SNAP

from RACGP

1. Smoking (Tobacco / Nicotine-Vaping Product Use)

0 cigarettes or NVP use (complete abstinence).

Ex-smokers should have a clinic exhaled CO < 4 ppm and remain nicotine-free.

5 A’s step	Key tasks
Ask	Record smoking & NVP status every visit.
Assess	• Cigarettes/day, time to 1st cigarette (Heaviness of Smoking Index). • Previous quit attempts & methods. • Vaping device / nicotine concentration. • Stage-of-change & barriers.
Advise / Agree	• Brief, clear advice: “Quitting is the single most important thing you can do for your health.” • Agree on quit date ≤2 weeks.
Assist	Non-pharm • Behavioural counselling (≥4 sessions doubles quit rate). • Quitline (13 QUIT) / MyQuitBuddy app. • Written action plan, identifying triggers & coping strategies. Pharm (first-line unless contraindicated) • Combination NRT (patch + oral) for ≥12 weeks. • Varenicline 0.5 mg d → 1 mg bd for 12 weeks (extend to 24 w if partially abstinent). • Bupropion SR 150 mg d → 150 mg bd for 7–9 w. • Prescription NVPs as second-line (max 3-month PBS authority script).
Arrange	• Review one week after quit date, then at 4, 12 weeks. • Re-issue scripts, manage adverse effects. • Relapse prevention plan.

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2. Overweight / Obesity

Body-mass index (BMI): 18.5 – 24.9 kg/m² (healthy range).
Waist circumference (WC): < 94 cm (men), < 80 cm (women) to minimise metabolic risk.

5 A’s	Tasks
Ask	Document weight every encounter; normalise discussion.
Assess	• BMI, waist circumference (WC). • Obesity staging (Edmonton), CVD & T2DM risk, sleep apnoea, mental health.
Advise / Agree	• Explain 5–10 % loss → ↓SBP, HbA1c & lipids. • Agree SMART goal (0.5–1 kg wk).
Assist	Non-pharm • Dietitian-led 500–750 kcal deficit; Mediterranean or high-protein preferred. • ≥150 min moderate PA + 2 resistance sessions/wk. • CBT / group programs (e.g. Get Healthy Service). Pharm (BMI ≥30 or ≥27 + comorbidity) • Orlistat 120 mg tds with meals. • Naltrexone / Bupropion (Contrave®) up-titrated to 8/90 mg 2 bd. • Liraglutide 3 mg sc daily (PBS only for T2DM 1.8 mg, private weight-loss scripts). • Semaglutide 2.4 mg sc weekly (TGA approved; expected late 2025). Surgical • Bariatric surgery if BMI ≥40 (or ≥35 + comorbidity) after failed conservative therapy.
Arrange	• F/U 1 mth, then q3–6 mths for weight, WC & metabolic risk. • Chronic Disease Management plan & allied-health referrals.

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3. Poor Diet (Unhealthy Nutrition Patterns)

• Vegetables & legumes: ≥ 5 serves/day.
• Fruit: ≥ 2 serves/day.
• Grains (mostly wholegrain): 4-6 serves (women) / 6-8 serves (men).
• Lean meats/alternatives: 1-3 serves.
• Dairy/alternatives (reduced-fat): 2-3½ serves.
• Discretionary foods: ≤ 0-2½ serves.
Additional nutrient targets: < 10 % energy from saturated fat, < 10 % from free sugars, < 5 g salt/day, ≥ 25-30 g fibre/day.

5 A’s	Tasks
Ask	Recall 24-h intake; focus on fruit/veg, discretionary foods, sugary drinks, salt.
Assess	• Diet Quality Index, fibre, Ca²⁺/Vit D. • Relationship to BMI, lipids, BP, HbA1c.
Advise / Agree	• Link diet to CVD & cancer risk; set targets: ≥5 veg + 2 fruit serves/day, < 5 g salt, limit SSBs.
Assist	Non-pharm • Refer Accredited Practising Dietitian. • Mediterranean or DASH pattern; culturally appropriate swaps. • Cooking skills / label-reading education. Pharm • None specific; manage downstream conditions (e.g. statin for dyslipidaemia) if targets unmet after 3–6 mths.
Arrange	• Telephone coaching, web-based programs, 3-month review of lipids, weight & BP.

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4. Hazardous Drinking

• ≤ 10 standard drinks/week AND ≤ 4 standard drinks/day (men & women).
• 0 drinks if <18 y, pregnant, breastfeeding or planning pregnancy.
1 Australian standard drink = 10 g ethanol

5 A’s	Tasks
Ask	AUDIT-C for all adults ≥15 y.
Assess	• Full AUDIT if AUDIT-C ≥4 (M) / ≥3 (F). • Readiness to change; withdrawal risk (PAWSS).
Advise / Agree	• NHMRC 2020 guideline: max 10 standard drinks/week & 4/day. • Personalised harm (liver, mental health).
Assist	Non-pharm • Brief Intervention (5–15 min): feedback, advice, goal-setting. • Motivational Interviewing, CBT, relapse-prevention therapy. • Referral to AOD service / inpatient detox if dependence. Pharm (post-withdrawal, for relapse prevention) • Acamprosate 666 mg tds. • Naltrexone 50 mg d (contra: opioids, hepatitis). • Disulfiram 100–200 mg d (high-risk; supervise). • Off-label: Baclofen (up-titrate to 30 mg t ds).
Arrange	• Review fortnightly until stable; LFTs every 3 mths. • Engage family, peer-support groups; relapse plan.

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5. Physical Inactivity / Sedentary Behaviour

• ≥ 150–300 min/week moderate-intensity OR 75–150 min vigorous (or equivalent mix).
• Muscle-strengthening activities on ≥ 2 days/week.
• Break up sitting every 30 min; aim for total sedentary time < 8 h/day.

5 A’s	Tasks
Ask	Minutes of moderate/vigorous PA & sitting time/week.
Assess	• Compare to Australian guidelines: ≥150–300 min mod-intensity + 2 strength days. • Health risks (CVD, mood, MSK).
Advise / Agree	• Brief advice that every 30 min of sitting → stand/move. • Set SMART goal (e.g. 30 min brisk walk 5 days/wk).
Assist	Non-pharm • Written Exercise Prescription (FITT). • Refer Exercise Physiologist (MBS item 10953) or physio. • Pedometer / smartphone app tracking. • Incorporate resistance exercise & balance for ≥65 y. Pharm: none.
Arrange	• Review at 4 & 12 weeks; adjust program. • Link to community programs (Heart Foundation Walking).

Abbreviations:

PA – physical activity; NRT – nicotine-replacement therapy;

NVP – nicotine-vaping product;

SMART – specific, measurable, achievable, relevant, time-based;

CBT – cognitive behavioural therapy;

AOD – alcohol & other drugs.