Effectiveness of Motivational Counseling for Lifestyle Modification in Obese Patients Using a Patient-centered Approach

Abstract

Obesity is a predictor of a significant number of non-communicable diseases. Reduction of body weight by 5–10 % in 6 months, has a positive effect on the prognosis of life and is one of the goals of treatment. To achieve such goals, there is a need for a patient-oriented approach, where the degree of individualization corresponds to the personal risks and needs of the patient with his involvement in the process of choosing a treatment strategy and forming new flexible life habits through the use of motivational counseling. The objective: is to determine the effectiveness of motivational counseling for lifestyle modification in obese patients of prime working age using a patient-oriented approach. Materials and methods. 37 patients with obesity I (27 people) and II (10 people) degree, aged 38.03±1.27 years (20 women and 17 men) were examined. Patients were given motivational counseling according to the «5 As» system, the patient-oriented approach included recommendations regarding the regime and caloric content of food, physical activity (monitoring with a pedometer), compliance with sleep hygiene, correction of psycho-emotional disorders. Clinical laboratory examination in dynamics after 1 month, 3 months and 6 months included measurements of BMI, waist and hip circumference, body surface area, waist/hip ratio, conicity index, body shape index, abdominal volume index, blood pressure, levels of blood glucose, insulin, HOMA index, cholesterol, lipidogram indicators, serotonin and leptin. In addition, surveys were conducted using the HADS hospital anxiety and depression scale, Beck’s scale, Hamilton scale, Dutch Eating Behavior Questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Questionnaire, SF-36, The International Physical Activity Questionnaire, The Finnish Diabetes Risk Score. Statistical analysis was performed using IBM SPSS Statistics, Statistica 12, descriptive statistics Excel 2010. Results. During 6 months of observation, patients lost more than 5 % of their body weight (p<0.05), which was accompanied by a significant decrease in BMI (p<0.01) and an increase in the level of physical activity (p<0.001). The levels of lipid and carbohydrate metabolism exceeded the recommended values and had a positive tendency to decrease during treatment (p>0.05). Assessments of the manifestations of anxiety and depression according to the HADS depression and Hamilton scales, eating disorders, serotonin and leptin levels, quality of sleep, quality of life of patients improved. The prediction of the risk of developing diabetes had significant positive dynamics (p<0.05). Conclusions. The obtained results make prove that the application of of motivational counseling according to the step-bystep system «5 As» with a patient-oriented approach in patients of working age with obesity is an effective method, which is confirmed by reliable positive results and allows to reduce body weight by more than 5 % in 6 months, reduce levels of metabolic disorders, blood pressure, increase physical activity, reduce the manifestations of depression and anxiety, eating disorders, improve the quality of sleep and life of patients, improve the prognosis and reduce the risk of non-infectious diseases. If it is necessary to achieve stricter targets of indicators in obese patients and/or in a shorter time, it is necessary to carry out a further search for effective measures and consider the additional use of pharmaceutical products in prevention.