Start the conversation on weight management
A number of techniques are available to initiate a conversation around long-term weight management.
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
- Provide education and resources
- Refer to appropriate provider
- Arrange follow-up
Bringing Culture into the Conversation
Your patients’ culture 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.
Learn how to approach weight history effectively with Dr. Kushner
Estimated time: 24 mins
Using Weight History to Inform an Effective Obesity Treatment Plan
Robert F. Kushner, MD
Learn how Dr. Kushner uses the OPQRST mnemonic to engage a patient about weight history. This interactive module demonstrates the benefits of having greater context about a patient’s struggle with obesity—including how much weight was gained, efforts taken to control their weight, and the effect that weight gain has had on their health.
Chapters
1. Introduction
2. Onset
3. Participating events
4. Quality of life
5. Remedy
6. Setting
7. Temporal pattern
8. Eating & physical activity
The importance of motivational interviewing2
Motivational interviewing is a collaborative, goal-oriented approach of communication to elicit behavior change in patients. The approach is designed to identify and resolve a patient’s ambivalence toward a specific goal by connecting necessary changes to incentives that reduce barriers for change.2
There are 4 key principles that 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.2
Open-ended questions2
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 health right now?
Affirmative statements2
Recognize and support your patient’s personal strengths, successes, and efforts to change. This will help promote a collaborative relationship.
Your dedication to improving your health and losing weight is really noticeable. You’ve made a lot of improvements.
Reflections2
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 statements2
The statements that recount and clarify the patient’s statements and identify specific points to act upon.
So 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 and quality of life. Let’s discuss some strategies to develop a plan to help you address your concerns.
Weight bias is real
Improve your obesity care skills
References
1. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59(1):27-31.
2. DiLillo V, Siegfried NJ, Smith West D. Incorporating motivational interviewing into behavioral obesity treatment. Cogn Behav Pract. 2003;10(2):120-130.
