A new client has prediabetes and needs your help. Her doctor says she needs to lose 5% of her body weight and exercise 150 minutes per week—the standard advice for preventing type 2 diabetes. While she doesn’t want to get diabetes, she hates exercise and has never succeeded at losing weight and keeping it off. She has little confidence that this time will be any different.
These options use contrasting communication styles that have a profound impact on people’s receptiveness to change. Option A is a “directing” communication style—gathering information, determining what’s wrong and telling the client how to fix the problem. It’s like wrestling because the client often strikes a defensive pose. Option B is a “guiding” communication style—helping the client explore reasons to change. This is like dancing because the two of you cooperate to reach a common goal.
Motivational Interviewing Role-Play – Precontemplation Stage – Weight Loss
Concepts of Motivational Interviewing
The motivational interviewing framework takes a different approach than the standard “lose weight for your health,” said Gretchen Ames, PhD, assistant professor of psychology at Mayo Clinic College of Medicine in Jacksonville, Florida. “A health care provider who does motivational interviewing also has to abandon the traditional role of expert,” she said. Rather, the health care provider is a partner in the effort; inspiring patients to look at the ambivalence that is associated with any change, then address that ambivalence to figure out how to change.
“Most of us have been trained to give information, as advice giving,” said Janelle Coughlin, PhD, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University (Baltimore, Maryland) and a consultant for Healthways, Inc. “We are the experts, and we set the agenda and persuade the patient to change. [ However ] advice giving isnt really going to be what helps people change.”
The techniques include goals of working together, focusing on what needs to change (with the patient coming up with suggestions, based on information) and planning how to change.
Nobody likes to be told to do something because it is “good for them.” From their first steps, children challenge their parents and they get better at it as the years progress. Still, like a parent to a child, there is an obligation to deliver a consistent message backed up by role modeling and examples of others who have overcome or are trying to overcome the barriers presented.
|Sometimes, just telling someone they need to stop smoking, eat better, or exercise more doesnt get the results we seek.|
As mentioned above, the first step in screening for obesity, according to the U.S. Preventive Services Task Force, is measuring the Body Mass Index (BMI) of every patient aged 6 and greater.6 In our intervention, practices found that the standard of obtaining height, weight, and BMI from patients at every visit was the easiest change to implement. Although some staff or clinicians may argue that BMI measures are not perfect, they are the clinical standard in many cases. Heavily muscled people often have BMIs in the overweight or obese range. These patients may need another tool to assess their weight status such as waist circumference or percentage of body fat.
Clinicians sometimes say their “eye ball” is enough. However, the BMI provides you with an objective measure of obesity status rather than a subjective assessment. Weight is often gradually gained or lost. If BMI is recorded at every visit, it will be more likely that you will catch these changes and be able to praise patients (for weight loss) or provide additional interventions (for weight gain).
Using the results from your chart reviews and observations in Chapter 2, have the Clinician Champion and Intervention Team discuss the protocols in place at your clinic to obtain an accurate weight and height on each visit. Tool 5 is a worksheet that considers elements and personnel required for obesity screening. The worksheet and suggested protocol in Tool 6 will help you frame the issue in a logical way.
The Institute for Healthcare Improvement uses the Model for Improvement as the framework to guide quality improvement. The Model for Improvement is a process that allows you to decide what you want to do, implement it, measure to see if it worked, and then to make adjustments based on testing your change strategy. Links to the Model for Improvement as well as a YouTube video on the Plan-Do-Study-Act (PDSA) cycle are listed in the resource section.
How Motivational Interviewing Works
Dr. Ames gave a case history to illustrate how the technique works. Miss Jones, a college senior with a body mass index (BMI) of 44.6 and obstructive sleep apnea, is trying to lose some weight before having bariatric surgery. Instead of giving the patient a diet to follow at the first meeting and telling her its important to follow it, Dr. Ames indicated she will give Miss Jones diet information but then ask: “What do you think is going well with your eating?” Given that question, she said, patients will tell you the good part and then are likely to mention things they need to work on.
Dr. Ames then focuses on the efforts that are going well, giving the patient positive feedback. Affirmation is a crucial part of motivational interviewing, she said. For instance, if Miss Jones told her she keeps track with a food log, she affirms the value of that.
If Miss Jones mentions problematic areas, Dr. Ames wont say, “You need to do x, y, z.” Instead, she asks her to think about why they are problems and what could be done. The technique inspires patients to come up with the solutions. For instance, Miss Jones discovers by calorie tracking that alcohol calories add up, and told Dr. Ames she plans to go out to eat less with friends—as that means she eats and drinks too much. Coming up with her own solutions builds confidence.
The approach recognizes that ambivalence is a major part of making any change, including weight loss, and patients typically go back and forth between resistance (known as sustain talk) and change talk. “The research has shown that change talk is the active ingredient here,” Dr. Ames said. However, change never happens overnight. And if patients develop the plan to change, it seems to work better.
For Miss Jones, for instance, her sustain talk was noting that it was easier to eat out than fix meals at home, but recognizing that wouldnt work well once she had the surgery. Then she moved on to change talk—what steps she needed to take to eat at home most often, such as making time to go to the market.
What is motivational interviewing for weight loss?
What are good motivational interviewing questions?
- Determine Why You Want to Lose Weight. …
- Have Realistic Expectations. …
- Focus on Process Goals. …
- Pick a Plan That Fits Your Lifestyle. …
- Keep a Weight Loss Journal. …
- Celebrate Your Successes. …
- Find Social Support. …
- Make a Commitment.
What are the 5 A’s of motivational interviewing?
- What are the good things about your work?
- How would you improve your work?
- What attempts have you already made to improve your situation?
- What’s different about your job now from when you started?
- Can you tell me more about what you do at work?