It’s time for a robust conversation on weight management
A number of techniques are available to initiate a conversation around long-term weight management.
The journey to weight management isn’t easy
Lisa spent years looking for support with creating her weight-management plan. Now, she’s here to share her experience and to help others with their search for an obesity care provider.
Hear how Lisa found a health care professional who helped her confront obesity and spoke with her truthfully about her excess weight.
The 5As provide a framework to start a conversation with your patients1
The 5As model is a behavioral intervention strategy that’s been modified for obesity management. It helps increase patient motivation and behavioral change in weight-management consultations.1
ASK1
- Ask for permission to discuss weight
- Explore readiness for change
ASSESS1
- Assess obesity class and stage
- Assess for drivers, complications, and barriers
ADVISE1
- Explain benefits of modest weight loss
- Explain need for long-term strategy
- Discuss treatment options
AGREE1
- Agree on realistic weight-loss expectations and focus on behavioral goals and health outcomes
- Agree on treatment plan
ASSIST1
- Assist with education and providing resources
- Refer to appropriate provider
- Arrange follow-up
DISEASE PROGRESSION
Bringing culture into the conversation
Your patients’ cultures may impact their acceptance of your medical advice. When creating a weight-management plan with your patients, consider various cultural factors that may impact their goals. Explore more about how culture impacts weight.
The importance of motivational interviewing2
Motivational interviewing is a counseling strategy intended to assist and motivate individuals to resolve ambivalence to behavioral changes. The essential elements of motivational interviewing include importance of change, confidence in the ability to change, and readiness to change.2
4 key principles guide the practice of motivational interviewing in weight management with patients:
Expressing empathy2
This reassures your patients that you are listening to them and seeing their point of view on the problem. As a result, patients are more likely to honestly share their experiences and perspectives.
Supporting self-efficacy2
Motivational interviewing is based on patients’ existing capacity for change. By focusing on previous successes, they will feel capable of achieving and maintaining their desired change.
Rolling with resistance2
Resistance can occur when patients realize a need for change in their behavior patterns. It is best to sidestep or “roll with” any resistance and to avoid trying to fix or solve each problem.
Developing discrepancies2
Throughout discussions of weight management, you and your patients will begin to see the differences between where they are (current habits) and where they want to be (goals). Help patients realize these discrepancies and guide them to self-identify ways to bridge the gap.
The practice of motivational interviewing involves some specific skills and strategies to help patients reduce ambivalence and advance their readiness to make changes. The OARS strategy is one simple way to generate the intended benefits of motivational interviewing.3
Open-ended questions3
Ask open-ended questions that encourage thought-provoking responses and engage a 2-way dialogue. This is an important first step to understanding a patient’s barriers and expectations.
“How do you feel about your weight and health right now?”
Affirmative statements3
Recognize and support your patient’s personal strengths, successes, and efforts to change. This will help promote a collaborative relationship.
“Your dedication to losing weight and improving your health is really noticeable. You’ve made a lot of improvements.”
Reflections3
Use reflective listening and respond thoughtfully by paraphrasing. Confirm that the patient has been heard and validate his or her point of view.
“I get the feeling that there is a lot of pressure on you to lose weight, but you are not sure you can do it because of the difficulties you have had losing weight in the past.”
Summary statements3
Summarization allows you to restate and clarify your patient’s statements and ensure that you and your patient are on the same page.
“I’m hearing that you’ve struggled with weight for most of your adult life and are now starting to recognize how it is affecting your health. Let’s discuss some strategies to develop a plan to help you address your concerns.”
DIAGNOSING OBESITY
Weight bias is real4
INITIATING A PLAN
Improve your obesity care skills
References:
1. Agency for Healthcare Research and Quality. Five major steps to intervention (The "5 A’s"). Accessed May 17, 2024. https://www.ahrq.gov/prevention/guidelines/tobacco/5steps.html
2. Psychology Today. Motivational interviewing. Updated June 6, 2022. Accessed October 8, 2024. https://www.psychologytoday.com/us/therapy-types/motivational-interviewing
3. Agency for Healthcare Research and Quality. Building rapport with patients: OARS communication skills. Published May 2016. Accessed October 8, 2024. https://www.ahrq.gov/evidencenow/tools/oars-model.html
4. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26:485-497.
