Obesity module 1: management in primary care

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Derbyshire Appendix:

Five steps to assessing readiness to lose weight

Step 1. How to begin

Some suggestions are:

  • “How do you feel at the moment about losing weight?
  • “How would life be different if you were to lose weight?”
  • “What changes, if any, are you thinking of making regarding your weight?”

Step 2. Using a rating scale to measure readiness

E.g. “How ready do you feel to make changes regarding your weight at the moment?” On a scale of 0 to 10, where 0 is not ready at all, and 10 is totally ready, what score would you give yourself?”

0 — 1 — 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 — 10
Not ready                                         Totally ready

Follow up as necessary, with questions such as:

  1. “What puts you at your chosen number, and not a higher number?”
  2. “What would it take to move you from your chosen number to a higher number?”

A score of 0–3 indicates that the patient may not be ready to make changes at the moment. It may not be the right time to discuss treatment options and may be best to summarise your discussion and make the patient aware of future support.

If the patient scores 4–10, go to step 3.

Step 3: Using a rating scale to measure importance and confidence

For example: “On a scale of 0 to 10, with 0 being not at all important and 10 being extremely important, how important is it for you to lose weight at the moment?”

“Also on a scale of 0 to 10, with 0 being not at all confident, and 10 being extremely confident, how confident do you feel about being able to lose weight at the moment?”

Use appropriate follow-up questions. Low rating on importance – target questions on what could help to make losing weight a higher priority.

Low rating on confidence – target questions on what could help them feel more confident about losing weight. Plan with the patient how to increase importance and/or confidence. Then, when appropriate, ask the patient to rate again.

Scores of 0–3 on both scales indicate that the patient may not be ready to make changes at the moment. It may be best to summarise your discussion and make the patient aware of future support.

If ratings are 4–6 explore further by using a pro’s and cons list in step 4.

If ratings are 7–10 go to step 5.

Ask the patient to list pros and cons or advantages and disadvantages of losing weight. This can help explore ambivalence (mixed feelings) about change.

Step 4. Using a pros and cons list

Before discussing a referral, check whether there are any significant barriers which may prevent the patient from making good use of the weight management options at the moment. Check: current stressors/time available/lack of knowledge/support, psychological issues. Plan with patient how to manage or overcome barriers.

Step 5. Check barriers to change

Before discussing a referral, check whether there are any significant barriers which may prevent the patient from making good use of the weight management options at the moment. Check: current stressors/time available/lack of knowledge/support, psychological issues. Plan with patient how to manage or overcome barriers as appropriate.

Data from NHS Derbyshire28