5 Questions That Can Prompt Patients to Make Lifestyle Changes

I enjoyed the 2-part article by Robert Kushner, MD, and Deborah Ognar, MS, RD, "How to Counsel Patients About Diet: Sorting Fact From Fiction" (CONSULTANT, February 2006). As the authors pointed out, the secret to weight management is to communicate the answers to patients' questions about diet in a way that motivates them to apply the information. I have a weight management practice, and I would like to share some motivational strategies that I have found effective.

If I see a patient with a high body mass index, hypertension, and elevated glucose or lipid levels, I discuss the implications of his or her abnormal findings and the need for lifestyle changes. If this approach is not enough to motivate the patient to lose weight or alter eating habits, then I ask him the following 5 questions:

1. What will motivate you to change? Health-related reasons usually are not sufficient motivation. A more likely motivator is that the patient can no longer fit into her clothes or can no longer climb a flight of steps without being out of breath. The "what" has to be so strong that every time the patient wants to eat a favorite unhealthful food, the image of what she wants will come to mind and win out over that urge.

2. Why do you think your results are elevated/abnormal? Patients sometimes know what they are doing wrong. They may tell you that they are eating more fast food or are dining out more and drinking with their friends. If they do not know the reason that their test results are abnormal, you may have to ask if there have been any changes in their life that would affect their eating and activity patterns and their health status.

3. How will you change? How are we going to get these results within a normal range? Most of the time patients know the right things to do. They may tell you that they need to bring a lunch from home and skip the 5 o'clock drink with their friends. If they have no idea how to make changes, this is the time to talk to them about healthier eating and increased activity. If the problem is severe and closer monitoring is needed, this may be a good time for a referral to a nutritionist or a health care provider specializing in weight issues.

4. Where do you eat most of your meals and where do you spend most of your free time? The answer to this 2-part question will help you understand your patient's lifestyle. If a patient eats at fast food outlets and spends most of her free time in front of the TV, you can introduce alternative activities and ways to eat healthfully when pressed for time.

5. Who do you live with and who does most of the shopping and cooking? If one family member is overweight or has hypertension, another family member may also have these health problems. If teaching, further counseling, and closer monitoring are needed, it is helpful to meet with the family member who does the cooking and shopping.

- Sheryl Zang, EdD, RN, FNP
   Clinical Associate Professor
   SUNY Downstate Medical Center
   Brooklyn, NY