achievable and sustainable for your patient. For instance, - How much leisure time do you usually have? What could you do to be physically active during some of that time? - Do you feel that you can afford fresh fruits and vegetables? - How supportive are your family or friends in your efforts to improve your health? - Discuss the significance of lifestyle changes in the context of health improvements, rather than just emphasizing weight loss Focus on health, rather than weight - Congratulate your patient’s successes, while offering specific feedback during setbacks For your patient’s weight loss efforts, ü Stay up-to-date about his or her progress ü Offer non-judgmental feedback ü Focus on health, not weight loss ü Aim to set achievable and sustainable goals In reducing weight bias in your practice, consider your patient’s: ü Past experiences of weight stigmatization from providers ü History of weight loss efforts ü Family history of obesity ü Food and social environment (at home, school, and work) ü All weight- and non-weight related health concerns 11 Part 4: Motivational Interviewing for Diet and Exercise, and Obesity Motivational interviewing (MI) allows providers to encourage patients’ self-efficacy and personal control to be successful in their efforts for health behavior changes. By using reflective listening, asking open-ended questions, and expressing empathy, you can evoke patients’ own motivation, strengths, and aspirations for behavior change.53,54 Research consistently documents the benefits of MI for weight loss, and improvements in diet and physical activity. For example, Among patients with overweight and obesity, a 2011 meta-analysis indicated that compared to patients in typical interventions, those receiving MI reported greater reduction in body mass, body weight, and BMI.56 In a 2009 review, MI alone or in combination with other interventions was associated with increased selfefficacy related to diet and exercise, increased physical activity, and fruit and vegetable consumption, and reduced caloric intake.57 To effectively conduct MI in a busy office practice, it is necessary for physicians to develop and practice the specific skills related to asking, listening to, and informing patients. Despite time constraints during patient visits, studies consistently show that counseling sessions ranging from 5 to 15 minutes can be effective in increasing adherence to treatment, improving health behavior habits, and achieving weight loss. 55 Here are some examples of the types of questions to ask using a MI style when assessing ambivalence and motivation for lifestyle changes in patients with obesity: Visit these detailed guides on motivational interviewing to begin: MI Strategies for Diet, Exercise, and Weight MI: Example Scripts Practicing a 12-minute MI Intervention Videos Did you know… - How ready do you feel to change your eating patterns and/or lifestyle behaviors? - How would you like your health to be different? - What concerns do you have about eating healthier, exercising more, or losing weight? - How can I help you succeed? - Tell me about some barriers in your life for taking a first step? 12 Part 4: Setting S.M.A.R.T Goals As you and your patient work towards creating a plan to achieve long-term weight loss and physical health improvements, be sure to develop SMART diet- and exercise-related goals. With your patient, brainstorm and write down some goals using the following guidelines: I will bring my lunch to work every day for this next month. S M A R T pecific easurable chievable elevant Ime-based What actions are needed to achieve the long-term goal? · Rather than general goals to “lose weight” or “eat more healthy foods,” specify an action. · For example, replacing soda with water, or cooking dinner at home. How much will you do and at what frequency? · Quantifying an action can help track progress and define success. · For example, walking for 30 minutes for 5 days a week or cooking dinner at home on 3 nights a week. How realistic are these goals? · With your knowledge, skills, resources, and lifestyle, is the goal attainable? · For example, if you have never cooked, it may be helpful to begin by striving to cook just one night a week. How important are these goals to improving your current life? · Select a goal that you are personally motivated to achieve. · For example, if you are not interested in weight loss, but want to lower your blood pressure, you could focus on sodium reduction. What is the duration of time for working towards this goal? · Having a timeframe can help initiate and sustain motivation. · For example, walking for 30 minutes for 5 days a week for a month, or cooking dinner at home 3 nights a week for a month. I will eat 2 servings of fruits or vegetables with each meal, on 4 days each week this month. I will ride my bike for one hour 3 times each week this month. I will replace soda with water every day for the next two weeks. I will use the stairs instead of the elevator for 5 times a week this month. 13 Part 4: Physicians of the 21st Century Teaching Resources: ü "Weight Bias in Health Care" Video ü Facilitated Video Discussion Guide ü Validated Measures to Assess Weight Bias Research Highlight Despite the prevalence of weight bias in medical education, 58 most medical schools do not address this issue and many students remain unaware of their weight biases.59-62 A 2014 study61 of 4,732