This document provides guidance on discussing weight sensitively in a primary care setting. It emphasizes using motivational interviewing techniques to explore a patient's readiness for change. Physicians are advised to avoid blame and focus instead on health goals. International research finds patients want specific strategies and support, not just information. The document outlines best practices for asking permission to discuss weight and assessing a patient's situation and barriers in a non-judgmental way. It cautions that weight loss expectations often exceed evidence-based outcomes and recommends managing expectations by discussing weight as a long-term process with multiple phases.
This document provides an overview of chronic disease prevention and management of obesity in primary care settings. It discusses key principles of obesity management, including:
1. Obesity is a chronic disease influenced by genetic, environmental and lifestyle factors.
2. The goal of obesity management is improved health and well-being rather than weight loss alone.
3. Early intervention requires addressing the underlying causes of obesity and barriers to weight management.
4. Success varies between individuals and may not mean achieving an "ideal" weight.
5. A patient's "best" weight sustains health improvements and quality of life.
The 5 As framework is presented as a tool for primary care providers to structure conversations about
The document outlines the 5 A's approach to obesity management, which includes asking permission to discuss weight, assessing risks, advising on risks and options, agreeing on goals and expectations, and assisting by addressing barriers and referring to other providers. It provides guidance on setting SMART behavioral goals focused on sustainable lifestyle changes rather than weight targets alone. The document also discusses following up to support patients in achieving their goals as obesity requires long-term management.
1. The document discusses various facts and myths about obesity management. It addresses that obesity is a chronic disease, and the goal is to improve health rather than focusing solely on weight loss. Even modest weight reduction can significantly improve health.
2. Understanding the root causes of individual weight gain is important for effective management of obesity. Identifying personal roadblocks to weight control is key to making positive changes.
3. Success in obesity management is not solely defined by amount of weight loss but also by improved energy, self-esteem, health, and preventing further weight gain. Individual goals guide what success means.
The document contains a quiz with 9 true/false questions about facts related to obesity, physical activity, nutrition, and weight management. Each question is followed by an explanation of the answer. Some key facts covered include: obesity is a chronic disease similar to diabetes; muscle weighs the same as fat despite taking up less space; physical activity provides health benefits regardless of weight loss; and regular weighing can be a sign of an eating disorder rather than a cause. The document encourages discussion of challenges to health promotion in the areas of nutrition, physical activity, and obesity.
This document discusses motivational interviewing (MI), a patient-centered counseling technique that aims to explore problems from the patient's perspective and unlock solutions that lie within the patient. MI assumes behavior change is motivated by the patient, not information from providers. It involves agenda-setting, reflective listening, and shared decision-making. The four guiding principles of MI are resisting the "righting reflex," understanding patient motivations, active listening, and empowering the patient. Extensive evidence supports low-intensity MI interventions for behavior changes related to health areas like smoking, medication adherence, obesity, and more.
This document provides guidance on physical activity recommendations and the health benefits of physical activity. It recommends that adults engage in at least 150 minutes of moderate physical activity per week, or 75 minutes of vigorous physical activity per week. For children and adolescents, it recommends at least 60 minutes per day of moderate to vigorous physical activity. It outlines that physical activity can include activities like walking, cycling, sports, and muscle-strengthening exercises. The document also notes that physical activity is effective at reducing the risk of many health conditions like cardiovascular disease, diabetes, cancer, and depression.
This document outlines the aims and objectives of a training course on nutrition, physical activity, and obesity in primary care settings. The course will cover five themes split into three sections: services overview, communication skills training, and developing local facilities. It will help participants understand public health context, explore WHO guidance, highlight evidence, review local resources, identify barriers and enablers, and devise work plans. The communication skills training will focus on positive conversations, identifying at-risk groups, conveying advice, understanding behavior, and setting goals. Participants will also reflect on resources and set priorities and goals to address gaps.
This document provides guidance on assessing obesity and its root causes. It discusses assessing obesity class based on BMI and stage based on health impact. It also discusses assessing obesity drivers like medical issues, psychosocial factors, nutrition, physical activity, and weight bias. The document provides tools and checklists for comprehensively assessing these obesity drivers and root causes in order to develop effective management plans.
This document provides an overview of chronic disease prevention and management of obesity in primary care settings. It discusses key principles of obesity management, including:
1. Obesity is a chronic disease influenced by genetic, environmental and lifestyle factors.
2. The goal of obesity management is improved health and well-being rather than weight loss alone.
3. Early intervention requires addressing the underlying causes of obesity and barriers to weight management.
4. Success varies between individuals and may not mean achieving an "ideal" weight.
5. A patient's "best" weight sustains health improvements and quality of life.
The 5 As framework is presented as a tool for primary care providers to structure conversations about
The document outlines the 5 A's approach to obesity management, which includes asking permission to discuss weight, assessing risks, advising on risks and options, agreeing on goals and expectations, and assisting by addressing barriers and referring to other providers. It provides guidance on setting SMART behavioral goals focused on sustainable lifestyle changes rather than weight targets alone. The document also discusses following up to support patients in achieving their goals as obesity requires long-term management.
1. The document discusses various facts and myths about obesity management. It addresses that obesity is a chronic disease, and the goal is to improve health rather than focusing solely on weight loss. Even modest weight reduction can significantly improve health.
2. Understanding the root causes of individual weight gain is important for effective management of obesity. Identifying personal roadblocks to weight control is key to making positive changes.
3. Success in obesity management is not solely defined by amount of weight loss but also by improved energy, self-esteem, health, and preventing further weight gain. Individual goals guide what success means.
The document contains a quiz with 9 true/false questions about facts related to obesity, physical activity, nutrition, and weight management. Each question is followed by an explanation of the answer. Some key facts covered include: obesity is a chronic disease similar to diabetes; muscle weighs the same as fat despite taking up less space; physical activity provides health benefits regardless of weight loss; and regular weighing can be a sign of an eating disorder rather than a cause. The document encourages discussion of challenges to health promotion in the areas of nutrition, physical activity, and obesity.
This document discusses motivational interviewing (MI), a patient-centered counseling technique that aims to explore problems from the patient's perspective and unlock solutions that lie within the patient. MI assumes behavior change is motivated by the patient, not information from providers. It involves agenda-setting, reflective listening, and shared decision-making. The four guiding principles of MI are resisting the "righting reflex," understanding patient motivations, active listening, and empowering the patient. Extensive evidence supports low-intensity MI interventions for behavior changes related to health areas like smoking, medication adherence, obesity, and more.
This document provides guidance on physical activity recommendations and the health benefits of physical activity. It recommends that adults engage in at least 150 minutes of moderate physical activity per week, or 75 minutes of vigorous physical activity per week. For children and adolescents, it recommends at least 60 minutes per day of moderate to vigorous physical activity. It outlines that physical activity can include activities like walking, cycling, sports, and muscle-strengthening exercises. The document also notes that physical activity is effective at reducing the risk of many health conditions like cardiovascular disease, diabetes, cancer, and depression.
This document outlines the aims and objectives of a training course on nutrition, physical activity, and obesity in primary care settings. The course will cover five themes split into three sections: services overview, communication skills training, and developing local facilities. It will help participants understand public health context, explore WHO guidance, highlight evidence, review local resources, identify barriers and enablers, and devise work plans. The communication skills training will focus on positive conversations, identifying at-risk groups, conveying advice, understanding behavior, and setting goals. Participants will also reflect on resources and set priorities and goals to address gaps.
This document provides guidance on assessing obesity and its root causes. It discusses assessing obesity class based on BMI and stage based on health impact. It also discusses assessing obesity drivers like medical issues, psychosocial factors, nutrition, physical activity, and weight bias. The document provides tools and checklists for comprehensively assessing these obesity drivers and root causes in order to develop effective management plans.
The document discusses weight management in primary care. It explores why weight is important to discuss due to its effects on health, how to influence patients who already have answers, and what to explain such as nutritional facts and support. The goals are to help patients succeed rather than fail, and where to get help shaping obesity services. Breakout groups then discuss promoting activity, education, children, community, and training to develop a plan on timelines and challenges.
The document discusses stages of change for healthy eating habits. It explains that good nutrition and physical activity can help maintain a healthy weight and reduce risks of chronic diseases. The transtheoretical model is introduced as stages someone may go through when trying to change unhealthy eating habits, including precontemplation of needing to change, contemplation of options, preparation by addressing obstacles, action of implementing a plan, maintenance of changes, and potential relapse. References for further information are provided.
Learning and regularly practicing self-management skills can help people adopt and maintain healthy lifestyles. Self-management skills include self-assessment, self-monitoring, and goal-setting. These skills can help influence factors like knowledge, beliefs, attitudes, and access to resources that promote making changes to diet, physical activity, stress management, and other healthy behaviors. While it takes time to develop unhealthy habits, self-management skills allow people to progress through stages of change to eventually maintain healthy lifestyles long-term.
Nutrition and food science counselling feb2017Amina Iftikhar
This document discusses nutrition counseling and its various aspects. It describes counseling as giving professional advice to help resolve personal problems. Nutrition counseling specifically focuses on assessing an individual's diet and identifying areas for change. The counseling process involves gathering information, setting goals, providing education, developing motivation, and identifying actions to facilitate dietary changes and positive behaviors. Nutrition counseling works to advise people on what to eat, how much, and when for a healthy diet.
Integrative Health Coaching: The Missing Link In Our Healthcare Systempbhbs
The document discusses the benefits of integrative health coaching, noting that clinical research has shown it can help reduce cardiovascular risk, diabetes symptoms, asthma hospitalizations, cancer pain, and increase bone mineral density. Integrative health coaching takes a whole-person approach and promotes ongoing engagement between patients and providers to support lifestyle behavior changes. Contracting with PB Healthcare Business Solutions would provide clients with continuity of care and more engaged, informed patients.
This document provides an overview of health coaching for chronic disease self-management. It discusses various patient case studies and challenges with adherence to treatment recommendations. The key points are:
- Health coaching can help patients better manage chronic conditions through supporting them with knowledge, motivation and skills to make healthy behavior changes and problem solve barriers to care.
- Many patients are not fully adherent to treatment plans due to lack of knowledge, motivation, or confidence in their ability to self-manage.
- Effective self-management involves patients engaging in health-promoting activities, monitoring their condition, managing impacts on daily life, and following treatment plans.
- Changing behaviors can be difficult as knowledge does not always translate to action
The document discusses bariatric surgery for obesity treatment and the psychological evaluation and support needed for patients undergoing such surgery. It covers factors like assessing patients for active mental illness, substance abuse issues, or risk of noncompliance that could exclude them from surgery. For suitable candidates, it recommends providing psychological treatment both before and after surgery to address issues like eating triggers, coping skills, and maintaining lifestyle changes needed for successful weight loss and health outcomes.
Review the prevalence of eating disorders
Identify assessment areas
Identify risk and protective factors
Explore complications
Explore potential guidelines for treatment
Based on APA Guidelines for Eating Disorders, the NICE Guidelines for Eating Disorder Recognition and Treatment, and the NEDA Coach and Trainer’s Toolkit
A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/56/c/
Will be released as part of the Counselor Toolbox Podcast
Best Weight Loss Treatments in AhmedabadPooja Patel
The document discusses weight loss treatments available at Shankus Natural Health Centre in Ahmedabad, India. It begins by noting the obesity problem in the United States and importance of maintaining weight loss. It recommends talking to a healthcare professional to determine BMI, set a realistic weight loss goal such as 5% of body weight, and engage in lifestyle changes like modifying eating habits and increasing physical activity. Support from family/friends and developing self-control when tempted can also contribute to successful and maintained weight loss. Choosing an appropriate calorie-controlled diet plan depends on factors like age, gender and starting weight.
Yoga is an ancient practice that unites the body and mind. It has various types including Hatha yoga, Raja yoga, Karma yoga, and Bhakti yoga. Yoga aims to achieve harmony between the individual being and universal being through practices like asanas, pranayama, meditation, and lifestyle modifications. Regular yoga practice can help keep the body and mind healthy by improving flexibility, strength, breath control, and reducing stress and tension. Key asanas described in the document include paschimottanasana, sarvangasana, shavasana, and several others. Practicing asanas along with proper diet, exercise and lifestyle as prescribed in yoga can help maintain overall physical and mental well-
How Americans Can Lose Weight and Get the Bodies of Our DreamsBurst Your Cocoon
Over 1/3 of Americans are obese. This presentation explains how you can lose weight. Low-tech, sensible, and incredibly powerful. Get started with this refreshing solution today!
Dolores Van Bourgondien is an advanced registered nurse practitioner whose goal is to promote health and wellness. Her master's thesis proposed a model utilizing ARNPs, dieticians, trainers, and other specialists to provide integrated preventative healthcare and ensure compliance with screenings. This would decrease future medical issues. The document advocates for a synergistic approach combining diet, exercise, mind-body practices, and other wellness elements. Small, steady changes in each area can have significant impacts on health when combined. An integrated approach is needed since focusing on only one area does not provide optimal results.
NFMNT Chapter 8 Interview Clients for Nutrition-Related InformationKellyGCDET
This document discusses interviewing clients for nutrition-related information. It provides guidance on identifying different client types, planning appropriate questions, gathering information while addressing cultural and religious needs, and obtaining additional data from other healthcare providers. The goal is to conduct thorough interviews and carefully document the diet history and client preferences to optimize nutrition care.
A wellness coach helps clients achieve physical and emotional goals by finding solutions to dilemmas that prevent a healthy, stress-free life. They differ from psychotherapists who focus on chronic issues and thought processes, and counselors who examine the past and seek diagnoses. Coaches work as partners with clients to improve performance and quality of life. Wellness coaching in hospitals and centers benefits patients, staff and facilities by increasing revenue through a more pleasant experience.
The document discusses the four pillars of holistic health coaching: mindful presence, authentic communication, self-awareness, and safe/sacred space. It provides details on each pillar, including reflective questions. It also discusses how holistic health coaching helps with change and transformation. The coaching model takes a holistic view of health and sees the individual as the source of their own solutions. The University of Minnesota offers a certificate program in health coaching for healthcare professionals.
This document provides information about diabetes, including defining what diabetes is, discussing the different types of diabetes, and outlining strategies for preventing and managing diabetes. It explains that diabetes occurs when the body is unable to properly use blood sugar and discusses the ABCs of diabetes management - A1c, blood pressure, and cholesterol. The document contains a diabetes IQ test, discusses symptoms, risk factors, diagnosis, and complications of diabetes. It provides tips for healthy eating, weight management, exercise, and monitoring A1c, blood pressure, and cholesterol levels.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
This research report follows individuals at different stages in their healthy living journey - starting out, on the way, and maintenece. We uncover how motivations and habits shift from stage to stage and what helps them along the way. Insight around what makes a healthy brand is also included as well as pointed reccomendations for those brands in that space on how to best engage,market, how to sell, and where to sell.
Key takeaways:
Discover the five musts for a brand in order to be considered healthy
Unearth what consumers in the three stages want and need from brands
Find out what sources consumers' trust and how they want to be approached
The document discusses supportive nutrition care for cancer patients. It emphasizes adopting a peaceful relationship with food by reducing stress and focusing on overall nourishment rather than specific foods. InspireHealth's nutrition team provides personalized and group resources to help cancer patients manage nutritional challenges from treatment side effects and develop a balanced mindset around eating.
Obesity- Tipping Back the Scales of the Nation 19th April, 2017mckenln
This document summarizes the development of a new "Eat, Think, Change" group for patients struggling with disordered eating and binge eating disorder (BED) within an existing weight management program. The group aims to address the mechanisms maintaining disordered eating behaviors before focusing on weight loss. Initial outcomes show reductions in binge eating frequency and increased awareness of eating behaviors among participants. The program aims to provide more effective support for this population and prevent cycles of unsuccessful weight loss attempts.
The document discusses issues that arise when discussing weight with healthcare providers. It notes that when visiting the doctor for unrelated issues, weight is often tied to the problem. When visiting specifically about weight, discussions are often unhelpful or focus more on weight loss methods that have already been tried. The document advocates being prepared for appointments by having information about weight history and weight loss attempts. It encourages finding a provider willing to have constructive conversations and work as part of the healthcare team.
The document discusses weight management in primary care. It explores why weight is important to discuss due to its effects on health, how to influence patients who already have answers, and what to explain such as nutritional facts and support. The goals are to help patients succeed rather than fail, and where to get help shaping obesity services. Breakout groups then discuss promoting activity, education, children, community, and training to develop a plan on timelines and challenges.
The document discusses stages of change for healthy eating habits. It explains that good nutrition and physical activity can help maintain a healthy weight and reduce risks of chronic diseases. The transtheoretical model is introduced as stages someone may go through when trying to change unhealthy eating habits, including precontemplation of needing to change, contemplation of options, preparation by addressing obstacles, action of implementing a plan, maintenance of changes, and potential relapse. References for further information are provided.
Learning and regularly practicing self-management skills can help people adopt and maintain healthy lifestyles. Self-management skills include self-assessment, self-monitoring, and goal-setting. These skills can help influence factors like knowledge, beliefs, attitudes, and access to resources that promote making changes to diet, physical activity, stress management, and other healthy behaviors. While it takes time to develop unhealthy habits, self-management skills allow people to progress through stages of change to eventually maintain healthy lifestyles long-term.
Nutrition and food science counselling feb2017Amina Iftikhar
This document discusses nutrition counseling and its various aspects. It describes counseling as giving professional advice to help resolve personal problems. Nutrition counseling specifically focuses on assessing an individual's diet and identifying areas for change. The counseling process involves gathering information, setting goals, providing education, developing motivation, and identifying actions to facilitate dietary changes and positive behaviors. Nutrition counseling works to advise people on what to eat, how much, and when for a healthy diet.
Integrative Health Coaching: The Missing Link In Our Healthcare Systempbhbs
The document discusses the benefits of integrative health coaching, noting that clinical research has shown it can help reduce cardiovascular risk, diabetes symptoms, asthma hospitalizations, cancer pain, and increase bone mineral density. Integrative health coaching takes a whole-person approach and promotes ongoing engagement between patients and providers to support lifestyle behavior changes. Contracting with PB Healthcare Business Solutions would provide clients with continuity of care and more engaged, informed patients.
This document provides an overview of health coaching for chronic disease self-management. It discusses various patient case studies and challenges with adherence to treatment recommendations. The key points are:
- Health coaching can help patients better manage chronic conditions through supporting them with knowledge, motivation and skills to make healthy behavior changes and problem solve barriers to care.
- Many patients are not fully adherent to treatment plans due to lack of knowledge, motivation, or confidence in their ability to self-manage.
- Effective self-management involves patients engaging in health-promoting activities, monitoring their condition, managing impacts on daily life, and following treatment plans.
- Changing behaviors can be difficult as knowledge does not always translate to action
The document discusses bariatric surgery for obesity treatment and the psychological evaluation and support needed for patients undergoing such surgery. It covers factors like assessing patients for active mental illness, substance abuse issues, or risk of noncompliance that could exclude them from surgery. For suitable candidates, it recommends providing psychological treatment both before and after surgery to address issues like eating triggers, coping skills, and maintaining lifestyle changes needed for successful weight loss and health outcomes.
Review the prevalence of eating disorders
Identify assessment areas
Identify risk and protective factors
Explore complications
Explore potential guidelines for treatment
Based on APA Guidelines for Eating Disorders, the NICE Guidelines for Eating Disorder Recognition and Treatment, and the NEDA Coach and Trainer’s Toolkit
A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/56/c/
Will be released as part of the Counselor Toolbox Podcast
Best Weight Loss Treatments in AhmedabadPooja Patel
The document discusses weight loss treatments available at Shankus Natural Health Centre in Ahmedabad, India. It begins by noting the obesity problem in the United States and importance of maintaining weight loss. It recommends talking to a healthcare professional to determine BMI, set a realistic weight loss goal such as 5% of body weight, and engage in lifestyle changes like modifying eating habits and increasing physical activity. Support from family/friends and developing self-control when tempted can also contribute to successful and maintained weight loss. Choosing an appropriate calorie-controlled diet plan depends on factors like age, gender and starting weight.
Yoga is an ancient practice that unites the body and mind. It has various types including Hatha yoga, Raja yoga, Karma yoga, and Bhakti yoga. Yoga aims to achieve harmony between the individual being and universal being through practices like asanas, pranayama, meditation, and lifestyle modifications. Regular yoga practice can help keep the body and mind healthy by improving flexibility, strength, breath control, and reducing stress and tension. Key asanas described in the document include paschimottanasana, sarvangasana, shavasana, and several others. Practicing asanas along with proper diet, exercise and lifestyle as prescribed in yoga can help maintain overall physical and mental well-
How Americans Can Lose Weight and Get the Bodies of Our DreamsBurst Your Cocoon
Over 1/3 of Americans are obese. This presentation explains how you can lose weight. Low-tech, sensible, and incredibly powerful. Get started with this refreshing solution today!
Dolores Van Bourgondien is an advanced registered nurse practitioner whose goal is to promote health and wellness. Her master's thesis proposed a model utilizing ARNPs, dieticians, trainers, and other specialists to provide integrated preventative healthcare and ensure compliance with screenings. This would decrease future medical issues. The document advocates for a synergistic approach combining diet, exercise, mind-body practices, and other wellness elements. Small, steady changes in each area can have significant impacts on health when combined. An integrated approach is needed since focusing on only one area does not provide optimal results.
NFMNT Chapter 8 Interview Clients for Nutrition-Related InformationKellyGCDET
This document discusses interviewing clients for nutrition-related information. It provides guidance on identifying different client types, planning appropriate questions, gathering information while addressing cultural and religious needs, and obtaining additional data from other healthcare providers. The goal is to conduct thorough interviews and carefully document the diet history and client preferences to optimize nutrition care.
A wellness coach helps clients achieve physical and emotional goals by finding solutions to dilemmas that prevent a healthy, stress-free life. They differ from psychotherapists who focus on chronic issues and thought processes, and counselors who examine the past and seek diagnoses. Coaches work as partners with clients to improve performance and quality of life. Wellness coaching in hospitals and centers benefits patients, staff and facilities by increasing revenue through a more pleasant experience.
The document discusses the four pillars of holistic health coaching: mindful presence, authentic communication, self-awareness, and safe/sacred space. It provides details on each pillar, including reflective questions. It also discusses how holistic health coaching helps with change and transformation. The coaching model takes a holistic view of health and sees the individual as the source of their own solutions. The University of Minnesota offers a certificate program in health coaching for healthcare professionals.
This document provides information about diabetes, including defining what diabetes is, discussing the different types of diabetes, and outlining strategies for preventing and managing diabetes. It explains that diabetes occurs when the body is unable to properly use blood sugar and discusses the ABCs of diabetes management - A1c, blood pressure, and cholesterol. The document contains a diabetes IQ test, discusses symptoms, risk factors, diagnosis, and complications of diabetes. It provides tips for healthy eating, weight management, exercise, and monitoring A1c, blood pressure, and cholesterol levels.
Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity
This research report follows individuals at different stages in their healthy living journey - starting out, on the way, and maintenece. We uncover how motivations and habits shift from stage to stage and what helps them along the way. Insight around what makes a healthy brand is also included as well as pointed reccomendations for those brands in that space on how to best engage,market, how to sell, and where to sell.
Key takeaways:
Discover the five musts for a brand in order to be considered healthy
Unearth what consumers in the three stages want and need from brands
Find out what sources consumers' trust and how they want to be approached
The document discusses supportive nutrition care for cancer patients. It emphasizes adopting a peaceful relationship with food by reducing stress and focusing on overall nourishment rather than specific foods. InspireHealth's nutrition team provides personalized and group resources to help cancer patients manage nutritional challenges from treatment side effects and develop a balanced mindset around eating.
Obesity- Tipping Back the Scales of the Nation 19th April, 2017mckenln
This document summarizes the development of a new "Eat, Think, Change" group for patients struggling with disordered eating and binge eating disorder (BED) within an existing weight management program. The group aims to address the mechanisms maintaining disordered eating behaviors before focusing on weight loss. Initial outcomes show reductions in binge eating frequency and increased awareness of eating behaviors among participants. The program aims to provide more effective support for this population and prevent cycles of unsuccessful weight loss attempts.
The document discusses issues that arise when discussing weight with healthcare providers. It notes that when visiting the doctor for unrelated issues, weight is often tied to the problem. When visiting specifically about weight, discussions are often unhelpful or focus more on weight loss methods that have already been tried. The document advocates being prepared for appointments by having information about weight history and weight loss attempts. It encourages finding a provider willing to have constructive conversations and work as part of the healthcare team.
The document discusses body image, nutrition, and proper diet. It defines body image and explains how it can impact mental health. Negative body image is becoming more common due to social media and unrealistic portrayals in media. The document then discusses the importance of nutrition and a balanced diet for health. A proper diet includes lean proteins, complex carbs, good fats and limiting saturated fats, simple carbs and sugar. Maintaining consistent, balanced eating habits is key to providing one's body with proper nutrition.
This document provides information and strategies to help readers change unhealthy habits and adopt healthier eating and physical activity routines. It discusses how habit change is a process that occurs in stages: contemplation, preparation, action, and maintenance. For each stage, the document offers advice on how to identify where the reader is at, challenges they may face, and tips to help them progress to the next stage of change. The overall message is that developing new healthy habits takes time and persistence, but can significantly benefit one's health and well-being.
This document is a guide to optimal nutrition published by Baptist Health. It discusses making balanced nutrition choices and incorporating physical activity. The guide provides research-based advice in simple terms to help readers make better food choices and reach their health goals. It covers topics like understanding popular diets, fueling the body with the best food sources, making mindful eating choices, and how food choices affect metabolism. The overall goal is for readers to develop a healthy lifestyle and positive relationship with food.
Chapter 15 Teachback (Pregnancy and Preparing for Birth)ginaabcg
This document provides information about pregnancy and preparing for birth. It discusses the physical and emotional changes that occur during pregnancy. Physically, organs adapt to support the growing fetus and hormonal changes occur. Emotionally, a woman's identity and self-confidence transform as she prepares to become a mother. The document also outlines various aspects of prenatal care, such as regular checkups, tests, and considerations for high-risk pregnancies. Additionally, it covers choices for birth settings, pain management options, and preparing to breastfeed. The overall message is that learning about the pregnancy and birth process helps women feel more confident in their abilities.
This document provides a list of 10 things for patients to prepare before visiting their doctor for a diet or weight-related consultation. It advises patients to think about their medical history, allergies, food habits, lifestyle, goals for the consultation, and expectations from their doctor. Preparing this information will help the doctor better understand the patient's health issues and develop an effective treatment plan. The consultation will involve analyzing the patient's information and potentially requiring additional medical tests before starting a new diet or lifestyle program. It reminds patients that lasting health changes take time and commitment.
This document provides information about pregnancy and preparing for birth. It discusses the physical and emotional changes that occur during pregnancy. Physically, organs adapt to support the growing fetus and hormonal changes affect skin, hair, and pelvis size. Emotionally, a woman's identity and self-confidence transform as she prepares to become a mother. The document also outlines considerations for choosing a birth place, classes to take, prenatal care and tests, special circumstances, preparing for labor and breastfeeding.
Foublie is a telehealth platform that connects families to Registered Dietitian coaches and personalized resources that are backed by science.This deck introduces the Foublie Way.
Here are the key points to include in your illustration:
1. Show screening tests being conducted in a school setting by a nurse or doctor. Include students lining up or getting their tests done.
2. Illustrate the specific screening tests - like vision test using an eye chart, weight and height being measured, blood pressure check.
3. Include speech bubbles or captions explaining the importance of catching issues early and maintaining good health through regular screening.
4. Add images of happy, healthy students to represent the benefits of screening in promoting wellness.
5. Sign and date your work. Make sure to label the different screening tests shown.
Focus on clearly showing the screening process and communicating the value of these
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Obesity is associated with depression through several mechanisms including inflammation, dysregulation of the hypothalamic-pituitary-adrenal axis, increased body dissatisfaction, low self-esteem, pain, insufficient physical activity, and unhealthy eating patterns. Behavioral obesity treatments include cognitive behavioral therapy strategies like self-monitoring, stimulus control, problem solving, contingency management, cognitive restructuring, and social support. Pharmacological treatments for obesity include Orlistat, Sibutramine, Phentermine, and other less FDA-approved drugs, but all have potential side effects and should only be used as an adjunct to lifestyle changes focused on diet and exercise.
This document provides an overview of medication adherence and strategies to improve it. It begins with an example patient case of Mr. Avery, a man with poorly controlled diabetes. It then discusses defining adherence, common reasons for non-adherence, assessment strategies, and evidence-based approaches to address non-adherence, including education, motivational interviewing, addressing barriers, self-management training, and making medication-taking a habit. Templates for the EHR and after-visit summaries are also presented.
Mr. Avery, a 62-year-old man with diabetes, has poor medication adherence as evidenced by his hemoglobin A1c of 9.0. The provider hopes to address modifiable factors impacting his behavior and establish strategies to improve his medication adherence. Effective approaches include education, motivational interviewing to explore importance and build confidence, addressing specific barriers, training in self-management, and establishing medication-taking as a daily habit. Documentation templates and other resources can help providers structure discussions and monitor adherence over time.
The document discusses how weight loss is difficult and weight maintenance is even harder. It describes the author's 35-year struggle with weight loss, trying various diets and exercise plans that failed. Their doctor eventually recommended bariatric surgery after other attempts to control their blood pressure failed. The author argues that bariatric surgery should not be seen as the "easy way out" given the lifelong lifestyle changes and challenges of maintaining weight loss.
This document discusses various aspects of diet counseling including models of behavior change, communication skills for counselors, the nutrition care plan process, and tips for effective counseling. It emphasizes the importance of active listening, asking open-ended questions, reflecting clients' statements, summarizing discussions, and using a caring and non-judgmental approach to help clients make sustainable dietary changes. The overall goal of diet counseling is to build rapport, understand clients' perspectives, and facilitate behavior changes through empathy, education and action planning.
This document promotes a premium membership program called "Power UP Premium" that provides health, fitness, and nutrition advice. It offers live videos, workouts for muscle groups, help with diet, supplements, and goals. The monthly membership is $39 or free with $39 of purchases from 1st Phorm. The promoter, Katherine Hood, says she can help prevent mistakes and give a more efficient approach to health based on her own struggles and challenges overcome.
world diabetes day awareness lecture notessuser2b23a31
1. Diabetes is a growing global health problem, with over 400 million cases worldwide and 74 million cases in India alone. Many cases remain undiagnosed.
2. The document discusses ways to manage diabetes at both the individual and societal level. At an individual level, lifestyle changes like diet, exercise, weight loss, not smoking, and stress management can help control blood sugar. Family support is also important.
3. At a societal level, advocacy, education, community programs, and ensuring access to healthcare can help prevent diabetes and manage the disease. Changing attitudes and language around diabetes is also discussed.
This document discusses the pediatric obesity initiative at Cleveland Clinic Children's Hospital. It begins by establishing obesity as the most prevalent chronic disease in childhood. It then discusses the scope and definition of obesity, prevalence trends, and consequences of obesity like hypertension, diabetes and social stigma.
The document outlines Cleveland Clinic's key objectives to address obesity through prevention education, clinical treatment programs, and community outreach. It provides examples of school-based interventions and curriculums to teach nutrition literacy. Data from studies on a BMI screening program and a pediatric weight loss program are presented. Finally, it discusses using comprehensive policy and environmental strategies modeled after anti-tobacco efforts to most effectively address the obesity epidemic.
Similar to Session 3: Ask – getting a good conversation started (20)
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Session 3: Ask – getting a good conversation started
1. Ask –
getting a good conversation started
Session 3
Acknowledgements
Obesity Canada
2. 5 As of Obesity Management framework
• Ask for permission to discuss weight.
• Assess obesity-related risk and potential “root causes” of
weight gain.
• Advise on obesity risks, discuss benefits and options.
• Agree on realistic weight management expectations and
on a SMART plan to achieve behavioural goals.
• Assist in addressing drivers and barriers, offer education
and resources, refer to provider, and arrange follow-up.
3. What we know from international experience:
patient perspective
• Physicians routinely asked and advised patients to lose weight; they
rarely assessed, assisted or arranged.
• Information from physicians is seldom helpful.
• Physicians lack sensitivity in addressing obesity.
• Patients want more support in self-management.
• Patients want specific tailored weight management strategies.
• Patients want reliable resources.
4. Recall: primary care setting
• Primary care is an ideal setting for weight management.
o Long-term patient care establishes the relationships needed for
sensitive and complex issues to be addressed.
o The embedded nature of weight issues can be harnessed as an
advantage, providing multiple starting points for treatment.
o Primary care has the space to work on prevention as a goal.
• Provider knowledge is only one aspect of weight management.
Interventions should address team issues and the work environment,
and build upon existing experiences and skills.
5. Ask
• Weight is a sensitive issue.
• Many patients are embarrassed or fear blame and
stigma.
• So it is important:
– to be non-judgmental
– to explore readiness for change
– to use motivational interviewing
– to create weight-friendly practice.
6. Ask (adults/paediatrics)
• Do NOT blame, threaten or provoke guilt in your
patient.
• Do NOT make assumptions about their lifestyles or
motivation (your patient may already be on a diet or
have already lost weight).
• Do acknowledge that weight management is difficult
and hard to sustain.
7. Ask (pregnancy)
• Do acknowledge that weight gain in pregnancy is
expected.
• Do provide education about the recommended
amount of weight gain to optimize health.
• Do not make assumptions about a woman’s life,
lifestyle or motivation. She may be living as healthy as
she can, or she may be ready to take action, or in the
action stage of making a change.
8. Why are obesity discussions difficult?
• Obesity commonly triggers the judgemental view that the
individual is responsible for their own misfortune and can thus
be blamed for their condition; this results in dismissive and
sometimes bullying attitudes.
• Many health workers struggle with the balance between
personal responsibility ("why don’t they just eat less?") and
difficulties of medicalization ("the treatments I can offer are
either rationed or ineffective").
9. Poppy’s comments – a patient with obesity and co-
morbidities
• “Just because I’m fat doesn’t mean I’m stupid.”
• “I’ve got a good brain and even greater is the size of my
feelings.”
• “I’ve felt degraded, dismissed, stupid and treated like a freak by
some of the so-called ‘caring profession’.”
• “These phrases raise my hackles: ‘Do you know you’re
overweight?’ ‘You need to consider losing weight.’”
• “If I come to see you with earache, please treat my earache
and don’t go on about my weight – ask me if I want further
help.”
10. A doctor’s comments may convey something quite
different to the patient ...
I think you ought to lose some weight. The doctor thinks I’m fat, despite my diet attempts.
Your weight is making your joints worse. My pain is my fault.
Do you realize your weight is causing your
illness?
To rescue my dignity I shall have to become either
defensive or aggressive – or simply not come back
to this doctor.
You can’t have your operation until you
lose weight.
My actual needs don’t count. They are rationing
care for obese people.
You just need to eat less. This doctor has no idea what it is like fighting
obesity.
11. Pitfalls to watch out for
• Being judgemental – people appreciate discussing their concerns,
they dislike being judged by their appearance.
• Jumping to conclusions.
• Passing on blame.
• Being unkind.
• Being sensationalist.
• Being dismissive.
• Frightening patients – fear is a poor motivator but good at generating
denial.
• Misinterpreting denial.
12. Safe openers: let the patient set the agenda
Question GP’s hidden agenda Patient perception
How do you feel about your
weight?
Is this a touchy subject? Open invitation to talk about
topic that may be of
concern.
Do you keep an eye on your
weight? / When did you last
weigh yourself?
Where should I start? Is the
patient actively engaged or
in denial?
I can explain whether this is
important to me or not.
What has happened to your
weight over the last few
years?
Where is the patient on their
weight continuum?
I can explain some
background to my
successes/difficulties.
13. Or – simply ask permission …
Would it be OK if I
ask you about your
weight?
14. Would it be helpful if we
talked about your activity
levels? Would today be OK,
or would you prefer to have
a think about it and come
back another time?
Would you like to
hear some healthy
eating suggestions
that other patients
have found useful?
We know that weight
can affect health/
arthritis/breathing. Is
this something you
would like to discuss?
Lifestyle can have quite an
impact on people diagnosed
with cancer. Is this something
you would like to find out more
about?
15. Ask
• Use motivational interviewing to move patients along the stages
of change.
• Ask questions, listen to patients’ comments, and respond in a
way that validates their experience and acknowledges that they
are in control of their decision to change.
• If patients are not ready to address their weight, be prepared to
address their concerns and other health issues, and then ask if
you can speak with them about their weight again in the future.
16. Ask
Explore readiness for change.
• Determining your patient’s readiness for behaviour change is
essential for success. Recognize that different patients will be
at different stages of readiness.
• Use a patient-centred collaborative approach (genuine
collaboration that acknowledges that the patient is central).
• Initiating change when patients are not ready can result in
frustration and may interfere with future attempts to support
healthy change.
18. Sample questions (adults)
• Would it be all right if we discussed your weight?
• Are you concerned about your weight?
• On a scale of 0 to 10, how important is it for you to
lose weight at this time?
• On a scale of 0 to 10, how confident are you that you
can lose weight at this time?
19. Sample questions (paediatrics)
• Are you concerned about your (child’s) health?
• Are you concerned about your (child’s) weight?
• Would it be all right if we discussed your (child’s)
weight?
Depending on a child’s age and developmental stage, it
may be more appropriate to speak with parents alone.
20. Sample questions (pregnancy)
• Could we discuss your thoughts and feelings
regarding weight gain during your pregnancy?
• Are you concerned about weight gain during your
pregnancy?
• Would you be interested in information about
weight gain during your pregnancy?
21. Ask
Create a weight-friendly practice.
• Facilities: handicapped accessibility, wide doors, large restrooms,
floor-mounted toilets.
• Scales: over 160 kg (350 lb) capacity, wheel-on accessible,
located in a private area and used with sensitive weighing
procedures.
• Waiting room: sturdy, armless chairs, appropriate reading material
– no glossy fashion magazines.
• Exam room: oversized gowns, scales, wide and sturdy exam
tables, extra-large blood pressure cuffs, longer needles and
tourniquets, long-handled shoe horns.
22. Exercise A1
Doctor, patient and optional observer (in groups of 2 or 3)
• How might you introduce the patient’s weight into the
conversation?
• What sentences work well?
• What element of a phrase causes upset or risks a defensive
response?
• Role play (patients)
How does it feel to be challenged about a topic that is sensitive or
difficult?
23. Recap
• Recognize the importance of discussing weight and
physical activity.
• Get off to a good start and avoid upsetting the patient.
• Recognize the need to begin with the patient’s
perspective and understand a bit of the “back story”.
• Do not get too hung up on specific dieting regimes or
detailed description of a person’s diet.
24. Explore confidence in how to move forward
Understanding
factual
nutritional/physical
activity information
Understanding eating
behaviour – to achieve
good nutrition in
practice
Motivational
approaches
“What to do” “How to do” Swapping “I Can’t”
for “I Will”
“I get confused with
food labels and
knowing what is good
for me.”
“I know what to do but
my family doesn’t like it
…”
“I’d love to lose
weight but nothing I
try ever works”
What does the patient want help with?
25. How confident are you
about choosing or
preparing healthy
foods?
You mentioned
difficulties with your
family accepting
healthy options.
Would you like
more help with this?
Are there
particular
aspects of doing
physical activity
that you struggle
with?
You said you feel
disheartened because
previous weight loss was
not maintained. Would
this be a good area to
explore more?
26. Consider the resources you/your patient can access
• How much time/capacity do you have? “Quick fix” suggestions have no
place in weight management.
• Ongoing engagement is more important than short-lived bursts of
effort.
• Ensure any approaches you recommend are accessible, affordable
and culturally acceptable to the patient, as well as evidence-based.
• Encourage a family-based life-course approach.
27. Learning points
• The “back story” will typically highlight both emotional and
organizational issues.
• Most people will have already tried something and have some
nutritional knowledge.
• Struggling to lose pregnancy weight is a common factor for many
overweight/obese women.
• Medical causes of obesity are comparatively rare – hypothyroidism,
Cushing’s syndrome, medication, genetic conditions.
• Although stopping smoking can trigger weight gain, the health benefits
of stopping outweigh the harm.
28. After you have asked for permission to talk about
weight and assessed readiness to change, you may
need to have some critical conversations with
patients.
29. Having critical conversations
• Health professional–patient relationship
• Talking about weight
• Potential barriers for patients
30. Therapeutic relationships: what works
• empathy
• alliance
• goal consensus and collaboration
• unconditional positive regard
• genuineness
• feedback
• recognition and repair of alliance ruptures
31. Therapeutic relationships: what does not work
• confrontation
• negative processes
• assumptions
• rigidity
• the ostrich
• one approach fits all
32. What we can do
Be clear about expectations and minimize the risk of
misunderstandings. This will:
• demonstrate respect for patients
• acknowledge patients’ autonomy
• increase engagement in treatment.
33. Critical conversations: talking about weight
Have you heard this?
• What is a healthy weight?
• How much should I weigh?
• My goal? Well, I was 65 kg in Year 10, so that would be nice.
• 10% weight loss? That’s it? Maybe to start with, but I want to lose more.
• I am doing everything you said, but it isn’t working – I only lost a kilo this
week!
• I need to lose 45 kg to get my hip fixed.
• But that girl on TV lost 73 kg in four months, why can’t I?
34. Expectations
• Weight loss expectations are high.
• Evidence-based outcomes are lower than
expectations.
• Patients want permanent weight loss when regain is
normal.
• Effort and outcome are mismatched.
37. Where do weight loss expectations come from?
Classification BMI (kg/m2)
Healthy weight 18.5–24.9
Overweight 25–29.9
Obesity I 30–34.9
Obesity II 35–39.9
Obesity III 40 or more
38.
39. EdmontonObesity StagingSystem(EOSS)
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
co-morbidity
moderate
moderate
Obesity
Sharma AM, Kushner RF. A proposed
clinical staging system for obesity. Int J
Obes (Lond). 2009;33(3):289–95.
41. Setting a weight goal
• First step is not weight loss
o Stop the gain and maintain
o Assess: is weight loss indicated? Wanted?
• Yes?
o Target up to 10% of current weight in 6 months, maintain loss at 1 year
• Rate?
o Up to 1 kg (2.2 lb) on average per week
• Outcomes
o Improve health, prevent or delay the onset of obesity-related conditions
42. How do you talk to your patients about weight loss
expectations?
1. Listen to patients’ expectations.
2. Acknowledge that weight management is difficult and
requires long-term strategies.
3. Present evidence on weight outcomes.
4. Discuss phases of weight management.
5. Focus on health outcomes.
43. Evidence on weight outcomes
Intervention Short-term –
6 months
Long-term
Commercial
programmes
4.6% 3% at year 2
Calorie restriction (-
400 calories per day)
5% 3% at 3 years
Diet and exercise 8.5% 4% at 4 years, back to
baseline by 5.5 years
Low calorie diet 9.7% 5% at 1–2 years
Medications + lifestyle 8% 7–11% up to 3 years
Behaviour therapy 10% 8% at 18 months
VLCD (< 800 Kcal) 16% Rapid weight regain
44. Weight expectations and goals
% weight
loss (n+658
adults)
All Women Men BMI
25–25.9
BMI >30
Expectation
(realistically)
8.0 ± 6.4 9.1 ± 6.6 6.7 ± 5.8 6.8 ± 4.5 9.2 ± 7.8
Goal (ideally) 16.8 ± 9.5 19.7 ± 8.5 13.7 ± 8.5 12.1 ± 9.7 21.2 ± 10.5
This attempt 8.9 ± 7.2 62% achieved “less than expected”
• Predictors for higher expectations/goals: higher BMI, younger age, female.
• Higher attrition rates for patients who expect the highest reductions.
• Challenging to alter patient perceptions of “realistic” weight loss.
45. Weight loss expectations from bariatric surgery
• Different procedures have different outcomes.
• Realistically, 20–30% weight loss.
o 20–30% of patients do not achieve “successful” weight
outcomes.
o Average regain of 21% of total weight lost.
o 10–20% of patients regain a significant portion (2–3 years
post surgery).
46. Weight loss expectations from lifestyle interventions
• 20% are successful in keeping 5% weight off with
long-term support (McGuire 1999).
• Most regain 30% of weight lost within 1 year and
95% within 5 years (Barte 2010).
• 6% weight loss (2 BMI points) at 12 months; weight
returned to baseline in 5.5 year (Dansinger 2007).
47. Discuss the phases of weight management with your
patient
• Patients want to focus discussion on weight loss outcomes.
• Weight loss is only one phase of weight management.
• Develop a strategy and plan for all phases:
o prevention of further weight gain
o weight loss
o weight stability/plateau
o weight regain.
48. It’s not just about the weight
Discuss with the patient what the true goals are
(health, quality of life, etc.).
• What is important for the patient?
• What is the goal?
• How will you define/assess success?
• What is the plan?
49. Summary: critical conversations
• Use evidence about weight outcomes to structure the
conversation.
• New evidence is becoming available constantly.
• Recognize individual variation and responses to treatment.
• Discuss the phases of weight management and develop
strategies for each phase.
• Keep focus on health, not numbers on the scale or BMI
ranges.
50. Summary: critical conversations
• Building therapeutic relationships.
• Critical conversations: what to do?
o patient-centred goals
o support self-management
o expectation management
o focus on quality of life
o address barriers
o set up supports
51. Reflection
Please take a moment to consider your own practices in
the past.
• What worked well in conversations you have had in
the past? What did not work well?
• When you had a situation where the conversation did
not work out, were you able to retrieve the therapeutic
relationship? If so, how?
52. Future practices
Please consider your future practices.
o How will you balance active listening and empathy
with the time constraints of a busy practice?
o Do you have personal examples of utilizing the
various styles of motivational interviewing (following,
guiding, directing)? If so, please discuss.
Editor's Notes
Speaker notes
In this session we will provide an overview of obesity as a chronic disease and outline causes and consequences.
Speaker notes
To implement the five key principles, we have created a five-step programme called the 5 As of Obesity Management.
This framework has been modified from existing behaviour change programmes in areas such as smoking cessation. There is extensive evidence behind the 5 As programme from other disease areas such as smoking cessation and pain management.
In the field of obesity, Obesity Canada (formerly the Canadian Obesity Network) has been working with researchers to evaluate the effectiveness of this framework for primary care practice.
SMART = Specific; Measurable; Achievable; Relevant; Timely.
Speaker notes
It is not only the sensitivities of patients that we need to consider. What about our own beliefs about the value of discussing obesity?
Do we feel these discussions are a good use of our time? Or a complete waste of our time?
Is the topic of weight something we have been told we must talk about – or do we believe we can help our patients in some way? Is this a useful and relevant topic to mention?
For certain, we don’t want to push reluctant staff to talk about a problem they think should be squarely blamed on the patient!
We are all encouraged to reflect on our own attitudes to obesity before discussing the topic with our patients.
Speaker notes
Poppy, aged 51, is a patient who initially requested a home visit because of knee pain due to arthritis. She later explained some of the background to her morbid obesity, which stemmed from childhood and was intertwined with a complex set of problems – child abuse, financial hardship, agoraphobia, domestic violence and complex family dynamics. Her self-esteem was extremely low, resulting in a tendency to defensive aggression when she sensed a challenge to her lifestyle.
Poppy’s daughter took a similarly aggressive stance in defence of her mother – indeed, the visiting doctor who tried to discuss her mother’s obesity was almost hurled out of the house! But they both responded to an initial listening approach and an offer to explore their difficulties.
The end result for Poppy was not any significant change in her BMI but a very different and more positive approach to accessing health care and taking more responsibility for her health. She had counselling, which helped address her underlying low self-esteem to some extent. Her complex problems, however, continue, although her diabetes is now more actively managed and her depression is more stable. She has declined the offer of bariatric surgery.
Speaker notes
Ask how often we, as health professionals, question how our comments and well-meaning advice actually come across. How much do we use a patient’s body language to modify the approach we take?
The first column gives a set of comments that are ones to avoid. They demonstrate approaches that are judgemental, blaming, superficial and dismissive. It is no surprise that they might result in upset.
The last comment, in particular, is one to avoid. There is nothing simple about obesity – other than gaining weight in the first place. If the solutions were easy, nobody would have a weight problem.
Speaker notes
You may convey any of these impressions without realizing it. What body language changes might indicate that a comment is not being received in the way it was intended?
Fear is a poor motivator – it is more likely to induce resistance than change.
Make sure you do not misinterpret denial – don’t imagine a patient does not realize they have a weight problem. Denial – dismissing or denying an evident weight problem – commonly stems from a patient being pushed into facing a problem they do not feel equipped to deal with. It is easier to ignore the problem altogether than be seen to fail to solve it. They may have tried and failed – perhaps they have tried hard and failed miserably. Denial means “I don’t want to think about this insoluble problem”, not necessarily “I don’t realize I have this problem.”
We “deny” all sorts of things – such as those piles of papers we should have sorted through months ago or that pile of clutter behind the sofa. Denial might mean “not now” rather than “not ever”. But we should be careful about forcing the issue – making someone face a problem that feels insoluble might result in hostility or despair.
Consider the sage advice to “choose your battles”. Denial might simply be a sign that the patient is focusing on a different battle right now.
Speaker notes
These questions are designed to “set the scene” and indicate where next to take the conversation.
How do you feel about your weight? – This allows you to open the conversation without jumping to any conclusions. It is not uncommon for patients now to reply: “I feel great – I joined a slimming group four months ago and have already lost 5 kg!” Clearly, a very different discussion follows if you get this sort of response, rather than another common reply: “I feel terrible. Every diet I try just fails.” Unless we ask, we will not know if a patient’s weight is currently in a phase of increase, decrease or stability – i.e. where they are on their “weight continuum” (this is discussed more in a later slide).
Do you keep an eye on your weight? – This very quickly gives an indicator of engagement. Following up a positive reply with “When did you last weigh yourself?” quickly indicates either active engagement (yesterday, at gym, last week, etc.) or potential denial (“well, not for some months – actually I don’t have any scales”).
Remind patients that regular weighing (most days) is one the strongest predictors of weight stability, especially after a phase of active weight reduction.
What has happened to your weight over the last few years? – This can be a logical way of helping a patient link their physical symptoms with weight increase (e.g. irregular periods, development of knee pain, etc.). This might help the patient recognize for themselves that controlling their weight may help them manage other aspects of their health.
Case example: “So your periods became less frequent and then stopped altogether – which matched a time when your weight had gone up because of a change in your work pattern. We know that increasing weight can make periods disappear for some women. Do you think that weight loss might help your periods to regulate? Has this happened to you in the past?”
Speaker notes
This question was trialled in the Medical School at King’s College Hospital, London, and was found to be a universally acceptable way of opening a discussion about weight. The patient can always decline if now is simply not the right time. At the same time, starting with a polite request acknowledges that this may be a sensitive issue.
Speaker notes
These are all variations on the same theme – putting the topic on the table so that the patient has the option to engage, or come back at a later point.
Phrasing the factual information in the third person, rather than the first person, can help avoid implying judgement or blame: “People can find that …” rather than “You might find that …”
Speaker notes
The aim is to try out some of the “safe starter” phrases to see which sentences work well.
You could also try out the non-recommended phrases to see what responses they trigger.
Role play (patients)How does it feel to be challenged about a topic that is sensitive or difficult?
This is a short exercise – no more than 5–7 minutes. After 3 minutes remind groups to swap around and try a different case example.
On bringing the group back together, ask for a few suggestions about which sentences were effective. Did asking “how do you feel …” work well?
Speaker notes
People do appreciate talking about things they feel concerned about. They don’t like being judged by their appearance or being forced to face issues they feel they cannot tackle.
We can glean very valuable patient information about lifestyle, motivation, barriers and health priorities without getting stuck in a lengthy discussion of dietary specifics. Basically, “why” and “how” are more relevant than “what”.
In a short consultation, use this information to guide effective signposting.
Speaker notes
In a short consultation, the primary aim is to support the patient in finding appropriate support – not necessarily to provide all the support yourself. What sort of support is needed? Weigh up the patient’s various comments to help steer them towards support that is relevant to them.
Do they need factual information? What is the patient’s understanding of healthy diet and physical activity recommendations? Do they need help to learn (e.g.) cooking skills?
Is the family clear about what they should be doing but can’t seem to put the guidance into practice? Perhaps healthy foods are disliked and exercise is unpopular? A behavioural approach may help to understand how behaviours develop in the first place and how they can be influenced.
Is motivation the problem? Do excuses and barriers get in the way of good intentions?
The next slide suggests simple tester questions to check which direction to take next.
Speaker notes
Your initial conversation may already have shown the direction of travel. Test out your hunch to ensure you are responding to the patient’s needs rather than imposing your own views.
Speaker notes
Wherever possible, convey the need for lifelong commitment to a healthy lifestyle rather than a short-lived blitz. This is particularly important for children, as habits established in childhood are likely to track throughout adulthood.
A small change that persists over years will achieve far more than a one-off marathon.
Speaker notes
Allowing the patient to explain their “back story” can give valuable clues about their level of engagement, understanding of nutritional issues, and health priorities. Use this to steer the direction of your conversation.
Explore what happened at the point when weight regain began. What factors caused a change in motivation to control eating and/or physical activity?
While medical causes of obesity are rare, they should be considered. Investigate if there is clustering of symptoms or a sudden weight change without any apparent explanation. Running some blood tests while reassuring the patient that an abnormality is unlikely can help to show that you are taking the person’s weight concern seriously, but that – after this initial check-up – you would like to move towards exploring weight management options together. Alternatively, you might suggest that if weight control attempts are unsuccessful, then checking blood tests at a later point might be an option.
Explain relative benefits if a patient is uncertain whether to try stopping smoking or lose weight – or might be considering both together. More health gain will accrue from stopping smoking first, even if it results in further weight gain. On average, people gain 5 kg (11 lb) in the year after stopping smoking.*
* Aubin H-J, Farley A, Lycett D, Lahmek P, Aveyard Paul. Weight gain in smokers after quitting cigarettes: meta-analysis. Brit Med J. 2012;345:e4439.
Speaker notes
For this workshop, we will discuss how we can work together to create a space for critical conversations with patients about obesity and weight.
We want to reflect on the conversations we have had with patients. What kind of conversations would you have with a patient you see for the first time? For example, the first thing you may ask is: what brings you here today?
Speaker notes
From the fields of psychotherapy, nursing and health care in general, we know that building a strong therapeutic relationship with a patient is at the heart of any successful communication strategy between patients and health care professionals.
Communication is not just about giving information. The goal is to give that information while also helping the patient feel heard, understood and respected. To create that foundation, we need to create an atmosphere of safety and trust so the patient can feel free to tell you what might be working well for them and what may not be working for them. It is very important for patients to be able to trust their health care professionals if they are to sustain long-term behaviour change such as healthy lifestyles or long-term chronic disease management plans for various conditions including obesity.
Here are some things that work and don’t work. Some of these things you will be familiar with from other areas of therapy. But this is an opportunity to reflect on some of the things we know from the literature.
The idea of empathy is no surprise.
Alliance is about the bond you create with your patient – the idea that we are in this together.
Having that bond or alliance will support the creation of consensus on shared goals with which we can move forward together.
Unconditional positive regard refers to the inherent sense of value we have for the human being we are interacting with. It means we can see their worth and their humanity, but it does not mean that we are going to accept all their behaviours. It is about separating the person from the behaviour.
Genuineness (or congruence) – we know that people pick up when there is no sense of genuineness.
Feedback is about telling the patient what is working well or what you are noticing in their behavior, and potentially pointing out some incongruencies. For example: “I know that this is what you value but I have noticed that this particular behaviour does not really fit with that value. What do you think about that?” It is about having an open and honest dialogue.
Recognition and repair of alliance ruptures: if there is a rupture in the communication or relationship and you can repair it in a way that does not cause the patient to feel that they are being judged, then this will actually help towards building a stronger therapeutic relationship. Sometimes, when there is a rupture in the therapeutic relationship, the patient may stop coming to see us, so there is no opportunity to repair the relationship. But hopefully, if there is already a strong therapeutic relationship, you will be able to see the rupture and to address it.
Speaker notes
A lot of the evidence here comes from the field of addictions.
Confrontational approach: one study found that the more the clinician told the client what to do, the less likely the patient was to take their advice. “You have to stop drinking”, “Don’t do that”: these statements were associated with patients increasing their alcohol consumption.
Negative processes: this refers to critical and blaming comments.
Assumptions: it is important to clarify – where is the patient coming from? What are they thinking? According to the literature, health care professionals are not good at making assumptions about these things, so it is important to ask.
Rigidity: you need to have flexibility in your approach – provide options and respect the patient’s autonomy.
The ostrich: don’t stick your head in the sand! We often see that something is not working but hang onto the hope that it will change on its own. Generally it will not change on its own, so it is important to address it.
One approach fits all: this is about looking at the contextual nature of what we do. Just because one approach works for one client does not mean that it will work for another.
Speaker notes
Be clear about our roles and expectations of what services we can and cannot provide.
Patients often come with traditional expectations about receiving some kind of treatment, but it is important to clarify that this lifestyle modification/behaviour change treatment requires active participation.
Speaker notes
Within a primary care environment, patients come in for many reasons – weight might or might not be the reason a patient comes to see you. Once you have identified the issue, you may need to have that critical conversation with them.
These are the types of critical conversation that may come up. What do you do? What do you say? How can you prepare for these conversations?
We find that we get a lot of these questions. They seem simple enough, but they are not easy to deal with.
Healthy? Normal? These are loaded terms and can mean different things.
We might tell a patient that the success rate is about 10%. That is a hard conversation.
What about when patients come to you and say they need to lose weight for a wedding? Or to get life-saving surgery? Or an MRI? What do you do and say?
A lot of patients see things on TV and think that – because you are a health professional – you should be able to help them do as well as, or even better than, the people on TV.
Speaker notes
When you tell a patient that the treatment you can provide is likely to fall below their expectations, it can be really frustrating.
There is a real struggle here: the amount of effort and work that your patient will have to do to manage their weight is completely off the chart, and then you have to tell them that – even after all that effort – the treatment will have modest results/outcomes (typically, 10% weight loss).
It is also hard for us, as health professionals, to think that all that work we do with patients will only lead to modest outcomes. We want to be rewarded ourselves too.
We also have expectations of the programmes we implement. There are operational demands, there are staffing problems, etc. – these are genuine barriers.
Speaker notes
As health professionals, we have to consider where our patients are getting their information from. Which media are they using – magazines, the internet, TV shows like The Biggest Loser, etc.? They see people in the media who have lost half their weight, and then ask why they can’t do that too. They form a distorted image of what is normal.
This is a critical conversation to have with patients. Where are they getting these expectations from? Are they getting them from the media? What do they think is “normal”? What are they seeing or reading in the media is a “normal” weight?
Speaker notes
We are all familiar with this table and the idea of height, weight, BMI, etc. But it presents a big challenge: the label “normal” is what people see – and who doesn’t want to be normal?
A patient tells you “I want to be a normal weight”, and you tell them that 10% weight loss is the best we can do. Their answer is likely to be: “Well, that only brings me down to BMI 40 and I’ll still be obese. I don’t want to be obese. I want to be normal. I want to be healthy.”
This is a critical conversation to have with your patients; and we have to understand that the labels we use in health care – normal weight, healthy weight – also influence patients’ expectations about their weight loss. These labels influence their perceptions of what they want to achieve – they want to be normal, healthy, etc.
Speaker notes
A lot of patients use the BMI classification to determine if they have a healthy weight and to set their weight loss goal.
This is in fact incorrect. The BMI range is a disease risk tool. It tells you the lowest risk of mortality (death) based on your height and weight. It tells you that the lowest risk of mortality lies between 18.5 and 24.9; what it does not tell you is that if you lose weight and go from a BMI of 45 to a BMI of 25, you decrease your mortality. The current data on BMI and mortality risk is J-shaped and actually flattening out – there are studies that show that people in the normal and overweight category have lower mortality risk.
The critical conversation with your patients is to explain that going down in BMI range does not mean that their mortality rate will necessarily decrease. It just means that where you are in the BMI range today helps to determine your mortality risk.
Speaker notes
Padwal et al. showed that BMI is a poor predictor of mortality and developed a new staging system to classify people with obesity: the Edmonton Obesity Staging System (EOSS).
Speaker notes
Based on EOSS, the risk level varies. People who have a BMI of 30 and are at EOSS stage 0 do not have a greater risk of mortality. It is not how big you are, but how healthy you are. So if you are in a normal BMI range and unhealthy, that increases your mortality risk; but if you have a BMI of 40 and are healthy, your risk for mortality does not change.
This is a critical conversation to have with your patient: it is not just about weight and how big you are – it is about how healthy you are. It is critical that you discuss this with your patient and help them understand it.
So, when you are setting a goal with your patient, the focus may be stopping the weight gain. You could try explaining this to a patient by saying: if I met you 10 years from now and you were the same weight, would that be a success? Often, they say yes, because they think, “When I was 20, I weighed 90 kg and now I weigh 180 kg, so not gaining weight would have been good.” This can help the patient to understand the value of doing something, even if they don’t see the weight loss they had initially expected. It will take effort and won’t be easy for a patient to stay the same weight over 5 or 10 years, but it will certainly help their health: they need to recognize the value of this goal and put it in their plan.
NHANES III = Third National Health and Nutrition Examination Survey.
Speaker notes
This is a good study to show your patients. This systematic review looked at all the various weight loss interventions and assessed their impact on weight. The important thing to look at is the long-term impact of these interventions. What you can see is that all these programmes show weight regain.
We all assume – and like to think – that we can lose weight and keep it off, but this is not evidence-based.
Speaker notes
This study looked at over 6000 people and asked them how much weight they thought, realistically, they would lose; and then, how much weight they would like, ideally, to lose. The study found that people’s expectations were that they could realistically lose about 8% of their weight. This is pretty good and could be achieved in an intervention. Some patients’ expectations about what weight loss could realistically be achieved could be reframed.
If you then look at answers on ideal weight loss, they are about 16%. This is what the respondents really wanted, but it is not achievable with healthy lifestyles. Younger people and females are found to have higher expectations. This kind of information can help you determine who you need to have this critical conversation with.
Speaker notes
Realistically, someone undergoing bariatric surgery will lose about 20–30% of their excess weight in total. They will not lose 100% of their excess weight and are unlikely to get to a normal BMI. It is therefore important to explain to patients that bariatric surgery – while it has good clinical outcomes – will not enable them to reach their ideal weight or normal BMI range. You can help them to reframe their expectations by providing the relevant evidence.
Bariatric surgery is not always successful. Many patients do not achieve successful weight loss outcomes, and many regain weight – most commonly, in year 2 or 3 after surgery. This may be the time that you, as a primary care professional, get to see a patient who has had bariatric surgery, because at this point they will have finished the specialty programme/ intervention.
Speaker notes
Here are the results from lifestyle interventions.
Some people are successful, but it is not particularly common. People tend to compare themselves to these exceptional cases. They do not realize that their own experience of not achieving success with lifestyle interventions is in fact common and normal; this is mainly due to the media focusing almost exclusively on the few cases where people do succeed in managing their weight through lifestyle interventions.
McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7(4):334–41.
Barte JC, ter Bogt NC, Bogers RP, Teixeira PJ, Blissmer B, Mori TA et al. Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obes Rev. 2010;11(12):899–906.
Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50.
Speaker notes
Patients want to focus the discussion on weight loss outcomes. Right at the outset, it is important to discuss the different phases of weight management. The first step is to prevent further weight gain. Then we enter the weight loss phase. Next, we need to explain that they will reach the weight loss plateau and may also experience weight regain. The key is to have a plan to deal with each of these phases.
Speaker notes
Weight should not be the measure of success.
Speaker notes
We will discuss the last two points in this slide later.