All too often, diabetes educators encounter patients who for any number of reasons have difficulty with diabetes self-management. And educators tirelessly work to facilitate lifestyle modification to help prevent or delay chronic disease and improve outcomes for their patients.
Elizabeth M. Venditti, PhD, assistant professor of psychiatry and epidemiology at Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, looked at ways to help educators help their patients during Friday’s breakout session “Prevailing Trends in Behavior Therapy, Weight Loss, and Weight Management.”
“Lifestyle behavior change is central to the energy balance process. Despite complex individual differences, at the end of the day, learned behaviors are central to what we do. The food and activity environment is very potent. Part of what health behavior change psychologists and practitioners do is helping their clients manage what is sometimes a toxic environment,” said Dr. Venditti, a health psychologist.
Behavior change is important as well because it creates bargaining.
“When we change lifestyle behavior, you’re not just necessarily losing weight. You might be improving mood, you might be improving stress and you might be improving sleep,” she said.
Dr. Venditti herself has difficulty grappling with the fact that some of her patients will not change. By embracing motivational interviewing, she can respect their right to do that and see how they come up with their own reasons to change, even if they are not the same reasons she provides.
“The spirit of motivational interviewing is we need to allow our patients to talk about their ambivalence and about change, and come up at the end of a session with their own best reasons for making some type of a change,” Dr. Venditti said. “Prescribing rarely works. What you want are individuals to come up with their own reasons for changes. This is the hardest thing any clinician has to deal with.
“We can help our clients and patients build their own capacity to self-regulate. We can work with social norms, social support and social ecology. We can work on a guiding communication style — what motivational interviewing tells us — that respects personal autonomy, including the individual’s right not to change even though we know it’s good for them, and elicits change talk.”
While weight loss of 5 percent to 10 percent is feasible and clinically meaningful, she called on attendees to be mindful of nonadherence: Do not take the behavior personally. First explore if lack of planning/skill — and not motivation — is the problem. Avoid criticism and safeguard self-esteem. Identify barriers. Discuss how obstacles signal a learning opportunity. Acknowledge the difficulty of behavior change and provide encouragement. Develop a revised plan, a reasonable goal and shorten the interval required for success.
She recommends that the first half of lifestyle intervention for obesity and primary prevention focus on self-management of diet, nutrition, physical activity, weight, and environment in a period of about the first four to six months. The second half is where “the rubber meets the road” because patients can put the psychological and behavioral skills they’ve learned to work with trial-and-error problem-solving and application to personal barriers, she said.