Page 163 - Nutrition Counseling and Education Skills: A Guide for Professionals

and physical activity. Several factors are relevant to the prediction of success in weight control, one of which is
motivation to reduce weight. After the Stages of Change model is applied to assess the readiness to change
behavior, realistic and individual goal setting is critical.25,26

Explaining realistic weight loss achievements is essential. Clients may see improvements in comorbidities
associated with overweight/obesity when there is an initial reduction of about 10% of their body weight over a
6- to 12-month period.26 To expect more than that initially would be a setup for disappointment; however,
weight goals can be reevaluated after successful weight loss. Another motivator may be a deposit-refund
system in which patients are asked to deposit money that is later returned if the patient attends meetings
faithfully, or achieves a previously determined weight loss, or both.4 However, a financial reward system may
not be effective for long-term behavior change.27

An added benefit of significant weight reduction based on cognitive-behavioral treatment in a long-term
therapeutic setting has been the reduction in psychosomatic symptoms, anxiety, and depression in treated
clients. More adaptive behavioral alternatives in longer goal-oriented programs seem effective in promoting
continued weight loss.25 Taken together, these results emphasize the fact that there is no quick fix in weight
reduction and that the outlook must be long term.

Diabetes Mellitus

Behavior modification methods have proved to be a useful component in the management of diabetes
mellitus. Patient adherence to appropriate dietary regimens to control glucose is challenging. Behavioral
interventions such as cueing, self-monitoring, and reinforcement for appropriate behavior can be successfully
implemented to improve glycemic control and reduce risks of complications in patients with diabetes. As
previously noted, though, the problem of control of overweight and obesity from the standpoint of any
particular treatment is complex.

Behavioral management techniques may be used to prevent progression to diabetes in people with
prediabetes and to reduce the burden of diabetes complications in those with diagnosed disease.28 The
American Association of Diabetes Educators advocates seven self-care behaviors that should be emphasized in
patient care, including healthy eating, physical activity, glucose monitoring, medication adherence, problem
solving, reducing risks by seeking preventative services, and coping.29 Additionally, clinicians should help
patients identify factors that help self-management and burdens, and factors that hinder behavior change.29
Implementation of structure and use of technology to increase counselor and social support are important and
effective strategies to achieve optimal behaviors.30 Proactive management by care providers and self-
management by patients is warranted and has demonstrated positive outcomes.26,29

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