For Health Care Professionals Only

New MBS item Number for “very long complex consults”

• The National Obesity Strategy 2022 recognises, and seeks to improve, the currently inadequate funding for GP consultations with people living with obesity, which often extend beyond 20 minutes.
• In 2023, Medicare Benefits Schedule introduced a new item number for GPs to utilise for very long complex consults

"RACGP Obesity Management Webinar September 2023" available on-demand for 12 months

I was privileged to be asked by the Royal Australian College of General Practice [RACGP] to participate in a webinar facilitated by Terri-Lynne South, current Chair of the Obesity Management SIG.

It will be available for RACGP members to access on demand for the next 12 months.

We know that obesity is a chronic progressive health condition and so over the course of time, there will be a need to intensify i.e. step-up therapy.

Essentially the webinar covers:

1. obesity is heterogeneous in how it affects individuals with the lived experience(PwO) ranging from: age of onset, etiology/drivers, presentation, response to treatment etc
2. our responsibilities as HCPs to " ASK, MEASURE + IDENTIFY" (+/- offer treatment if the PwO is agreeable; if the PwO currently does not wish to engage, set up recall as per RACGP Red Book & revisit this at a later date)
3. covers the evidence behind using combination adjunct anti-obesity therapies in addition to adoption of healthy lifestyle (LS): i.e. OMMs + VLEDs or AOM + BMS.
4. how the AIHW guidance on chronic care plans + AU National Obesity Strategy + RACGP obesity position statement align
5. importance of longterm follow-up and how recall systems help facilitate this

The Role of GLP1-RA in the management of people living with concurrent T2DM and CVD, November 2023

Today is “World Diabetes Day”

Fortuitously this morning I was privileged to present at the St George Public Hospital Cardiology Grand Rounds on a very hot topic at the moment “role of GLP1 -RA in the management of people living with concurrent T2DM and CVD”.

The time to treat is now.

We have

• robust GLP-1 RA CVOT data,
• effective obesity-modifying medications which also improve dysglycemia in a glucose-mediated manner (Hence reducing risk of hypoglycemic episodes)
• informed and aware patients seeking treatment
• as HCP we have an ethical and medico-legal responsibility to inform patients of effective evidence-based treatments, without assuming/ presuming to know if they can afford therapy/ have a preference for method of administration etc.

Let's work together to assist patients in making an informed decision.

Australian CardioVascular Disease Risk Calculator, 2023

People with risk factors such as smoking, diabetes, family history of premature CVD,* kidney impairment, gestational diabetes, pre-diabetes, familial hypercholesterolaemia (FH), severe mental illness,† and severe obesity generally develop CVD at a younger age than the general population. Therefore, earlier monitoring of CVD risk factors may be warranted.

The new Australian cardiovascular disease risk calculator (Aus CVD Risk Calculator) includes optional risk factors not included in the previous iterations, including BMI and severe mental illness.

The Aus CVD Risk Calculator allows for improved CVD risk estimation in people living with T2 diabetes, factoring in the number of years since diagnosis of T2DM, HbA1c, uACR, eGFR, BMI and the use of insulin in the preceding 6 months.

It also includes new guidance on factors that may help HCPs reclassify risk estimates when using the Aus CVD Risk Calculator; this is particularly relevant for people whose estimated risk is close to the threshold of another risk category. Reclassification factors include ethnicity, eGFR and uACR measurements, severe mental illness, a coronary artery calcium score, and family history of premature CVD.

The Australian Obesity Management Algorithm. 2022

Managing Obesity within Australian Primary Care: Breaking Down the Barriers

• Step One: Baseline Assessment (Preparatory Consultations 1&2)
• Step Two : Advice, Support and Therapy (Review Consultations 3&4)
• Step Three: Referral as per Obesity Algorithm (Review Consultations 5-8)
• Step Four: Revision and Re-evaluation (Review Consultations 9+)

Medication absorption after Bariatric Metabolic surgery

It is important to broadly understand how the bariatric operations work, so then you can understand how/why the subsequent absorption of certain /common medications can be altered after bariatric metabolic surgery. See this article by my friend and colleague Teresa Girolamo, Adelaide.

TGA alert: caution if high vitamin B6 levels

I would like to inform you of a recent TGA health professionals alert, on Vitamin B6.

It contains a good summary of the issues as they relate to clinical practice, highlights some data around some new adverse event reporting and encourages health professionals to communicate with the TGA regarding new cases.

Weight stigma: Why everybody needs to act

Weight stigma is one of the most common forms of discrimination in modern societies, alongside racism and sexism, writes Dr Georgia Rigas.

It is estimated that 19–42% of adults living with obesity experience stigma.

Weight stigma has been well documented in a large variety of societal domains, such as education, the workplace, healthcare, and the media.

Weight stigma: causes and effects

Image courtesy of World Obesity

Dear Colleagues,

In these for ever changing times, I thought I'd share these valuable resources with you.

Given we are all working in different therapeutic landscapes with different resources available to us, and different degrees of enforced lockdown, virtual consults are becoming increasingly utilised.

In this module there are two vignettes:

1. one possible example of how to conduct a new patient virtual consult with a patient living with obesity;
2. one possible example of how to conduct a follow-up virtual consult with a patient living with obesity

This is by now means the only way it can be done; nor is it meant to be prescriptive. Its to empower you and reassure it that it can be done during the time constraints of clinical practice.

Remember- obesity is a chronic progressive disease- we don't have to tackle everything in one consultation; rather we should work collaboratively with the patient -chipping away at it a little at a time.

I hope you find it and the other modules in this series useful.

Virtual Obesity Clinics Programme

RACGP Specific Interest Obesity Management Network

If you are a GP and would like to learn more about the management of people with obesity, please consider joining this Network of like-minded GPs.

The Obesity Management Network acts as an educational support, reference group and networking body for general practitioners with an interest in this area. Our knowledge about obesity, the factors that contribute to excess adiposity, and the different treatment modalities are constant changing and evolving as further ongoing research into these areas is being undertaken. The Network keeps up to date with and discusses a variety of evidence-based therapies for obesity management.

There is no fee to join if you are a RACGP member, so please email at: [javascript protected email address]

For more information click on below links

• Obesity Factsheet
• Adapted from table 6.4 of NHMRC 2013 Obesity management guidelines

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