think it's just that consistency and, and just always be open and honest and, and allowing for the conversation to keep happening." (nurse 20)Cultural sensitivity "The cultural one, I think I'll try to figure out what a good way to ask about the food because it's important and I know lots of the ones that I talk to some of them are traditional, some are very Western, like they've adapted and some are kind of in-between but I think I always assume that they're still quite traditional so finding more about what, what role food plays in their household now." (dietitian 6) Changes in goal-setting "I'm remembering the session when she said, you know, trying to … nurture your body versus nourish [your emotions] so those people that get cravings at night, try to find activity that's not necessarily food focused so like go for a walk or take a bubble bath or whatever. … I find those are what's more helpful that I take out because I apply those to practice definitely." (dietitian 7)
"The concept of weight maintenance is new to me because honestly I would have focused on getting down to maybe not an ideal body mass index but at least approaching that and so I think it's a different focus for me since, since the program started." (nurse 9)Patient empowerment "Yeah, you have to meet them where they're at so it, it's not something that we can do for them. They have to do that exercise piece. They have to, you know, monitor their diet and they have to, if it's the surgery they want they have to take those steps to get into that program and we can just guide them." (nurse 26) *Quotes were edited to improve readability.
Impact Representative quote* Development of the 5As Team team "[Dietitian X] said she started seeing more patients jointly and that it helps her learn more, and the patient." (field notes, session 4)
"One other thing that came up was that afterwards [nurse Y] came up to X and pointed out that her and another dietitian are doing a new prenatal class in French around weight management. A goal they set." (field notes, session 5)
"[Nurse X] shared how her and [dietitian X] piggyback on each other's appointments and do the pass-off in front of the patient." (field notes, session 12)
"I actually like the interaction between all team members because I found we all have slightly different perspectives which is super, it's great." (nurse 7)Provider empowerment "Since I've done it, I can talk more comfortably and not be so afraid to kind of challenge some of the physician's statements and opinions so that's been helpful to feel a little bit more, more assertive I guess in that and have something to back it up with." (mental health worker 6)
"I was really excited. … The first morning back I went around to all the doctors and gave them a copy of each of the tear-offs saying, you know … this is finally actually on one piece of paper, the approach we've been using with weight." (nurse 20)
"[X] gave an example of a doctor who is telling patients that walking is not physical activity and they should aim for something different if they want to be active. She disagrees strongly and asked for the group's advice. She is going to speak to the doctor and bring a source that [X] mentioned in her talk about the benefits of walking." (field notes, session 8)Interprofessional relations Areas for improvement "The hardest thing I find obviously is the coordination with the physicians because they sort of have a different mindset and it's not that we have sort of sit-down meetings about our patients and that sort of thing." (nurse 7)
"[X] said she sees in clinic all the time - that when they weigh people the MOA [medical office assistant] will yell the weight out loud - she doesn't know what to say to make it stop." (nurse 3)
"What do you do when you have a problem with one of the doctors? What do you do when it is the person on the top of the chain doing these things? [Referring to the slide (X) gave about physicians:] She was nodding on every point as she has a provider and this is everything he believes. She has tried to challenge it especially in the area of mental health. But the doctor is set in his ways and his comments make her feel sad and helpless." (mental health worker 6)Strengths "Very good. Yeah, my doctors are very supportive, receptive, you know they're, they're really great to work with and very appreciative so yeah it couldn't be better." (nurse 8)
"We have a really good relationship, Dr. [X] and I. We're on the same page with managing patients, great communication." (nurse 21)
"Oh yeah. It's great working here. Oh yeah, we get along. It's wonderful. I can talk to Dr. [Y] across the hall. If I come up with something from a patient that I don't understand, he'll explain it to me, like, I don't feel that he would criticize me for not knowing anything or not knowing that." (nurse 19)Importance of context "Oh boy, complicated. It depends on what clinic you go to. Some, some are very dysfunctional. They see me more as someone to talk about diabetes but not weight management. They wouldn't, you know, they would probably tell their patient to go to Weight Watchers before they would refer to me and then my home clinic, the environment is excellent and they're very open, and I think if I said 'Why don't you start telling people to come see me for weight management,' I think they would do that." (nurse 26)
"They have never had nurses before and we're really just working through it and trying to figure out, like, they've been together for over 30 years so they can't just have me coming in and saying 'This is how we're going to do it now,' so it's something that I will probably bring up." (nurse 26)Impacts within different disciplines [In response to the question "Is weight management important in your practice?"] "No. No it's not. … Often sometimes they'll bring it up to me, you know, because they've, you know, when they go into the … downward spiral of depression, they often get quite sedentary, sometimes they put on a lot of weight, sometimes it's exact opposite, they're not eating and they're losing a lot of weight so, I mean, there is that aspect of it and I think that maybe it has brought me to a place where I'll tick it off in, in terms of addressing it which maybe I didn't necessarily do before, I would only look at the symptoms of depression or anxiety or, or whatever so I think that, that has been helpful but again it's not their primary concern ever when they're coming to see me." (mental health worker 3) *Quotes were edited to improve readability.
Impact Representative quote* Changes to clinical environment "One provider mentioned that she wanted to move the scale in the her clinic and ended up moving it herself." (field notes, session 2)
"One provider said that she spoke with a nurse at their clinic and how they have ordered special chairs and portable scales so weighing can be more private." (field notes, session 2)Improved clinical visits "Structure things more and how I'm going to address patients and using the tools to kind of help me a bit more with patients as well." (nurse 21)
"I think, I feel more confident with some of the learning that I've done, even with just the presentations of actually taking on these clients and referring them on to Weight Wise [a tertiary bariatric program], whereas I can do probably better follow-up since I've done this [5As Team intervention]." (nurse 27)
"Absolutely. I find some of the questions that I ask are different than what they were before, I'm looking for slightly different things now than I was, so it, again, it gives me kind of a different perspective." (dietitian 1)Use of 5As Team tools "I'm actually using the 5As sheet where you can just jot down notes and actually putting that into the patient's electronic medical record so it's helping me chart as well just keeping my interactions with patients more organized as well." (nurse 3)
"I'm frequently given patients beause they, so many come with odd ideas from, that they gathered from the Web when they've got so many sites and none of them credible so to be able give them a handout that has good websites on them." (nurse 20)*Quotes were edited to improve readability.
Impact Representative quote* Gaps in programming "So after listening to [the] talk about the 4 Ms [Mental, Mechanical, Metabolic and Monetary], we had staff members say 'Well, I want to know what are questions that I can ask to help me identify the 4 Ms and I sat there a little bit with my jaw open because as a Primary Care Network we've already created that framework and we've created the questions and we trained the staff on it, but we haven't followed up." (dietitian 3) Scheduling "Well, it's mostly time, right, so, like, even if it would be, I don't know, I find the schedule is a little bit too full but I think that's more like a clinic problem than anything." (nurse 29)
"More time. That's the biggest thing honestly is just time because part of my role is to improve access to this clinic so we have four physicians with varying panel sizes from 1500-4000 patients so if you can't, they can't get in to see that doctor [for] 3 to 4 weeks. … So if I book hour-long appointments with everybody, I'm not improving. I am for a very, very small proportion of these people but then I'm going to be booked up for a month ahead." (nurse 9)Access "[X] and [Y] talked about waiting time for weight loss clinics and how they can wait for years and then find out they are not eligible and how some go out of the country to get it [procedure] done." (field notes, session 10) Resource allocation "She thinks the Primary Care Network is a lot better than the picture [X] painted. That the Primary Care Network has all this equipment but they have the staff but not their clinics." (nurse 7) Identified need "From this a discussion came up around the Primary Care Network offering more support to patients who are thinking of entering a bariatric program, or who have lost weight and might need emotional support." (field notes, session 10) *Quotes were edited to improve readability.