Effective weight loss conversations

Communication is the key to helping patients achieve a healthy weight. Amanda Clark outlines some useful pointers on how to develop effective conversations.

 With large numbers of people experiencing unwanted weight gain, simple, brief and effective strategies within the constraints of a medical consultation are key to spiking the patient’s interest in further input.

 GPs are the trusted health professionals that have the most clout when it comes to enacting health behaviour change, but it is often a difficult conversation to have. Patients who are sensitive about their weight often don’t appreciate the topic being raised when they have come to the doctor about something unrelated to their weight.

 As practitioners, our role is to create an enabling environment to initiate the process of change. Resistance to change is driven by fear, which in relation to weight loss includes fear of failure, discomfort in the form of hunger, and pain in the form of inconvenience and having to resist usual eating or shopping habits. Choosing a simple, doable strategy for step one can reduce that fear. Positive changes lead to increased self-esteem and self-efficacy which leads to more positive changes. Starting that ball rolling is the key.

 So, if we want an intervention to be comfortable and effective it is valuable to link the conversation to the reason for the consultation. For example, you can say “so, your blood pressure is fine today, though that is due to the medication. There’s evidence that how you make up your dinner plate can lower your blood pressure and result in weight loss and that might enable a reduction in medication in the future. Would you like to hear about that?”

 Here we have also focussed on one aspect of dietary change – just the dinner plate - rather suggesting a more global change.

 We can increase the retention of our discussion by using a seeing and then doing approach where you show the patient what you mean and then they take away some visual reminders and do it for themselves. This has been shown to be much more effective than just talking about behaviour change.

 Portion plates are perfect teaching tools for applying active learning principles. Use this plate model in clinic to convey any of 3 simple messages:

  1. Nutritional Balance: Serve ¼ plate of protein foods, ¼ plate of carbohydrate foods and ½ plate of low starch vegetables. This results in calorie reduction because the ½ plate contains very few calories.
  2. Portion Control: Fill the base of a 25cm plate 2cm deep with the recommended food types for weight loss for women (350Cal/1470 kJ) or out to the edge for weight loss for men (450Cal/1890 kJ) These calorie amounts are ideal for weight loss and using a smaller plate tricks the mind into feeling a larger quantity has been consumed.
  3. Mindfulness: following the prompts around the border of the plate enhance feelings of satisfaction on a reduced portion intake. Notice the presentation, register the variety, breathe in the aromas, notice the textures, experience the temperature, savour the flavours, slow down and enjoy the experience. Note that the first 3 steps occur BEFORE any food enters the mouth.

 Send your patient home with a copy of this free education page so they can get started straight away and read about the remaining strategies. This page also lists the foods which belong in each segment of the plate.

 By using this approach and sharing the concept amongst the practice – each contact point – be that another GP or the practice nurse can check up on the same strategy.

 If your patient has appreciated the content, then the opportunity exists to suggest a quick step on the scales to be able to monitor success of this strategy at a future date.

 For patients who show interest in taking the discussion even further, a referral to an accredited practising dietitian with expertise in weight management is indicated. Nutrition professionals have the time to take a detailed history and take multiple factors into account when planning dietary change strategies. Find an APD here.

Carol IrelandAmanda Clark AdvAPD
Amanda is an advanced accredited practising dietitian and author of Portion Perfection – a visual weight control plan. Amanda has a private practice on the Gold Coast, Great Ideas in Nutrition, specialising in weight management including bariatric surgery and is known for her practical approach to food and nutrition.