Primary care and primary healthcare in obesity management
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i9b.3731Keywords:
Primary healthcare, Obesity, Guideline, South AfricaAbstract
RECOMMENDATIONS
1. We recommend that PHPs identify PLWO, and initiate patient-centred, health-focused conversations with them (Level 3, Grade C).
2. We recommend that PHPs ensure that they ask PLWO for their permission prior to discussing weight or taking anthropometric measurements (Level 3, Grade C).
3. Primary care interventions should be used to increase health literacy in individuals’ knowledge about and skills in weight management as an effective intervention to manage weight (Level 1a, Grade A).
4. PHPs should refer PLWO to primary care multi-component programmes with personalised obesity management strategies as an effective way to support obesity management (Level 1b, Grade B).
5. PHPs can use collaborative deliberation with motivational interviewing to tailor action plans to individuals’ life context in a way that is manageable and sustainable to support improved physical and emotional health, and weight management (Level 2b, Grade C).
Features of primary care and primary healthcare community-based interventions for PHPs and developers:
6. Interventions that target a specific ethnic group should consider the diversity of psychological and social practices with regard to excess weight, food and physical activity as well as socioeconomic circumstances, as they may differ across and within different ethnic groups (Level 1b, Grade B).
7. Longitudinal primary care interventions should focus on incremental, personalised, small behaviour changes (the ‘Small Changes’ approach) to be effective in supporting people to manage their weight (Level 1b, Grade B).
8. Primary care multi-component programmes should consider personalised obesity management strategies as an effective way to support PLWO (Level 1b, Grade B).
9. Primary care interventions that are behaviour based (nutrition, exercise, lifestyle), alone or in combination with pharmacotherapy, should be utilised to manage PLWO (Level 1a, Grade A).
10. Group-based nutrition and physical activity sessions informed by the Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) programme should be used as an effective management option for PLWO (Level 1b, Grade A).
11. Interventions that use technology to increase reach to larger numbers of people asynchronously should be a potentially viable lower-cost method in a community-based setting (Level 1b, Grade B).
Educational recommendations to support development of obesity management skills in the primary healthcare clinical workforce:
12. Educators in undergraduate, graduate and continuing education programmes for PHPs should provide courses and clinical experiences to address the gaps in skills, knowledge of the evidence, and attitudes necessary to confidently and effectively support PLWO (Level 1a, Grade A).[20]
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