Approximately two thirds of the adult population are either overweight or obese, posing arguably the biggest threat to public health. The federal and WA state governments have become increasingly interested in ways to decrease this figure. Why? Money.
The Food Fix report, a state government inquiry into the role of diet in prevention and management of diabetes (released April 2019), estimated the cost to manage the complications of diabetes in WA to be between $880 million and $1.2 billion in the public system alone. That’s about 10% of the state health budget. The cost federally, quoted in the same report, is estimated to be $20.2 billion as of 2018.
The major risk for type 2 diabetes is obesity. The Food Fix recommends information and education in regard to low-carbohydrate diet, consistent with CSIRO recommendations, be distributed to GPs in WA. If the nation’s adults reduce both carbohydrate intake and, in turn, body weight, they and the governments’ coffers will be healthier.
GPs, be innovative
Science is about objectively testing whether new ways are effective in achieving goals and questioning, “Is it so?” Science is not, “I want it to be so, so it is so” (the latter becoming all too common in our society).
The eCal device being used in our practice (and the UK NHS) measures exhaled gases of patients via indirect calorimetry providing, via software integration an estimation of metabolic rate at the mitochondrial level and an indication of whether a patient is ‘burning’ carbohydrate or fat for energy in the fasting state.
The use of eCal is based on a new old idea that had been buried for many decades. That is, low carbohydrate diet can lead to reversal or cure of diabetes type 2 and may be the most effective non-surgical way of combatting obesity.
The ‘new way’ of testing is to have a specific, on-site multidisciplinary primary care team to combat obesity in our patient population. We have developed a process that is GP-workload neutral at worst, and less work, if possible, by having GPs direct a primary healthcare team of experts (nurse, psychologist, exercise physiologist, physiotherapist) within the practice to screen, motivate, educate and support patients to gain health by losing weight.
The goal of the program run by the exercise physiologist is for significant, sustained weight loss of 5% or more of initial body weight at 12 months from start of the program. The bias of the program is to educate patients about low carbohydrate diet, how they can take charge of their body weight by metabolic manipulation and give them the tools to do this in a sustainable, lifelong way.
Successful behavioural change is more likely with non-judgemental medical and paramedical advisors, regular coaching and positive feedback both subjective and objective. We do this all on-site. The exercise physiologist measures the usual biometrics including body mass composition but, in addition, I have found the availability and their use of the eCal device developed here in WA to be pivotal in motivating patients to enter the program and stay in the program.
My experience is that patients love the fact they get a ‘one-stop shop’ for healthy weight loss in a non-judgemental environment with people they know and trust. They get regular coaching, objective feedback and, if appropriate, professional psychological support.
We are engaging with several partners to help us undertake meaningful, ethical and significant research on our program to inform the management of this carbohydrate driven obesity epidemic. All this is taking place in a general gractice, where the battle should be owned, fought and driven.
Key messages
- To improve health outcomes, we need innovation
- The food fix report recommended a low carb diet be supported
- Technology and a team approach can allow patients to gain health
References available on request.
Questions? Contact the editor.
Author competing interests: nil
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