The 5 A’s approach to reimbursable obesity counseling
| Focus on: | Target this information: | |
|---|---|---|
| Assess (obtain this information in advance) | Weight history | Current body mass index (BMI) (kg/m2) Maximum weight, minimum weight, ideal weight Previous weight loss efforts |
| Eating habits | Number of meals per day Typical breakfast, lunch, dinner Quantify daily intake of sugary beverages Appetite | |
| Physical activity | Quantify amount and type | |
| Advise | Goals | 3% to 5% weight loss over 6 months (3 kg for Medicare patients) 6-month commitment to losing weight 150 minutes of moderate-intensity aerobic activity per week |
| Treatment plan | Create-your-plate method Mediterranean diet Consider role of pharmacotherapy for weight loss | |
| Agree | Goals | Use motivational interviewing, shared decision-making, and information from Assess and Advise |
| Assist | Identify barriers | Screen for depression Ask about access to healthy foods Identify social support for weight loss Review current medications to identify those that promote weight gain |
| Arrange | Follow-up and referrals | Consider consultation by a nutritionist or dietician Consider group support sessions Bariatric surgery consultation for patients with BMI ≥ 40 kg/m2, or for patients with BMI ≥ 35 kg/m2 and obesity-related comorbidities who have not responded to behavioral therapy |