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Motivational Interviewing Algorithm

1. Assess and Personalize Patientís 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 Patientís Understanding and Concerns

  • "How do you feel about what Iíve said?"
  • "On a scale of 1 Ė 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.

 

Facilitate Motivation for PRE-CONTEMPLATORS

 
1. Validate the patientís experience.
2. Acknowledge the patientís control of the decision.
3.In a simple, direct statement, give your opinion on the medical benefits of weight loss for this patient.

4. Explore potential concerns.

5. Acknowledge possible feelings of being pressured.
6. Validate that they are not ready.
7. Restate your position that the decision to lose weight is up to them.
  8. Encourage reframing of current state of change as the potential beginning of a change - rather than a decision to never change.  
     

GOAL:Move patient from" NO!" to "Iíll think about it."
Check Sample Scripts for hints and help

 

An answer between 5 Ė 7 means the patient
is ambivalent about taking action to lose weight.

Facilitate Motivation for CONTEMPLATORS

1. Validate the patientís experience.
2. Acknowledge patientís control of the decision.
3. Clarify patientís perceptions of the pros and cons of attempted weight loss.
4. Encourage further self-exploration.
5. Restate your position that it is up to them.
6. Leave the door open for moving to preparation.
     

Check Sample Scripts for hints and help

 

An answer between 8 Ė 10 means the patient
is very willing to take action about their weight.

Facilitate Motivation for those in PREPARATION

1. Praise the decision to change behavior.
2. Prioritize behavior change opportunities.
3. Identify and assist in problem solving re: obstacles.
4. Encourage small, initial steps.
5. Assist patient in identifying social supports.
     

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 DiClementeís 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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