28/01/2022
To my fellow medical professionals: Do you struggle when it comes to addressing weight with your patients? 😕 How do you inspire positive change without pushing people away?
If you missed yesterday’s post, it was about my personal experience with this very issue. Essentially, my own P*P remarked on my increasing BMI (25) without taking the time to hear about my newfound relationship with food and physical activity. I was labeled as “overweight” and told to diet and exercise. My doctor was coming from a really good place, but I left the office feeling discouraged and somewhat embarrassed. 😔
As much as I despise talking about weight, I know that we as medical providers cannot ignore the obesity epidemic altogether, so I decided to freshen up on my own motivational interviewing skills.
With motivational interviewing, the goal is to identify the PATIENT’S health concerns through the use of open-ended questions, active listening, reflection, and helpful snippets of information.
Here’s my favorite “ice-breaker” question (which can be modified as needed when speaking to a parent versus a child):
“On a health scale of 1-10, with 1 being very unhealthy and 10 being the healthiest person you could possibly be, where would you rank yourself?”
1. If the answer is not 10, great. Say, “May I ask why you don’t rank yourself at a 10?” and pause to let the patient tell you THEIR perceived health concern(s).
2. Next, reflect on what they’ve told you and validate as necessary. For example, “I can understand how difficult it is to stay active, especially in the winter” if their main concern is not getting enough exercise. This is a great time to talk about barriers to achieving their health-related goals.
3. Next, ask something like “Have you thought about ways that you’d like to change these things?” Give them time to express their OWN ideas.
4. Encourage THEM to list a few benefits of making said change(s). For example: Joining a sports club might lead to new friends, less bullying at school, and a faster running time in PE class. Who knows what they might tell you! Let them supply their OWN motivation for change.
5. Discuss reasonable goals that are specific enough to follow-up on during your next visit. Essentially, create an action plan and timeline.
6. Follow up as planned. Again, use open-ended question like “So, how is the new sports club going?” It doesn’t have to be about their weight at all. If the plan for change was a total flop, start over and let them identify new ideas for change.
If your patient is unable to identify any health-related concerns on their own, ask permission to talk about worries you may have. “In our remaining 10 minutes, would you mind if we talked about nutrition?” Then pose an open-ended question: “I’d like to start by asking, how do you feel about your nutrition overall?” If the answer is not “Perfect!”, then refer back to #1.
Sometimes it might be helpful to give a new snippet of information for the purpose of motivating change. For example, “I see on your intake form that you enjoy 1-2 cans of soda per day. May I offer a little insight about soda?” They say sure. “I learned that drinking just one can of sugar-filled soda per day can add 10-15 lbs of weight to your body every year – that’s more than my pet cat!” Again, ask open-ended question to gauge their perception of the new information, listening for any desire to make a positive change.
When in doubt, reflect the patient’s thoughts and feelings aloud in order to show your understanding. Use what THEY say to guide the conversation. Create action plans based on an individual’s schedule, preferences, and ability.
What are your thoughts? 🧐 Any different approaches that you find to be particularly successful? I'd love to hear!
Primary source: Change Talk: Childhood Obesity. Initiative of the American Academy of Pediatrics Institute for Healthy Childhood Weight and Kognito, accessed Jan 2022: https://go.kognito.com/changetalk
