Behaviour change – skill power not just will power

Most people who are of an unhealthy weight do not want to be unhealthy or have excess weight.¹ The problem is that we live in an environment in which it is extremely difficult to not gain weight. Knowing what and how much to eat, and being motivated to do so is only the tip of the iceberg (Figure 5). When people commit to losing weight they often assume that it is simply a matter of deciding to do so. In reality, life (work, family commitments, etc) do not stop when people are losing weight; there are many barriers that can get in the way. This is why simply telling patients they need to ‘eat less and move more’ is unlikely to result in successful weight loss. They need help to do it by, for example, identifying barriers before they arise and devising strategies and providing support to overcome or minimise them.

Self-monitoring by recording food intake and/or exercise can help patients to gain insight into their own eating habits and provide a useful starting point to developing a plan of action. Numerous smart phone applications have been developed for this purpose and can be a useful alternative to traditional pen and paper recording. The key to successful behaviour change is frequent contact and support to ensure that lifestyle changes are sustained. Sometimes simple interventions may not be enough and a referral to other healthcare professionals (including psychologists, dietitians and exercise physiologists) may be required for a more intensive intervention or approach. Ongoing involvement of the clinician in the patient’s efforts to initiate and maintain a healthy weight and lifestyle is integral. 

Putting it into practice

Using the 5A’s approach

The 5A’s approach (Assess, Advise, Agree, Assist, Arrange) can be used as a guide to structure weight management counselling. It does not necessarily have to be done all in the one session (Figure 6).²⁹ This approach is adopted in the NHMRC guidelines.²

A starting point

A useful starting activity when commencing any weight management program is to take a detailed weight history. If possible, represent it visually back to the patient, as shown in Figure 7. Discussing or displaying a patient’s weight history will help them to think about, understand and identify the reasons for their weight gain or weight regain over time. It will also aid the practitioner in encouraging appropriate and individualised lifestyle changes that will resonate with the patient.

Conclusion

Obesity has extensive medical implications. Most patients do want to lose weight and are motivated to do so. Identifying individual and personal reasons will aid motivation. Focusing on healthy eating, controlled portion sizes, increased movement and reduced sedentary time will all help with weight loss. Obtaining an extensive weight history will make treatment easier and will help patients understand their own weight status.     MT