The 5 A’s approach to reimbursable obesity counseling

Focus on:Target this information:
Assess (obtain this information in advance)Weight historyCurrent body mass index (BMI) (kg/m2)
Maximum weight, minimum weight, ideal weight
Previous weight loss efforts
Eating habitsNumber of meals per day
Typical breakfast, lunch, dinner
Quantify daily intake of sugary beverages
Physical activityQuantify amount and type
AdviseGoals3% to 5% weight loss over 6 months (3 kg for Medicare patients)
6-month commitment to losing weight
150 minutes of moderate-intensity aerobic activity per week
Treatment planCreate-your-plate method
Mediterranean diet
Consider role of pharmacotherapy for weight loss
AgreeGoalsUse motivational interviewing, shared decision-making, and information from Assess and Advise
AssistIdentify barriersScreen for depression
Ask about access to healthy foods
Identify social support for weight loss
Review current medications to identify those that promote weight gain
ArrangeFollow-up and referralsConsider consultation by a nutritionist or dietician
Consider group support sessions
Bariatric surgery consultation for patients with BMI ≥ 40 kg/m2, or for patients with BMI ≥ 35 kg/m2 and obesity-related comorbidities who have not responded to behavioral therapy