Abstract
Purpose: The purpose of this DNP project was to implement a new practice guideline and evaluate its utilization within a primary care setting in Arkansas. This was accomplished through the following aims: 1) implementing the 5As model for obesity management in a primary care setting, 2) obtaining patients' self-report on their motivation to make lifestyle changes, and 3) obtaining patients' self-report of their weight and lifestyle changes.|Background: Arkansas currently has the third highest adult obesity rate in the U.S, increasing from 17.0% in 1995 to 35.7% in 2017 (Trust for America's Health, 2017). Obesity remains poorly managed in the United States primary care system, with only one-fifth of obese patients being offered weight-related counseling by their primary care providers (Bennett et al., 2012). The U.S. Department of Health and Human Services (2012) developed the 5As model for obesity management, which serves as an evidence-based model for facilitating behaviorally-based obesity counseling (Canadian Obesity Network, 2016). This model consists of a five-step method: ask, assess, advise, agree, and assist. Implementing this model has shown to improve the quality of obesity counseling and interactions between primary care providers and patients, thus increasing patients' motivations and goals to enhance their quality of life (Alexander et al., 2011; Rueda-Clausen et al., 2014).|Sample/Setting: The setting was a primary care clinic in Arkansas. The sample included fifty-six English-speaking adults ages 18-65 with a BMI equal to or greater than 30. Complete data results were obtained from forty-nine of these patients.|Methods: Participants received weight loss counseling using the 5As method during a routine clinic visit. Motivation to make lifestyle changes was assessed during the initial visit and two weeks later via a telephone call from the provider using a self-reported motivational scale from 1 to 3 (1= "not at all motivated;" 2= "somewhat motivated;" and 3= "highly motivated"). Patients were also asked to self-report their weight at the two-week follow-up call.|Results: Immediately after counseling using the 5As model, the mean motivational rating was 2.7 on a 3-point scale (n=49). Two weeks later, the mean motivational rating was 2.5. The .14 decrease in average participant motivational rating at two-week follow up was not significantly different p = .07, 95% CI [-30, .01]. Participants' two-week follow-up weight (M = 232.8, SE = 7.7), was slightly less than their baseline weight (M = 235.2, SE = 7.7). This difference, -2.4, BCa 95% CI [-3.5, -1.3], was significant t(48) = -4.4, p < .001. Additionally, 8% of participants reported monitoring their calories, 86% made dietary changes, and 76% performed exercise activities.|Conclusions: Participants in this project remained either somewhat motivated or highly motivated to make lifestyle changes two-weeks after counseling. The 5As model can help guide providers in counseling patients about weight-management interventions in the primary care setting. Future work should focus on measuring patient motivation before and after counseling, and longitudinal studies of weight loss patterns following use of the 5As model.