Page 162 - Nutrition Counseling and Education Skills: A Guide for Professionals

home may affect them as well. Cultural and social factors may be contributing factors to obesity. If the family
system supports an obese lifestyle with high-calorie foods and little physical activity, change will be difficult
for the client unless the whole family participates in the challenge.4,19 The involvement and support of spouse
and family play an important role in weight loss.19

Ideally, family and friends are supportive of the client’s efforts to change eating behaviors. The counselor
may need to discuss with clients the important role of support in achieving permanent change. The
professional may suggest that clients request help from family and friends by seeking their agreement not to
eat inappropriate foods in front of them and not to purchase or prepare the unhealthy foods. In addition,
clients might ask their spouses, families, and friends to offer positive reinforcement for their efforts. Role-
playing some of these situations with clients may be helpful.

When family members are present at the counseling session, they should be asked to discuss ways in which
they can contribute to the client’s lifestyle change. Reinforcing proper behavior by the use of praise is an
example. Controlling antecedents by having proper foods available is of great assistance. Family and friends
should avoid acting the role of judge. “You shouldn’t eat that,” “It’s bad for you,” and “I told you so” are not
helpful remarks. Jealous and envious reactions may also be expected. “You’ve lost enough weight,” “Just this
once won’t hurt your diet,” and “Your skin is getting to look awful” are remarks that the client may need to
tolerate or confront.

Applications

Weight Management

The most common application of behavioral principles and methods to the treatment of nutritional problems
has been in the management of body weight. Although there has been much success using behavior
modification in weight loss regimens, weight regain is common and is a result of the failure to impose weight
maintenance behaviors.20 Research into the characteristics among people who successfully maintain weight
loss reveals that weight regain is due in part to not fully adhering to behavior change strategies.21 Successful
patterns of behavior and strategies to implement on a routine basis include maintaining consistent eating
behaviors on all days of the week, self-monitoring weight, eating breakfast regularly, and choosing a diet
without excess calories.22

Overweight and obesity are complex and not easily treated. While excess weight may manifest from a
variety of reasons, only one of which may be related to inappropriate eating behaviors,19 strategies to control
weight should be targeted to the etiology of the weight gain. The Academy of Nutrition and Dietetics
position on weight management emphasizes a lifelong approach to healthful lifestyle behaviors including
sustainable and enjoyable eating practices and daily physical activity.19

The American College of Sports Medicine, in a position statement, stressed that lifelong weight control
requires commitment, an understanding of your eating habits, and a willingness to change them.23 Realistic
goal setting, combined with a reduction of caloric intake plus a sound exercise program, is recommended.
Tailoring practical applications to a client’s lifestyle achieves the greatest success. Physical activity may have an
additive role in weight management as it can attenuate emotional overeating and improve dietary control.24

Motivation and readiness must be present for behavior change. This is particularly true of eating behaviors

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