Cognitive and behavioural approaches
In order for a patient to succeed with a VLED,
it is important to assess their readiness to undertake the necessary behaviour changes required for effective weight management. After assessing the patient and presenting the VLED program outline, it may be helpful to then assess how important it is for the person to make the change as well as assess their level
of confidence in making the changes required.
If the patient’s level of importance is low then assisting the patient to identify benefits or intrinsic motivators should be discussed. In addition if the patient’s level of confidence
is low then reducing the magnitude of the goals may be helpful, for example aim at losing 5kg rather than 20kg, or starting with 4 weeks on the program rather than 12 weeks, as well as identifying and working through any barriers that may inhibit making the necessary lifestyle changes.
Once you can confirm that the patient is ready to move ahead with the program then it is important to create some specific goals and action plan. A step wise approach is outlined below with some sample questions that can be used.
Step One – Assess Level of Importance
1. How important do you think it is for you to make change (i.e. lose weight) at the moment given all the other priorities currently in your life?
Step Two – Assess Level of Confidence
1. How confident are you that you can change your diet and increase your physical activity to lose weight and improve your health?
2. Do you feel you can succeed in losing weight right now?
Step Three – Help Patient to Identify Benefits or Intrinsic Motivators
1. If you made some changes, what benefits do you think you would gain?
2. How would your life be different?
3. How would losing weight impact the things or people that are important to you?
Step Four – Identify Obstacles or Barriers
1. Are there any stressful events in your life right now that might get in the way of you making the necessary changes?
2. Have you tried to lose weight before? What got in the way of you achieving or maintaining your goals?
3. What do you find most difficult about losing weight?
4. What would be not so good about making the changes you are thinking about making?
5. Are there people who can support you to lose weight? Do you think they will help you in your efforts?
Step Six – Confirm Level of Readiness
1. Given everything we have spoken about today can
I confirm that you are ready to work on this with me?
Step Seven – Set Specific Goals
Generating some specific goals is an important part of the process with which the patient may need some assistance. Goals may include one or a combination of the following:
1. Medical or clinical targets – certain amount of weight loss, reducing blood pressure, reducing waist circumference, lowering BMI.
2. Specific health goals – exercising 4 times per week, drinking 2 litres of water per day.
3. Motivation goals – fitting into old clothes or a certain dress, not having to take hypoglycaemic medication any longer, being able to run a 5km fun run in 6 months.
Step Eight – Create an Action Plan
An action plan should include as much detail as necessary for the client to feel confident that they can achieve the desired task. Some things to consider when creating an action plan are:
1. All the steps needed to overcome barriers and achieve the personal goal.
2. When and how to follow the program.
3. Prompts to aid memory where necessary.
4. Support mechanisms.
5. Contingency plans.
6. Tracking and monitoring strategies.
7. Review details.
We can’t harp on people to move their bodies when we live in a society that shames and judges us for our attempts.
One reason the United States has not made more progress against poverty is that our interventions come too late. If there’s one overarching lesson from the past few decades of research about how to break the cycles of poverty in the United States, it’s the power of parenting — and of intervening early, ideally in the first year or two of life or even before a child is born.