EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you assess Mark’s weight-related health risks and readiness to change?

• Prompt: What key components of history and examination are needed?
• Prompt: How would you assess his motivation for weight loss?

Q2. What evidence-based weight management strategies would you recommend?

• Prompt: What non-pharmacological interventions should be prioritised?
• Prompt: When should pharmacotherapy or surgery be considered?

Q3. How would you address Mark’s concerns about previous weight loss failures?

• Prompt: How can motivational interviewing be used to explore barriers?
• Prompt: What strategies can support long-term adherence?

Q4. What screening and preventive measures should be implemented for Mark?

• Prompt: What conditions are obesity-related, and what tests are needed?
• Prompt: How should cardiovascular and metabolic risks be managed?

Q5. When would you refer Mark to a specialist, and what multidisciplinary care options exist?

• Prompt: What are the indications for referral to an endocrinologist or bariatric surgeon?
• Prompt: What role do allied health professionals play in obesity management?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: How would you assess Mark’s weight-related health risks and readiness to change?

Mark’s BMI of 34 kg/m² and waist circumference of 108 cm place him in Obesity Class I with increased cardiometabolic risk. A structured assessment includes:

1. History and Risk Factor Assessment

• Weight history: Onset, patterns, previous attempts at weight loss
• Dietary habits: Type, quantity, timing of meals, snacking, emotional eating
• Physical activity: Sedentary job, exercise barriers, current activity levels
• Medical history: Hypertension, possible prediabetes, obstructive sleep apnoea symptoms
• Medications: Assess for weight-promoting drugs
• Psychosocial factors: Stress, sleep, mental health, readiness for change

2. Clinical Examination

• BMI and waist circumference (assesses visceral adiposity)
• Blood pressure, cardiovascular exam (risk stratification)

3. Assessing Readiness to Change

• Stages of Change Model: Precontemplation, contemplation, preparation, action, maintenance
• Motivational interviewing: “What would a healthier weight mean for you?”

This comprehensive assessment informs an individualised weight management plan.

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Q2: What evidence-based weight management strategies would you recommend?

1. Lifestyle Interventions (First-line Therapy)

• Dietary modification:
  • Reduce energy intake: Portion control, low-GI foods, whole foods
  • Minimise processed foods, refined sugars
  • Consider referral to dietitian
• Physical activity:
  • 150-300 minutes of moderate exercise per week
  • Incorporate resistance training
• Behavioural therapy:
  • Mindful eating, goal setting, addressing emotional eating

2. Pharmacotherapy (BMI ≥30 or ≥27 with comorbidities)

• Liraglutide (GLP-1 receptor agonist) or orlistat
• Requires ongoing lifestyle changes

3. Bariatric Surgery (BMI ≥40 or ≥35 with comorbidities)

• Consider referral if lifestyle and pharmacotherapy fail

A multidisciplinary, patient-centred approach ensures sustainable outcomes.

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Q3: How would you address Mark’s concerns about previous weight loss failures?

1. Empathise and Normalise Challenges

• Acknowledge difficulties with weight loss and validate his experiences
• Avoid blame and stigma

2. Identify Barriers and Solutions

• Lack of time → Incorporate short bouts of activity
• Cravings and snacking → Structured meal plans
• Lack of motivation → Set small, achievable goals

3. Use Motivational Interviewing

• Elicit Change Talk: “What has worked for you in the past?”
• Explore Values: “What would motivate you to sustain changes?”
• Address Relapse Prevention: “How can we overcome obstacles?”

A supportive and individualised approach increases adherence.

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Q4: What screening and preventive measures should be implemented for Mark?

1. Cardiometabolic Screening

• Fasting glucose/HbA1c (prediabetes monitoring)
• Lipid profile (atherosclerosis risk)
• Liver function tests (non-alcoholic fatty liver disease)

2. Obesity-Related Conditions

• Obstructive sleep apnoea (STOP-BANG questionnaire)
• Hypertension management

3. Preventive Strategies

• Dietary counselling and exercise referral
• Annual weight and metabolic risk monitoring

Proactive screening minimises obesity-related complications.

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Q5: When would you refer Mark to a specialist, and what multidisciplinary care options exist?

1. Endocrinology Referral

• Suspected secondary causes (Cushing’s, hypothyroidism)
• Failure to lose weight despite intervention

2. Bariatric Surgery Referral

• BMI ≥40 or ≥35 with significant comorbidities
• Psychological readiness for surgery

3. Allied Health Involvement

• Dietitian: Personalised meal plans
• Exercise physiologist: Tailored physical activity program
• Psychologist: Emotional eating, motivation

A multidisciplinary team enhances long-term weight loss success.

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SUMMARY OF A COMPETENT ANSWER

• Assesses obesity severity and related health risks using BMI and waist circumference
• Identifies and addresses weight loss barriers using motivational interviewing
• Develops an evidence-based management plan incorporating diet, exercise, and behavioural therapy
• Implements screening for obesity-related conditions such as diabetes and hypertension
• Refers appropriately to specialists or allied health for multidisciplinary support

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PITFALLS

• Failing to assess lifestyle, psychosocial factors, and readiness for change
• Focusing solely on BMI without considering waist circumference and comorbidities
• Prescribing pharmacotherapy or surgery without optimising lifestyle interventions
• Neglecting screening for obesity-related complications (e.g., sleep apnoea, fatty liver)
• Overlooking the role of allied health professionals in weight management

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REFERENCES

• RACGP – Obesity prevention and management
• GP Exams – Obesity

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MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communicates effectively about weight management without stigma.
1.3 Uses motivational interviewing to explore readiness for change.

2. Clinical Information Gathering and Interpretation

2.1 Conducts a detailed history to assess dietary, physical activity, and lifestyle factors.
2.3 Identifies obesity-related comorbidities (e.g., hypertension, diabetes, sleep apnoea).

3. Diagnosis, Decision-Making and Reasoning

3.1 Assesses obesity severity using BMI and waist circumference.
3.3 Identifies when further investigations (e.g., metabolic screening) are required.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an individualised weight management plan.
4.4 Prescribes pharmacotherapy or refers for bariatric surgery when appropriate.

5. Preventive and Population Health

5.1 Provides evidence-based dietary and lifestyle recommendations.

6. Professionalism

6.2 Ensures non-judgmental and supportive care to minimise weight-related stigma.

7. General Practice Systems and Regulatory Requirements

7.1 Uses GP Management Plans (GPMP) and Team Care Arrangements (TCA) where applicable.

8. Procedural Skills

8.2 Interprets relevant investigations, such as fasting glucose and lipid profile.

9. Managing Uncertainty

9.1 Addresses patient concerns about weight loss challenges and previous failed attempts.

10. Identifying and Managing the Patient with Significant Illness

10.2 Recognises when obesity-related complications require specialist referral.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD