A nurse practitioner (NP)-led weight management initiative based on the 5As framework led to implementation of effective weight management strategies in more than 75% of college students with a body mass index (BMI) of 25 or greater. The findings were presented in a poster session at the 2022 American Association of Nurse Practitioners (AANP) National Conference held June 21 to June 26, 2022, in Orlando, Florida, and published in The Journal for Nurse Practitioners.

Electronic health records of college students at the Brigham Young University’s Student Health Center (BYU-SHC) in Provo, Utah, showed that 41% of students had a BMI of 25 or greater. An audit of 20 randomly selected records of students with overweight showed that none had a documented referral to behavioral weight management interventions, explained study coauthor Allison Ensign, FNP, who is a family nurse practitioner at BYU-SHC and assistant professor at Utah Valley University Department of Nursing.

Weight Loss Intervention

To increase the rate of effective weight management in this population, the researchers developed an intervention that consisted of the 5 As framework (assess, advise, agree, assist, and arrange) as well as a screening trigger tool, shared decision-making tool, case management log, and team engagement plan.

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The clinical staff at the center included 6 physicians, 5 NPs, 1 PA, 2 registered nurses, and 24 medical assistants. 

Uptake of Weight Loss Intervention

The screening trigger tool identified 317 students with a BMI of 25 or greater. Of these students, 91% agreed to discuss weight management and 85% engaged in the shared decision-making on weight management resources. These initiatives led to 77.8% of participants obtaining effective care for weight management based on current evidence-based weight management guidelines within 90 days of the program start date.

“The effective care score was a compilation score of points for screening for obesity, offering weight management resources (such as a registered dietician, an exercise trainer, or stress management), ordering applicable labs, and scheduling follow-up care,” Dr Ensign explained.

The minimal cost of implementing the program “is overshadowed by the gains,” noted Dr Ensign and coauthor Kimberly Couch, DNP, CNM, FNP-BC. The researchers plan to incorporate weight screening and management into the clinic’s electronic medical records, place posters on weight management in clinic rooms, and collect data on weight loss outcomes among participants.

“Overweight and obesity are continuing to escalate and have only been made worse by the pandemic,” commented Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing in Stony Brook, New York. “Hypertension and type 2 diabetes are the very serious complications of these conditions that can only be addressed with evidence-based interventions. The work described in this poster is important because it details an easy to implement, cost-effective model developed by an NP that led to almost 78% of college students seeking care for overweight and obesity,” she said.  

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Ensign A, Couch K. Improving effective weight management with the 5As framework. Poster presented at: AANP 2022; June 21-26, 2022; Orlando, Fl. 

Ensign A, Couch K. Improving effective weight management in a university health center. J Nurse Pract. 2021;17(10):1183-1118. https://doi.org/10.1016/j.nurpra.2021.09.023