Greening Family Medicine clinic operations and clinical care, where do we start? A scoping review of toolkits and aids.

BACKGROUND: There is a pressing need for healthcare to respond to the climate crisis. Family physicians, given their central role in community healthcare provision, are strategically placed to lead, support, and promote sustainable healthcare, yet guidance on how to do this is fragmented. OBJECTIVE: To identify and evaluate toolkits and aids on sustainable healthcare to act as a curated resource for family physicians and their care teams interested in delivering evidence-based sustainable healthcare in their clinical practices. METHODS: A scoping review was completed of the published and grey literature across 4 databases and 2 search engines to identify articles and aids/toolkits from 1990 to present. Toolkits were subsequently evaluated for purpose, evidence-base, implementation process, adaptability to family medicine, and outcome measures. RESULTS: The search identified 17,751 articles. Screening resulted in 20 published articles and 11 toolkits. Most articles presented simple checklists to support greening clinic initiatives, 3 studies focussed on partial carbon footprint analyses, and 4 on educational initiatives. Toolkits ranged in sustainability topics and degree of depth covered, and adaptability and outcome measures. None of the resources identified have been formally evaluated for effectiveness. CONCLUSIONS: A range of aids exist to support greening of clinic operations; however, there is a significant gap in the literature for greening clinical care. Two toolkits were found to be comprehensive, one requiring tracking and reporting of sustainability initiatives. This scoping review provides a starting point for motivated family doctors and community clinics to initiate change and support more sustainable healthcare.

Prevention and harm reduction of obesity (clinical prevention)

Obesity is a heterogeneous disease that can develop via slow and steady weight gain over an extended period, or from rapid bursts of weight gain. Regular assessments of body weight are needed to catch early weight gain. Use the Edmonton Obesity Staging System to evaluate if the patient has obesity. Clinicians should initiate discussion around weight gain early and contemplate interventions that consider its com­plex causes, providing guidance beyond "eat less and move more." Many medications are associated with weight gain side effects that can contribute to long-term weight gain. Excess pregnancy weight gain and post pregnancy weight retention are significantly reduced with behavioural interventions. Clinicians should counsel women attending prenatal care not to exceed pregnancy weight gain guide­lines, and also give pregnant women the necessary coun­selling, as well as dietary, physical activity and psychological interventions within prenatal visits. Health benefits of smoking cessation outweigh the cardio­vascular consequences associated with smoking cessation related weight gain. Short-term behavioural interventions (generally six months or less) aimed at preventing weight gain in young adult­hood, menopause, smoking cessation and breast cancer treatment have not yet been shown to be effective. Longer interventions will likely be needed to properly examine strategies for preventing weight gain for many of these high-risk groups and in the general population.