Counseling Overweight Adults
Dr. Robert Kushner

By Robert F. Kushner, M.D., Nancy Kushner, M.S.N., R.N. and Dawn Jackson Blatner, R.D.

Publisher:
American Dietetic Association, September, 2008

Introduction
The Epidemic of Adult Overweight
According to the 2003-2004 National Health and Nutrition Examination Survey (NHANES), more than two thirds of Americans are overweight or obese (1). Between1960 and 2002, the prevalence of obesity (body mass index ≥ 30) increased by 1.36 times among men (from 22.8% to 31.1% of the population) and 1.29 times among women (from 25.7% to 33.2%). This translates into an average weight gain of more than 24 pounds for each person in four decades (2). This alarming rise in overweight and obesity in the United States is not caused by a change in the gene pool. Rather, it is primarily due to the response to our environment, in which excessive energy intake, shifting eating patterns, and limited physical activity predominate.

The consequences of overweight and obesity are serious. Being overweight or obese can lead to diabetes, hypertension, dyslipidemia, coronary artery disease, and metabolic syndrome, among other diseases (3). Additionally, overweight and obesity negatively affect the individual’s overall physical and psychological health and can diminish one’s quality of life on a daily basis. Patients often feel desperate as they search for help.

The process of treating overweight and obese patients can be daunting. Health care professionals face many barriers, including limited resources, inadequate reimbursement, time constraints, competing demands, insufficient training in counseling, and a lack of confidence in their ability to treat and change behaviors (4). Clinicians need resources to help them quickly and easily identify each patient’s weight-loss needs, tools to identify patients’ primary barriers and obstacles to losing weight, and a method for developing individualized messages and strategies to enable patients to successfully lose weight and maintain weight loss. Accordingly, our objective in this publication is to provide health care professionals with resources and tools that will allow them to tailor a personalized weight management program for each weight-loss patient.

Why This Publication?
Our decision to write this book emerged over several years, beginning with the development of the Lifestyle Patterns Approach to weight management and the 2003 publication of the consumer title, Dr. Kushner’s Personality Type Diet (5). In recent years, Lifestyle Patterns educational programs have become popular among professionals in the weight management field. More than 200 registered dietitians (RDs) have participated in continuing education teleconferences sponsored by Diet.com, and Lifestyle Patterns educational programs have also been presented to professionals attending annual meetings of the American Association of Diabetes Educators and to physician groups at Harvard Medical School and Mayo Clinic conferences. Through these programs, Robert Kushner, MD, and Dawn Jackson Blatner, RD, stimulated a groundswell of interest among RDs, nurses, and physicians for a weight loss approach that considers an individual’s lifestyle patterns for eating, physical activity, and coping.

During our various educational sessions, we heard clinicians express a common theme: counseling overweight adults is a challenge due to limited time, insufficient resources, and a lack of an organized structure. After presenting the Lifestyle Patterns Quiz and program, we received a great deal of positive feedback. The following are some of the things that clinicians said they liked about our approach:
–It helps the health professional to quickly identify problem patient areas.
–The Lifestyle Patterns Quiz results are printed in a visual format that patients can appreciate—they are able to see their progress and successes in a graphic, tangible format.
–The treatment plan handouts are both realistic for patients to follow and easy for them to understand.

Because the Lifestyle Patterns Approach had been successfully used at the Northwestern Memorial Hospital Wellness Institute since 2001, we believed that both patients and clinicians alike would appreciate these benefits. What surprised us, however, was the extent of the enthusiasm and positive comments expressed about our approach. The following comments received over the years from RDs, physicians, and nurses became our impetus to write this book:
–“The tool you have developed is wonderful and perfectly addresses my frustration in trying to get at the real issues of people’s eating, exercise, and coping behaviors. I would be very interested in utilizing this in my practice.”
–“Your method of ‘diagnosing’ the problem is exactly what we are searching for.”
–“The original names for the lifestyle personality patterns are very catchy and pertinent. I feel clients can easily identify with those that fit their personality.”
–“Your questionnaire enables the practitioner to give consistent care to all patients.”

And so, Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit was born.

How to Use This Publication
This publication has two separate components: the book and the CD-ROM. The book explains what you need to know to counsel patients using the Lifestyle Patterns Approach to weight management and provides numerous tips and resources to help make your counseling program a success. The CD-ROM gives you a variety of electronic tools so you can use this approach efficiently and quickly in your daily practice.

The Book
The book begins with a brief review of the basic counseling theories on which the Lifestyle Patterns approach is based (Chapter 1). This review then leads into a discussion of how the Lifestyle Patterns approach was developed (Chapter 2). In Chapter 3, we review how to use the Lifestyle Patterns Approach to evaluate and counsel overweight patients.

Chapters 4, 5, and 6 explain the counseling interventions for the three main dimensions of treatment--eating, exercise, and coping. These explanations are supported by full Lifestyle Pattern descriptions, patient case studies, examples of dialogue, pattern-specific strategies, and counseling tips and techniques for using this program.

In Chapter 7, we review the use of the Lifestyle Patterns Approach to monitor patients. This chapter outlines how to track patients’ progress, provides approaches to deal with relapses and weight plateaus, and discusses ongoing monitoring considerations and family patterns. Chapters 8 and 9 contain what you need to know to apply this approach to specific patient populations and in group settings. The appendixes include the Lifestyle Patterns Quiz and Mini-quizzes, an explanation of how to score the quiz manually, sample patient education handouts, and a list of relevant resources.

The CD-ROM
The CD-ROM provides clinicians with an easy-to-use program to score the Lifestyle Patterns Quiz and generate bar graphs of patient-specific test results. These graphs illustrate patient profiles and can be easily printed for use in counseling sessions.

Additionally, the CD-ROM includes patient education handouts for each of the 21 Lifestyle Patterns. Each handout offers four goals for patients and numerous tips and resources for meeting these objectives.

Other documents on the CD-ROM include a printer-ready version of the Lifestyle Patterns Quiz, the three mini-quizzes, a daily food and activity log, records to track progress, a health care provider letter, and a health assessment form.

We hope this approach and convenient tools will put you and your patients on the path to a program that will easily fit into their lives.

References
1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999—2004. JAMA. 2006;295:1549-1555.
2. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height, and body mass index, United States 1960-2002. Adv Data VitalHealth Stat. 2004;347(Oct 27):1-2.
3. Must A, Spadano J, Coakley E, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523-1529.
4. Kushner RF. Barriers to providing nutrition counseling by physicians. A survey of primary care practitioners. Prev Med. 1995;24,546-552.
5. Kushner R, Kushner N. Dr. Kushner’s Personality Type Diet. New York, NY: St. Martin’s Press; 2003.

Copyright 2009, The American Dietetic Association.