COUNSELING FOR

OBESITY PATIENTS
•Obesity, a condition
characterized by excess
body fat, carries
significant health
implications for both
chronic disease and
mortality.
•Obesity, usually defined in
terms of the body mass
index (BMI), which is a
measure of weight
adjusted for height.
•Adults with a bmi of 25 to
29.9 are identified as
overweight and those
with a bmi ≥ 30 as obese.
•Hormonal regulation of
appetite, satiety & activity
•Genetic factors
•Psychological issues
•Environmental
•Physical activity
•Drug induced
•Eating patterns, lack of
activity, & life-style
changes
•BMI
•Waist circumference
•Benefits of modest
weight reduction
•Motivation and
readiness for
change
1. Public health measures
for the population at
large
2. Screening and
intervention in the
individual patient’s
clinical encounter.
• Anthropometric
• Biochemical
• Clinical
• Dietary
• Diet history
• Food records
• Kcal intake
• Identify problem
areas
• Target interventions
• Patient knowledge,
motivation & compliance
• Success lies with the
patient
• Multifunctional
problem with many
issues to overcome
• Genetics is not a
modifiable risk factor
• High recidivism despite
aggressive treatment
• Lack of training of
primary care providers
• Intensive behavioral
therapy is time
consuming
• Medical model strongly
relies on
pharmacotherapy
• Frustration of prior
failed attempts
• Discrimination of obese
patients by providers.
Up to 25% of patients are
confused regarding diet
information. 10 weight
counseling by primary
care physicians is often
lacking, leaving
counseling to other
health professionals.
Effective counseling
begins patient
education on several
topics, including the
effectiveness of
popular diets.
Focus of counseling is 2-
fold: initial weight
loss and sustained
weight loss.
 Should address
unrealistic patient
expectations.
Emphasize that even
a small weight loss
can have significant
results. Encourage
patient to seek
counseling.
Usually assume that an
individual is ready to
change; however
this assumption is
probably not true
for many obese
individuals seeking
medical care.
 Since individuals
progress through a
series of stages of
change, some may not
yet be ready to
change.
The transtheoretical
model of behavior
change proposes
that individuals move
through stages of
change.
• Stages of change:
– Precontemplation
– Contemplation
– Preparation
– Action
– maintenance
• Change to obesity
treatment holds promise
because interventions
that match treatment
strategies to an
individual’s stage of
change may be more
effective than current
treatments.
• Primary care target areas
– Self-monitoring
– Portion size
– Eating out
– Exercise
– Sleep hygiene
– Beverage consumption
• The 5-A framework
– Assess
– Advise
– Agree
– Assist
– arrange
• Assess
– Ask about / assess
behavioral risk(s)
and factors
affecting choice of
behavior change
goals/ methods.
• Advise
– Give clear, specific,
& personalized
behavior change
advise, including
information about
personal health
harms and benefits.
• Agree
– Collaboratively
select appropriate
treatment goals and
methods based on the
patient’s interest in &
willingness to
change the behavior.
• Assist
– Using behavior change
techniques (self-help and / or
counseling), aid the patient in
achieving agreed-upon goals by
acquiring the skills, confidence,
and social / environmental
supports for behavior change,
supplemented with adjunctive
medical treatments when
appropriate.
• Arrange
– Schedule follow-up
contacts to provide
ongoing assistance /
support and to adjust
the treatment plan as
needed, including
referral to more
intensive or specialized
treatment.
1. Inform patients weight
loss occurs when
calorie intake is lower
than calories used;
patients should strive
to burn 500 to 1000
calories more than
calories consumed.
2. Emphasize 3500
calories equals 1
pound.
3. Review fda-approved
agents, noting side
effects and the need
to still exercise and
diet.
4. Emphasize avoidance
of diets that do not
include exercise.
Patients must make
lifestyle changes for
sustained weight loss;
without exercise,
sustained weight loss
will fail.
5. Caution against severe
calorie reduction.
Calorie intake less
than 1200 calories is
dangerous and must be
medically supervised.
6. When older patients
complain they are
gaining weight with no
change in eating
habits, explain how
calorie needs for
basal metabolism rate
decrease with age.
7. Recommend
www.caloriecount.com,
a website that helps
patients understand
calorie and nutrient
values of food. Up to
83% of its users give the
site positive ratings.
8. Patients must select a
diet they believe they
can follow.
9. Avoid diet plans that
sound too good to be
true, especially those
that promote
breakthrough
“supplements”.
• Self-monitoring –
food records
• Focus on reducing
portion size
• Target problem
foods, beverages, and
behaviors
• Breakfast – avoid skipping
meals – avoid bedtime
eating
• Meal replacements, liquid
supplements or nutrition
bars provide a balanced
meal at approximately 200
kcals & replaces meal that
is usually >500-600 kcals.
• Pre-portioned / portion
controlled meals
– Convenient and
inexpensive
– Elimination of difficult
food choice decisions
– Show appropriate
portion size
• Walk (more)
• Join a gym
• Take an aerobics,
dance, or tennis class
• Plan activities for
weekends with friends
& family; go to the park
of zoo
• Exercise videos; dance
• Find a buddy
• Find something active
to do while watching
tv
• Don’t use your kids as
slaves
• Take frequent trips up
and down the stairs at
home
• Clean house or walk
while talking on the
phone
• Wear comfortable
shoes
• Take a walk at work to
the bathroom, around
the building, up and
down the stairs during
breaks, get some fresh
air.

Avoid sedentary activities

•www.ahrq.gov
•www2.paeaonline.org
•www.pharmacytimes.com
•www.mayoclinic.pure.else
vier.com