GCWMS Assessment GCWMS Assessment key factors key factors

Dr. Ross Shearer, Clinical Dr. Ross Shearer, Clinical PsychologistPsychologist

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Rhonda Wilkie, Specialist DietitianRhonda Wilkie, Specialist Dietitian

GCWMSGCWMS

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Traditional processTraditional process AppointedAppointed 1:11:1 Diet and weight historyDiet and weight history→→Nutrition therapy targeted at weight lossNutrition therapy targeted at weight loss++(Advice on physical activity)(Advice on physical activity)++(Advice on behaviour change strategies)(Advice on behaviour change strategies) Variable monitoringVariable monitoring

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Traditional approachTraditional approach

DidacticDidactic Emphasis on dietary changeEmphasis on dietary change Variable emphasis on behaviour Variable emphasis on behaviour

changechange Variable emphasis on physical Variable emphasis on physical

activityactivity Goal oriented Goal oriented

therapist goals vs client’s goalstherapist goals vs client’s goals

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GWMS AssessmentGWMS Assessment Individual assessmentIndividual assessment

Client involvement Client involvement (Clients are active vs passive)(Clients are active vs passive) Opt inOpt in Pre assessment completion of Data sheet Pre assessment completion of Data sheet Pre assessment completion of 3 validated Questionnaires Pre assessment completion of 3 validated Questionnaires

Weight Loss ReadinessWeight Loss Readiness Quality of LifeQuality of Life Hospital Anxiety and DepressionHospital Anxiety and Depression

1:1 Clinician session for full assessment (motivational)1:1 Clinician session for full assessment (motivational)

Client empowermentClient empowerment InformationInformation ResponsibilityResponsibility Client choiceClient choice

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Client empowerment - Client empowerment - InformationInformation

Group size / frequencyGroup size / frequency Group ContentGroup Content

DietDiet (what)(what) ActivityActivity (what)(what) Behaviour changeBehaviour change (how)(how)

Role of GroupRole of Group SupportSupport Learning from othersLearning from others normalisationnormalisation

Lead cliniciansLead clinicians

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Client empowerment - Client empowerment - InformationInformation

VenueVenue Modest maintainable loss vs. large re-Modest maintainable loss vs. large re-

gainablegainable Change in weightChange in weight Quality of life measuresQuality of life measures

Duration of initial interventionDuration of initial intervention Duration of further intervention (Phase Duration of further intervention (Phase

2 & Maintenance programme)2 & Maintenance programme) Address questions re pharmacotherapy Address questions re pharmacotherapy

+/ surgery+/ surgery

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Client responsibilityClient responsibility

CommitmentCommitment Attendance in full (encouraged)Attendance in full (encouraged) ParticipationParticipation

SessionsSessions InterventionIntervention

Diet, Activity and Behaviour changesDiet, Activity and Behaviour changes Self monitoringSelf monitoring

Period of interventionPeriod of intervention Period of maintenancePeriod of maintenance

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Client choiceClient choice

6 months opt in period after 6 months opt in period after assessmentassessment Client takes final decision Client takes final decision

Resource management Resource management staggered opt in more manageablestaggered opt in more manageable

?? Ensures intervention used by more ?? Ensures intervention used by more motivated clients ??motivated clients ??

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GWMS – Assessment 1:1GWMS – Assessment 1:1

Individual session Individual session →→ Data sheet & measures Data sheet & measures Weight Loss ReadinessWeight Loss Readiness World Health Organisation Quality of Life World Health Organisation Quality of Life Hospital Anxiety and DepressionHospital Anxiety and Depression Dieting and weight loss historyDieting and weight loss history

Additional Additional psychological psychological assessment assessment if if indicatedindicated

Additional Additional physiotherapy physiotherapy assessment assessment if if indicatedindicated

patients opt in to Lifestyle interventionpatients opt in to Lifestyle intervention

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GCWMS Assessment GCWMS Assessment QuestionnairesQuestionnaires

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Points to consider Intervention is part of the assessment –

health behaviour change, but not formalised goal setting.

Generic assessment – carried out by MDT. Assessing stage of change/readiness to

change. May have never been asked some of these

questions about their weight before. Allows patients consider the severity/the

impact of their weight on their QOL.

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Points to consider cont.

A lot of questions in questionnaire, some very personal – can bring up a lot of emotions.

Clinicians need to be skilled in dealing with emotional patients – frustrated/angry/depressed about their weight.

Patients previous weight loss attempts - their beliefs based on their experiences.

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Case study examples of using GCWMS

assessment in practice

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Patient 1: Mr M, 60 yr old male.

Height = 1.68m, Weight = 147kg, BMI=52 kg/m2

GP stated on referral “for many years we have advised him to lose weight..”

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Scores from questionnaire

Depression = 16/21 (>14, psychological assessment)

Motivation = 11/20 (<6, ?? readiness to change)

Confidence = 11/32 Physical function = 54/55 (>25

physio referral) Self Esteem = 26/35

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Assessment information

Height = 1.68m, Weight = 156.4kgs, BMI = 55.4 kg/m2 Health issues – High BP, hypothyroid,

asthma. Pt reported assessment wt as

heaviest. Only one “half-hearted” past attempt

at weight loss via commercial slimming organisation.

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During assessment

Patient presentation – body language, pre-conceived ideas of what would be involved

“I do this, but your going to want me to do this…”

“your going to tell me to stop having that and eat this…”

It was clear patient expected a didactic approach and to be given a diet sheet to follow.

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How I conducted the session

Used questionnaire as a prompt. Used reflective listening and open

questions to respond to patient’s beliefs. Used Motivational interviewing

techniques eg rolling with resistance. Aimed to illicit change talk from patient

around his lifestyle. Where he identifies barriers trying to identify solutions also.

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Explored motivation- importance and confidence in relation to patient’s weight loss expectations.

By end of assessment he had stated changes he felt he could make and was aware which areas he needs to work on and how the service could support him with this.

He also challenged his own reported barriers “I’m just making excuses, aren’t I?...”

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Patient 2: Ms J, 52 year old female.

Height = 1.57m, Weight =111kgs,

BMI = 45kg/m2

History of hypertension.

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Scores from questionnaire

Anxiety = 19/21 (>14, psychological assessment)

Depression = 14/21 (>14, psychological assessment)

Binge Eating and Purging = 8/15 Self Esteem = 35/35

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During assessment Patient reported a long history of binge eating

and purging behaviour. Explored further with patient.

Patient felt she would be able to control her bingeing and purging when on the programme.

However, currently was attending slimming club and had binge eaten twice that week.

Patient apprehensive about attending psychology assessment. Keen to start programme.

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Recognising the issue – currently not under control and seeking specialist support for her weight. Patient had never disclosed this to anyone before.

Impact on her weight/self-esteem if not dealt with.

Highlighting skills of clinical psychologists and treatment options potentially available eg disordered eating group.

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Stressing purpose of assessment and questions asked to screen for disordered eating behaviours.

Also understanding group programme focus is on wt loss – could potentially make disordered eating worse.

Recognising that this is not my area of expertise but highlights the benefits of MDT working.