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Physician
Education
Home
Fundamentals
of Nutrition
Nutrition
& Atherosclerosis
Nutrition
& Cancer
Vertically
Integrated
Management
of Obesity
C.O.R.E.
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Motivational
Interviewing Algorithm
1.
Assess and Personalize Patient’s Risk Status
- "Based on your BMI, WC,
labs, physical exam, family history and symptoms, I am concerned about
the following: ______, ______, and _____."
- "I want to talk to you about
how your weight may be affecting your health."
2.
Stages of Change Evaluation
- "How do you
feel about your weight?"
- "What concerns do you
have about health risks?"
- "Are you considering/planning
weight loss now?"
- "Do the pros of changing
outweigh the cons?"
3.
Educate: Risks and Advise: Weight Goal
- Educate: Medical Consequences
Tip Sheet (longevity and quality of life)
- Advise: Establish a reasonable
goal for weight loss using a clear statement.
- "A 5-10% weight loss over
6 months for a total loss of ____ to ___ pounds."
4.
Assess Patient’s Understanding and Concerns
- "How do you feel about what
I’ve said?"
- "On a scale of 1 – 10, with
10 being100% ready to take action, how ready are you to lose weight?"
5. Facilitate motivation depending the patients
level of contemplation
An
answer between 1 - 4 means the patient
has very little intention to lose weight.
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Facilitate
Motivation for PRE-CONTEMPLATORS
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1.
Validate the patient’s experience. |
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2. Acknowledge
the patient’s control of the decision. |
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3.In
a simple, direct statement, give your opinion on the medical benefits
of weight loss for this patient. |
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4. Explore
potential concerns.
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5. Acknowledge
possible feelings of being pressured. |
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6. Validate
that they are not ready. |
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7. Restate
your position that the decision to lose weight is up to them. |
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8.
Encourage reframing of current state of change as the potential
beginning of a change - rather than a decision to never change.
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GOAL:Move patient from" NO!" to "I’ll think about it."
Check Sample Scripts
for hints and help
An answer between
5 – 7 means the patient
is ambivalent about taking action to lose weight.
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Facilitate Motivation for CONTEMPLATORS
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1. Validate
the patient’s experience. |
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2.
Acknowledge patient’s control of the decision. |
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3.
Clarify patient’s perceptions of the pros and cons of attempted weight
loss. |
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4. Encourage further self-exploration. |
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5.
Restate your position that it is up to them. |
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6.
Leave the door open for moving to preparation. |
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Check Sample
Scripts for hints and help
An answer between
8 – 10 means the patient
is very willing to take action about their weight.
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Facilitate
Motivation for those in PREPARATION
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1.
Praise the decision to change behavior. |
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2.
Prioritize behavior change opportunities. |
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3.
Identify and assist in problem solving re: obstacles. |
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4.
Encourage small, initial steps. |
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5.
Assist patient in identifying social supports. |
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GOAL: Provide direction
and support
Check Sample
Scripts for hints and help
6. Schedule
Follow-up
- Tell patient when
you would like to see them again.
- Give patient a
referral (to a dietitian / exercise specialist / therapist/ etc) if
appropriate.
Prochaska
and DiClemente’s Stages of Change Model Sample
Scripts for Stages of Change
*Adapted from the
work of Ockene JK et al. Arch Intern Med 1997;157:2334-2341, Simkin-Silverman
L, and Wing R. Ob Res 1997;5:603-612, and Taylor, S. St. Anthony Family
Medicine Residency, Denver CO
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