What Strategies do Registered Dietitian Nutritionists Use to Assess a Patient’s/Client’s Weight Loss Readiness?

Abstract

Behavior change theories and models are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. These theories provide an evidence-based approach for changing energy-balance behaviors that are important for obesity treatment.1Spahn J.M. Reeves R.S. Keim K.S. et al.State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.J Am Diet Assoc. 2010; 110: 879-891Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar According to the Academy’s position paper on weight management, the best combination of behavior-change strategies and techniques to apply in treating obesity is not known at this time. Instead, it is believed that a variety of strategies from different behavior change theories can be applied to assist with changing behaviors.2Raynor H.A. Champagne C.M. Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults.J Acad Nutr Diet. 2016; 116: 129-147Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar The Academy’s Evidence Analysis Library recommends “The registered dietitian nutritionist (RDN) should assess motivation, readiness, and self-efficacy for weight management, based on behavior change theories and models (such as cognitive-behavioral therapy, transtheoretical model and social cognitive theory/social learning theory). While research supports cognitive-behavioral therapy as an effective method of overweight and obesity treatment, there is limited research in the areas of the transtheoretical model and social cognitive theory and social learning theory.” The recommendation is rated “Fair, Imperative.”3Academy of Nutrition and Dietetics Evidence Analysis Library. AWM: Assess Motivation for Weight Management 2014. http://www.andeal.org/template.cfm?template=guide_summary&key=3503&cms_preview=true&project_id=1171. Accessed September 28, 2016.Google Scholar The concept of self-efficacy (or confidence) attempts to predict and explain human behavior that is fundamental to behavior change interventions.2Raynor H.A. Champagne C.M. Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults.J Acad Nutr Diet. 2016; 116: 129-147Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar Self-efficacy is not a general belief about oneself, but a specific belief tied to a specific task. Self-efficacy has been shown to be a strong predictor of health behavior, including weight-control behavior, sometimes explaining more than 50% of variability.4AbuSabha R. Achterberg C. Review of self-efficacy and locus of control for nutrition- and health-related behavior.J Am Diet Assoc. 1997; 97: 1122-1132Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar Patient motivation is a key component of success in a weight loss program and a prerequisite for weight loss therapy. Although it is difficult to quantify, research suggests that patients who have high pretreatment motivation and self-efficacy may lose more weight than patients with lower motivation and self-efficacy.5Kushner R.F. Kushner N. Blatner D.J. Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit. American Dietetic Association, Chicago, IL2009Google Scholar A sense of motivation can be determined by asking the following questions:•“How ready are you to commit time, energy, and resources to weight loss therapy?”•“How confident are you in your ability to lose weight and keep it off?” Motivational Interviewing (MI) is a collaborative, goal-oriented method of communication between a practitioner and a client with a focus on drawing out a client’s personal motives by allowing a person to find answers on his or her own. MI is believed to enhance motivation and self-efficacy, which are both considered to be key for changing behavior and sustaining behavior changes.2Raynor H.A. Champagne C.M. Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults.J Acad Nutr Diet. 2016; 116: 129-147Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar The Academy publication, “Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit,” includes a simple and rapid method to assess readiness by anchoring the patient’s interest and confidence to a numerical scale.5Kushner R.F. Kushner N. Blatner D.J. Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit. American Dietetic Association, Chicago, IL2009Google Scholar Readiness is viewed as the balance of two opposing forces: motivation (the patient’s desire to change) and resistance (the patient’s struggle against changing). Simply ask the patient, “On a scale of from 0 to 10, with 0 being not important and 10 being very important, how ‘important’ is it for you to lose weight at this time?” and “Also on a scale from 0 to 10, with 0 being not confident and 10 being very confident, how ‘confident’ are you that you can lose weight at this time?” This is a very useful exercise to initiate further discussion. The Weight Control Importance and Patient Confidence Scales can help to identify areas for behavior change and to focus behavior change counseling. If patients are motivated and confident, they should be ready to successfully initiate heath changes with the support and guidance of the RDN. It is important that RDNs empower individuals and provide them with the most effective behavior change strategies.