Encouraging patients to talk about their goals rather than their obstacles can lead to long-term change.
Fam Pract Manag. 2016 Sep-Oct;23(5):32-38.
Author disclosures: no relevant financial affiliations disclosed.
More than one third of U.S. adults are obese.1 The estimated medical cost of obesity in 2008 was $147 billion, with the medical costs for people who are obese being $1,429 higher than the costs for those of normal weight.2 Despite these statistics and a high rate of obesity that has not changed for more than a decade, physicians continue to struggle with speaking constructively with patients about weight.
Motivational interviewing is a collaborative conversation style that can strengthen a person's own motivation and commitment to change.3 In skillful hands, this tool can encourage patients to make behavioral changes they previously have been ambivalent about or have found difficult by linking the changes to the things most important to them. But even without proficiency, family physicians, with time and by leveraging the longitudinal relationship they often have with their patients, can learn, adapt, and use skills from motivational interviewing to support changes toward healthy eating and active living necessary to achieving and maintaining healthy weight.4
This article describes six key skills adapted from motivational interviewing and the evidence on which it is based. An annotated transcript of a discussion between a physician and patient illustrates key concepts. To improve conversations with patients about obesity and healthy weight, you may wish to incorporate some or all of these ideas:
Share the agenda,
Raise the issue,
Be respectful and express empathy,
Build on what you hear (Ask-Tell-Ask),
Cultivate change talk,
Guide toward a specific plan.
Share the agenda
Many family physicians were trained to focus visits on the patient's chief complaint. Some practices limit visits to a single issue or problem suggested by the patient, and others attempt to gather and address the patient's full list of concerns at each visit. It is assumed that physicians will also address important but unrelated issues such as abnormal laboratory results and age-appropriate screening as needed at any visit. But without a clear plan of what issues will be discussed and how they will be prioritized, encounters can become chaotic and not effectively meet the expectations of physicians or patients. Developing a shared agenda can help.
Sharing the agenda is straight-forward. After greeting the patient, the physician can ask open-ended questions to begin mapping the plan. Some physicians find it helpful to mention how much time they have.
An example will help to illustrate this and other concepts described in the article. Mrs. Jones is a 55-year-old female who is well known to the physician and followed for high blood pressure, glucose intolerance, and obesity with a body mass index
Referencesshow all references
1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–814....
2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff (Millwood). 2009;28(5):822–831.
3. Miller, WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press; 2013.
4. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgam BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709–723.
5. Harris Interactive. Many people who are overweight or obese have never been told by their doctors to lose weight. Feb. 22, 2011. http://bit.ly/29Pbvai. Accessed July 15, 2016.
6. Galuska DA, Will JC, Serdula MK, Ford ES. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282(16):1576–1578.
7. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999;281(3):283–287.
8. Magill M, Gaume J, Apodaca TR, et al. The technical hypothesis of motivational interviewing: a meta-analysis of MI's key causal model. J Consult Clin Psychol. 2014;82(6):973–983.
9. Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns. 2009;76(2):174–180.
Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions