Every health care provider has an important role to play in supporting families to stay well.  Discussing modifiable risk factors such as diet, physical activity, sleep and smoking with all patients, regardless of their weight is key to helping reduce future chronic disease risk. With support from health care providers, individuals can make small and sustainable changes that can have lifelong positive outcomes. 

Maintaining a healthy weight is associated with a lower risk of a wide range of chronic conditions such as diabetes, cardiovascular disease, hypertension and some cancers.  Weight is impacted by many social, economic, and environmental factors, which are important to consider for every individual.  Routine weight/height and BMI assessments as part of a holistic assessment are important to determine overall health risk.  

Conversations should focus on health behaviours such as healthy eating, physical activity, sleep and smoking/vaping rather than weight alone. Health behaviour focused conversations are an important part of preventive health care for all patients.   

Research has shown that patients value the advice of health care providers and expect health behaviours to be discussed as part of routine consultations.^[1] Supporting behaviour change requires an understanding of a patient’s readiness, motivation and confidence. Encouraging patient driven behaviour change with an emphasis on small and sustainable changes can make a big difference long term. Supporting patients by discussing this regularly and routinely increases the potential for long-term positive health and wellbeing outcomes. 

Patients may be eligible to access health assessments and chronic disease item numbers within the Medicare Benefits Schedule (MBS). These are dependent on patient age, ethnicity and co-morbidities. Conditions apply to each item number and health care providers should ensure these are understood prior to claiming item number/s.  

The item numbers that patients may be eligible for include:  

In 2010, the item descriptions for Level B, C, and D consultations were changed to include ‘providing appropriate preventive health care’. These changes were made to support patient access to preventive care. Patients are eligible to claim Medicare rebates for attendances when preventive healthcare has been provided.  For further information, visit: https://www.racgp.org.au/running-a-practice/practice-resources/medicare/preventive-healthcare

The Australian Department of Health provides the following response to queries about whether the following are chronic medical conditions for the purposes of the items: alcohol or other substance abuse; smoking; obesity; unspecified chronic pain; hypertension, hypercholesterolemia, or syndrome X; impaired fasting glucose tolerance or impaired glucose tolerance; pregnancy.

In some cases, these would not be commonly regarded as chronic medical conditions in themselves. The Department of Health recognises, however, that conditions such as these can occur across a wide spectrum of severity and in a broad range of circumstances. For example, some patients with one (or more) of the above conditions being unable to self-manage or comply with care and treatment, being functionally disabled by their condition etc. In many cases a patient may have complications or comorbidities that may be a result of or exacerbated by such conditions or risk factors and would make them eligible for chronic disease management (CDM) services. In these cases, the GP should satisfy themselves that their peers would regard the provision of a CDM service as appropriate for that patient, given the patient’s needs and circumstances.

Weight and health behaviours can be discussed in a way that is respectful and without any blame or judgement.  

It is important to seek permission from your patient to measure and discuss their weight, and offer feedback in a factual, but sensitive way.  Focus on how they can improve their health, rather than a focus on weight alone. Respect their willingness to engage in the conversation.

There is no evidence that suggests discussing weight as a matter of health, in a motivating and caring way results in psychological harm. However, there is significant co-occurrence of eating disorders in individuals living with overweight or obesity and this should be considered as a potential comorbidity^[2]. Disordered eating can contribute to the onset and maintenance of obesity, and conversely, obesity and associated stigma can also impact the development and persistence of eating disorders. 

Access National Eating Disorders Collaboration’s (NEDC) guideline for the management of eating disorders for people with higher weight HERE 

If the patient or family is unwilling to discuss weight or health behaviours, it is important to respect this decision. You can let the patient or family know that they are welcome to revisit the discussion at any time in the future.  

RACGP’s information and videos for supporting patients through various stages of change can support your confidence in these conversations: https://healthyhabits.racgp.org.au/patient-pathway/behaviour-change 

Some clinicians may have reservations in discussing weight and health behaviours if they themselves are above a healthy weight.  

Instead of avoiding this conversation, clinicians can demonstrate empathy and acknowledge the difficulties and complexities of weight, whilst focusing on health and the support required by the individual patient or family.   

When a child is above a healthy weight range, discussions should be framed positively and focus on health, growth and overall wellness. When framed in this positive way, this can help normalise positive conversations about health behaviours and de-stigmatise conversations about weight for the child.  

When asking for permission to discuss weight and health behaviours with families, the focus should be on health behaviours that can be made as a family, without a focus on the individual child. 

As adolescents begin to mature and exercise more autonomy on health decisions, it will become increasingly important to engage directly with the adolescent to support health behaviour changes.

Understanding your patients’ cultural background is an important part of building relationships. Cultural considerations such as food practices, beliefs, trust of health professionals or gender norms may influence health behaviours and an individual’s willingness or motivation to engage with health advice.

Each cultural and individual circumstances are unique. Understanding your patient’s culture and socio-economic environment may help you to better connect with them and create a plan that fits your patients’ preferences and needs.

Resources that may help improve confidence supporting patients of diverse cultures can be found below:

• RACGP Aboriginal and Torres Strait Islander Cultural Safety Training 
• SBS Cultural Atlas 
• Working with people from migrant and refugee backgrounds: a guide for social workers

Body mass index (BMI) is an internationally recognised standard to classify body weight and should be used as part of a holistic health assessment. Although BMI does not consider body fat to muscle distribution, it is a non-invasive and  inexpensive way for health care providers to identify who may be at greater risk of health problems due to their weight. Routine assessments where unhealthy upward or downward trends can be identified is a prompt to conduct further assessments and support patients with early intervention support. 

For adults, it is recommended that BMI is measured in conjunction with the measurement of waist circumference to identify potential health risks associated with centralised adiposity.

For children over 2, BMI is a valid indicator of health however a single measurement is not enough to assess long-term health status because height and weight will change as they grow. These measurements should be tracked on growth charts to assess trends over time.