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by Robin Allen MSPH, RDN, LDN

When I was in private practice I thought I could change the world one client at a time.  What I did not count on is my client’s unwillingness to change, no matter how much great information  and wisdom I imparted.  With one in three people in the United States suffering from hypertension and  obesity growing how can we help our patients change their lifestyles to help themselves?

To follow up on last week’s webinar, Hypertension Update: Nutritional Guidelines and Strategies, I learned that the 5 As has been used with success to motivate lifestyle changes.

The 5 As assessment system was originally developed for smoking cessation.  However, it is easily adapted to all lifestyle changes, including obestity.

The 5 A framework:

  • Ask, Advise, Agree/Assess, Assist, Arrange
  1. Ask– Ask permission to discuss weight; be nonjudgmental and explore the patient’s readiness for change.
  2. Agree/Assess– Assess body mass index (BMI), waist circumference, and obesity stage; explore barriers to change and complications of excess weight.
  3. Advise– In a clear, strong, and personalized manner. Advise the patient about the health risks of obesity, the benefits of modest weight loss, the need for a long-term strategy, and treatment options.
  4. Assist– Help the patient set realistic weight-loss or other behavior expectations, targets, behavioral changes, and specific details of the treatment plan.
  5. Arrange– identify and address barriers; provide resources, assist in finding and consulting with appropriate providers, and arrange regular follow-up. Schedule a follow-up contact, in person, email or by telephone, preferably within the first week.
  • The 5 As have been studied since mid-1990s for smoking cessation, substance abuse and more recently for lifestyle behavior change
  • Recommended in 2002 by U.S. Preventive Services Task Force (USPSTF)
  • Recommended in 2011 by USPSTF as a safe and effective way to counsel patients about their obesity.
  • Adopted in 2011 by Centers for Medicare & Medicaid for intensive behavioral therapy for obesity.

Can you make use of the 5 As in your practice?

Think about how you can help  your patients/clients to make even small changes to improve their lifestyle and health risk factors.



2014 Evidence-Based Guideline for Management of High Blood Pressure in Adults Report from the Panel Members Appointed to the 8th Joint National Committee.  James PA, Oparil S, Carter BL et al. JAMA. 2014; 311 (Feb 5):507-20.

Vallis M1, Piccinini-Vallis H, Sharma AM, Freedhoff Y, Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013 Jan;59(1):27-31.

Kolasa July 22, 2015 Hypertension Update: Nutritional Guidelines and Strategies.  OneOp Event Materials Slides

This post was written by Robin Allen, member of OneOp (MFLN) Nutrition and Wellness team which aims to support the development of professionals working with military families.  Find out more about the OneOp Nutrition and Wellness concentration on our website, on Facebook, on Twitter and on LinkedIn.