MOTIVATING WEIGHT LOSS: HOW TO TALK SO YOUR PATIENTS WILL LISTEN, HOW TO LISTEN SO YOUR PATIENTS WILL TALK. Erica Johnstone, MD. MHS Feb.

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1 MOTIVATING WEIGHT LOSS: HOW TO TALK SO YOUR PATIENTS WILL LISTEN, HOW TO LISTEN SO YOUR PATIENTS WILL TALK Erica Johnstone, MD. MHS Feb. 12, 2018

2 OBESITY: A BIG PROBLEM

3 CAN HEALTH BEHAVIORS CHANGE?

4 HOW ARE WE DOING AS HEALTH CARE PROVIDERS? Survey sent to the University of Utah Department of Obstetrics & Gynecology by

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12 IN SUMMARY We believe it is important to talk to our patients about obesity and lifestyle changes We feel moderately comfortable having these conversations Only ~ 10% of us believe that our counseling leads to weight loss

13 DOES TALKING TO OUR PATIENTS ABOUT WEIGHT MATTER? NHANES Survey of 5054 overweight and obese adults Those who recalled their physician telling them that they were overweight had1.79-fold greater odds of losing at least 5% of their body weight. More than 2-fold increased odds of losing at least 10% of their body weight Just telling your patient that they are overweight is not only okay, it may lead to weight loss! (Pool et al, 2013)

14 THE NUMBERS AREN T BAD (Pool et al, 2013)

15 DOES IT MATTER WHICH DIET WE RECOMMEND? Dansinger et al, 2005

16 SO HOW CAN WE DO IT? Transtheoretical model Motivational interviewing Volitional help sheet

17 THE TRANSTHEORETICAL MODEL: STAGES OF CHANGE Prochaska et al, 2002

18 HOW DOES THIS APPLY TO WEIGHT LOSS? First, assess where a patient is in stages of change Then, tailor counseling to that stage Reassess at followup visits

19 TRANSTHEORETICAL MODEL: A WEIGHT LOSS EXAMPLE

20 STAGE MAY DIFFER BY STRATEGY Increased exercise Specific dietary changes: Reduced carbohydrates Reduced calorie intake Following a particular diet

21 STRENGTHS OF THIS MODEL Counseling based on patient s stage and approach will seem less directive and forceful For providers, allows setting reasonable expectations Change can evolve over time

22 DOES IT WORK? LOSS OF 5% OF BODY WEIGHT OR MORE Johnson et al, 2007

23 MOTIVATIONAL INTERVIEWING Time-limited interview beginning with prepared questions Centered on the individual Patients set their own goals Can be performed by trained medical assistants Barnes et al, 2014

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25 MOTIVATIONAL INTERVIEWING EXAMPLE Open-ended questions Affirmative statements Reflections Summary statements "How do you feel about your health right now?" "Your dedication to improving your health and losing weight is really noticeable. You ve made a lot of improvements." "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." I m hearing that you have struggled with weight for most of your adult life and are starting to recognize how it is affecting your health and quality of life. Let s develop a plan to help you address your concerns."

26 DOES IT WORK? 15 Mean weight loss with MI < 1 kg kg >5 kg Barnes and Ivezaj, 2015

27 MOTIVATIONAL INTERVIEWING AND NUTRITIONAL PSYCHOEDUCATION Barnes et al, 2015

28 VOLITIONAL HELP SHEET Tool to support behavior change as participants form their own action plans List of critical situations that challenge behavior change, and list of potential responses to those situations Armitage et al 2017

29 VOLITIONAL HELP SHEET Armitage et al 2017

30 VOLITIONAL HELP SHEET Armitage et al 2017

31 VOLITIONAL HELP SHEET All participants lost weight in 6 months, but those who were randomized to draw links between situations and solutions lost nearly twice as much (6.15 kg vs kg). Armitage et al 2017

32 IN SUMMARY: Advising our patients to lose weight matters! Rose et al, 2013

33 IN SUMMARY There are a variety of tools that can be helpful, and incorporated into early visits. It takes time, but this can be a short amount of time per visit. Weight loss in kg is small, but this is true of virtually all weight loss interventions other than bariatric surgery.

34 REFERENCES Armitage CF, Alganem S, Norman P. Randomized Controlled Trial of a Volitional Help Sheet to Encourage Weight Loss in the Middle East. Prev Sci Nov;18(8): doi: /s z. Barnes RD, IvezajV. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev Apr;16(4): doi: /obr Epub 2015 Mar 5. Barnes RD, White MA, Martino S, Grilo CM. A randomized controlled trial comparing scalable weight loss treatments in primary care. Obesity (Silver Spring) Dec;22(12): doi: /oby Epub 2014 Oct 9.

35 REFERENCES Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA Jan 5;293(1): Johnson SS, Paiva AL, Cummins CO, Johnson JL, Dyment SJ, Wright JA, Prochaska JO, Prochaska JM, Sherman K. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Prev Med Mar;46(3): Epub 2007 Oct 23. Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract Mar-Apr;8(2):e doi: /j.orcp

36 REFERENCES Prochaska JO et al. The transtheoretical model and stages of change, In: Glanz K, Rimer BK, Lewis FM (eds). Health Behavior and Health Education: Theory, Research, and Practice. 3 rd ed. Jossey-Bass, Inc., San Francisco, CA. Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J. Physician weight loss advice and patient weight loss behavior change: a literature review and metaanalysis of survey data. Int J Obes (Lond) Jan;37(1): doi: /ijo Epub 2012 Mar 27.