2016-12-22 20:28:02 UTC

Obesity 106: Physician Discussion Guide

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  • As obesity becomes a growing problem in our country, it is of the utmost importance to be prepared with a strategic plan on how to best manage care and reduce health risks in patients who present as significantly overweight or obese. The American Gastroenterological Association POWER: Practice Guide on Obesity and Weight Management, Education and Resources paper provides resources to help you support and care for your patients looking to make a change. 
  • Obesity is a unique illness. Patients who are obese may experience stigma and psychological or social impacts in ways that differ greatly from other chronic-disease patients. Approaching obesity care with a unique perspective will be key to working with your patients to achieve successful management of both obesity and its likely comorbidities.
  • Start with this discussion guide to begin a conversation with patients who you believe are both in need and potentially willing to make the commitment to weight loss.

Adapted from the Let’s Go! Motivational Interviewing Guide

These recommendations are for the gastroenterologist or members of the health-care team working with obesity patients.

Step 1: Dig, Discover and Develop the Relationship

  • Learning more about who your patient is, including smaller details of his or her life, can help you build a picture to best understand the tactics that will be the most effective in creating changes needed for successful weight loss.
  • Beyond the clinical evaluations in the obesity assessment phase, it is critical to develop a trusting relationship and create a space where patients are motivated to push themselves toward change but are also not afraid of missteps.
    • Ask open-ended questions:
      • Describe a typical weekday, from when you wake up to when you go to sleep. Take note:
        • How much of the patient’s weekday is sedentary?
        • What are the patient’s typical eating habits?
        • When does he or she eat?
        • What does he or she eat?
        • With whom does he or she eat?
        • How do your weekends differ?
        • What are some activities you enjoy?
      • Talk to me about your health goals. Take note:
        • Where do you (or other HCPs) fit into these goals?
      • How do you think things will change if you lose weight?
      • Is there anything about losing weight that makes you afraid? Take note:
        • What barriers could the patient potentially have to achieving success?
    • Use reflective responses to convey that you are not only listening but also absorbing and understanding what they are saying:
      • It sounds like …
      • I am hearing that you are not happy with …
      • ­So you are saying you have trouble with …

Step 2: Weigh the Options, and Work to Commit 

  • With so much involved in managing obesity, it is important that patients not only hear all the options and all that is involved but fully comprehend it as well. Don’t be afraid to ask follow-up questions to ensure they understand what is in store as you take steps to move forward.
  • Commitment needs to come from both you and your patient. Your patient needs to feel that you are in this process with him or her and that you are committed. You need to feel that your patient understands the importance of the tasks ahead and is willing to work through, even if there are bumps in the road.
    • Use the AGA PatientINFO education resources on obesity to review comorbidities and treatment options.
    • Come prepared with your recommendations on how the patient should start:
      • Has he or she already tried diet and exercise changes?
      • Has he or she already lost weight but was unable to keep it off?
      • Does he or she have any current comorbidities that need to be addressed first that you are particularly concerned about?
      • Have resources on diet and exercise available either in print or links.
      • Check on the patient’s insurance. Does their policy cover:
        • Consultations with a nutritionist/RD?
        • Structured weight-loss programs?
        • Weight-loss drugs?
        • Weight-loss procedures or surgeries?
    • After you present the options, check in with your patient:
      • What can I explain further?
      • How are you feeling after hearing the options?
    • Be sure to include motivating language. The steps involved can feel intimidating, but you are there to work together. Communicate this clearly.

Step 3: Set the Stage for Next Steps

  • Once you are confident that your patient understands the options and process and is willing to commit and work together, it is crucial to develop a tangible action plan.
  • In this step, you should come to the table with the menu of options and pros and cons of each choice. 
  • Empower your patient to choose where they would like to start and to set their initial goal. Your role is to be sure that the option makes sense medically and that you feel the goal is realistic and achievable for their current state. 
    • Have your patient write down his or her goal.
    • Discuss with your patient any barriers he or she expects or anything that makes him or her nervous about achieving the goal.
    • Write down at least three action steps you are “prescribing” your patient to complete before the next visit. 
    • End the visit with more open-ended questions:
      • How are you feeling after this whole discussion?
      • Is there anything else you’d like to discuss?
      • What can I do to help you achieve success?

©AGA, February 2017

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