Magazine article American Nurse Today

Helping Dave Lose Weight

Magazine article American Nurse Today

Helping Dave Lose Weight

Article excerpt

July 2017 Vol. 12 No. 7

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You've seen Dave in the family practice clinic several times. He's 52, obese, and he has diabetes, hyperlipidemia, and hypertension. Each time you see him, you advise him to lose weight. Yet, here he is again today, not having made any health behavior changes. You want to help him, but you understand the challenges in making lifestyle changes, as well as time limitations with the busy clinic schedule.

Time: Our greatest enemy

Time is a limited commodity for nurses in almost any healthcare (https://www.americannursetoday.com/collaboration-key-healthcare-transformation/) setting, and it often seems there's not enough of it to provide individualized health behavior change counseling. How can we make the most efficient and effective use of limited time when it comes to this important aspect of patient care? The modified 5As framework and the Transtheoretical Model of Behavior Change (TTM) help nurses provide individualized behavior change counseling in clinic and office settings.

The modified 5As: An evidence-based model for behavior change

The modified 5As framework consists of Ask, Assess, Advise, Agree, and Assist, and it has been used in several areas of behavioral change counseling. (See Modified 5As framework flowchart (https://www.americannursetoday.com/wp-content/uploads/2017/07/ANT0717_WebExclusive_WeightLoss_5AsFlowChart.pdf).)

Let's look at how you can use this model along with TTM to help Dave approach weight loss.

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Ask--Begin by asking Dave, "Can we talk about your weight today?" Asking permission communicates respect. Patients are more likely to discuss making a change when asked rather than lectured to or told they need to change. Weight is a sensitive issue, and it should be approached without judgment. Don't make assumptions, blame, or attempt to elicit guilt.

If Dave agrees to have a discussion about his weight, use TTM to learn more about him; ask if he's been thinking about trying to lose weight and if he's made any recent weight-loss attempts. Assessing Dave's stage of readiness for change allows you to tailor interventions that are specific for him. (See TTM stages of change (https://www.americannursetoday.com/wp-content/uploads/2017/07/ANT0717_WebExclusive_WeightLoss_TTMStages.pdf).)

Dave tells you that he often thinks about needing to lose weight and has made several short-term and unsuccessful attempts. He says he knows what he should eat because of his diabetes and thinks his biggest problem is that he's an emotional eater--he eats when he's under stress, angry, or sad. He also tells you that with his busy work schedule, just grabbing lunch at a fast-food restaurant is easier than preparing and packing lunches. Dave identifies that his work schedule also doesn't leave much time for exercise. His greatest motivations to lose weight are to improve his health and to be able to play more actively with his grandchildren. Dave is ready to make a change; he's in the TTM Contemplation stage, so you can move to Assess, the next component of the 5As model.

However, if Dave wasn't ready to address his weight at this visit, you could go on to discuss his other concerns and ask if he would be willing to speak about his weight at the next visit. Trying to initiate change if Dave isn't ready might lead to frustration and may hinder future efforts to address weight management.

Assess--For Dave, risks related to obesity extend to his other health conditions--diabetes, hyperlipidemia, and hypertension. This is where you can review his current status regarding these comorbid conditions. Discuss the risks of being overweight to his current and future health and the benefits of even modest weight loss. …

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