Pri-Med Southwest: Motivational Interviewing Can Help Patients Lose Weight

At Pri-Med Southwest, Frank Domino, MD, discussed the benefits of using motivational interviewing techniques when counseling patients on weight loss.

Frank Domino, MD, Associate Professor and Clerkship Director of Family Medicine and Community Health at the University of Massachusetts Medical School, spoke Thursday at Pri-Med Southwest 2011 about using a technique called motivational interviewing when discussing weight loss with patients. During his presentation, titled “Motivational Interviewing for Weight Loss and Exercise,” Domino explained that the motivational interview is designed to enhance the patient’s own motivation to change using an empathic and non-confrontational approach. According to Domino, this technique not only works, but it can be done in about three minutes.

Domino outlined four key steps to conducting a successful, brief motivational interview:

1. Establish rapport and elicit “change talk” using OARS

Domino recommended the OARS (Open questions, Affirmations, Reflective listening, and Summaries) method for getting the patient to talk about his/her own ambivalence -- referred to by Domino as “change talk” -- and to express his/her reason for change:

• Open questions -- Use open-ended questions and phrases like “Please tell me more about what you eat for dessert.” Physicians should avoid questions like “How much ice cream do you eat?”
• Affirmations -- Offer affirmative statements, show empathy, emphasize successes, and be supportive. Use phrases like “Dealing with weight issues is difficult; you have worked so hard. I can understand why eating feels good to you.”
• Reflective listening -- Restate the patient’s words in a non-judgmental manner. Use statements, not questions. If the patient reveals a behavior or action that he or she knows is detrimental to his or her weight-loss goals (“I can’t control myself if I am stressed out. Sometimes I will eat an entire bag of chips.”), the physician’s responses should be designed to elicit further information from the patient (“You eat a bag of chips at one sitting” and “It must be hard to control yourself when you are worried”). Avoid judgmental questions and pronouncements (“You eat an entire bag of chips at once?”).
• Summarize - The summary shows that you have been paying attention and marks a transition point in the interview. Use phrases like “What you’ve said is important,” “This is what I hear you saying,” and “We covered that well. Now let’s talk about…”

2. Use discrepancy ruler to facilitate change talk and solutions

Physicians should use two questions to establish discrepancy between importance and confidence:

• On a scale of 1—10, how important is it for you to lose weight?
• On a scale of 1—10, how confident are you in your ability to lose weight?

Domino suggested offering supportive and encouraging responses to patients’ answers to question 1: “Great! Sounds like losing weight is important to you.” He advised that responses to patients’ answers to question 2 should also be supportive, but should be designed to elicit self-reflection and planning from patients: “That’s good; I thought you were going to rate it lower. What would it take to get you to go up 1—2 points?”

3. Offer advice

Domino cautioned physicians using motivational interviewing techniques during weight-loss counsel to avoid offering specific directions to the patient and instead offer options and advice based on the interview. This technique demonstrates to the patient that he or she has helped solve the problem.

Patient: “I could get all of the bad foods out of the house.” Doctor: “That is terrific and a great start! What will you do when you get the urge to snack? Do you know what snacks would be healthy to have in the house?” Patient: “Kind of…” Doctor: “We have a few options, I can give you a few ideas, I can refer you to a dietician, or you can join a weight-loss program.”

4. End the interview with a summary and a plan

Use the patient’s suggestions to set a goal and formulate an action plan. Be open-minded. Put the plan in writing, provide a copy to the patient, and schedule a follow-up appointment. For example: “Let me see you back in a month. How much can you lose by taking out snacks? A reasonable goal would be 0.5—1 pound per week. How does 2 lbs in a month sound? If you keep it up, that would be 24 pounds in one year.”