GP based obesity program; Dr Mark McGrath/ University of Queensland “The Non-Diet Approach To Healthy Eating Program”

Structured general practice consultations - beginning with 6 prolonged visits (ie >40mins) to introduce the basic concepts of the intervention, invite participants to practice a skill at home then return to troubleshoot and learn the next skill/ concept. Patients who are interested will begin with a 1-2 hour group session which acts as an introduction and to see whether they are interested in progressing on. The sessions are one on one thereafter. There is an initial medical examination, consent and paperwork session then 6 one on one visits with GP occurring fortnightly. Obesity Program Summary 0.Medical Assessment, Consent, Shifting Focus From Weight *Screen for causes & comorbidities *Arrange Ix including DEXA scan *Consent *Discuss visceral fat & waist circumference *Introduce values 1. The Basics - Values & Mindfulness *Introduce Values, explain why important; Generate values statement *Introduction to ACT & Mindfulness; practice (Notice; these don’t specifically relate to eating/ food at this time) 2. Mindful eating *Analyse values statement *Mindfulness applied to eating when hungry & Mindful eating *“Choice point model” 3. Over-eating, hunger, cravings *Eating until satisfied not full *Hunger scale *Cravings *Tie in with values & choice point model 4. REVISION & FOOD QUALITY, DIETICIAN REFERRAL *Revise 4 main points; a.Eat when you’re hungry b.Eat mindfully c.Eat until satisfied not full (hunger scale) d.Cravings *Priming/ body self-regulates *unprocessed food *+/-drinks *+/- treats 5. EXERCISE “Movement”, REFER EXERCISE PHYSIOLOGIST *Benefits of exercise (least of all weight loss) *A more or less approach 6. Values, deeper issues, psychology, REFER PSYCHOLOGIST *Not living in alignment with values/ ‘Subconscious’ factors/ psychologist referral *not eating to manage uncomfortable feelings Thereafter sessions will be approximately monthly. They will involve troubleshooting, assessing progress, introducing new concepts as relevant to the patient as an individual. The GP will suggest the interval but it is at the discretion of the patient. The sessions may become more spaced out as time progresses according to need. I anticipate 2-3 years of ongoing sessions but there is not maximum per se. There will be significant individual variation. It is hoped that these sessions will foster adherence until the patient is self-sufficient. If patients do drop out they are likely to remain patients of the practice so follow-up will still be possible and it will be easy to commence where they left off should they choose to do so in the future. The intervention is based mainly on the psychological principles of ACT (acceptance and commitment therapy). All patients will be referred to a Psychologist, Dietitian & Exercise physiologist who all practice in a similar manner based around ACT so that patients will receive a consistent message, As per any usual referral from the GP to an allied health professional, the GP does not dictate the content of the sessions. They will be tailored to suit the individual at the discretion of the allied health professional. The point of difference is that each allied health professional will be familiar with and incorporate ACT techniques into their practice and be familiar with the philosophy of the program. I anticipate that most patients will spend a higher proportion of their visits with the psychologist, then the dietician and the least with the exercise physiologist. The interval between visits will be determined by both the patient and allied health professional. This is likely to impact the interval of visits back to the GP. For example if in a two-month the patients has numerous visits each of the three allied health professionals they are not likely to require frequent troubleshooting with their GP. Phone calls/ letters or email may also be used to improve adherence. All patients will be encouraged to read one of three self-help books to also improve adherence and skills. Self Help books; *Neuroslimming – Dr Helena Popovic *The Diet Trap – Jason Lillis, Joanne Dahl, Sandra Weineland (audiobook & hard copy) *The Weight Escape – Joseph Ciarocchi, Ann Bailey & Russ Harris Headspace – Mindful eating