Question 1
Both the case management and usual care groups were allowed to join other weight management or diabetes programs outside of the ICAN program. As an RD, is there an additional weight management or diabetes program (Overeaters Anonymous, bariatric surgery, etc.) you would recommend to your patient? If so, which program would you recommend and how would it add to the ICAN program? If not, how will you ensure your counseling sessions will be successful?
posted by Anonymous @ 7:05 PM
14 comments
14 Comments:
Since many studies have not proven the long-term effectiveness of weight loss programs, I wouldn’t necessarily recommend it to the patient, but would allow them to make the choice on their own (and also help them research the program’s credibility and has realistic goals). However, some clients might require that extra support that a weight management program may offer in which case they might benefit. Even if they don’t lose extra weight by joining these programs, it may help prevent them from going back to their old ways by finding others to identify with or by having an extra program that reinforces the objectives of ICAN. A diabetes program would be beneficial in management of their disease since I have seen many clients struggle in really understanding proper management of their diabetes—even though they had the initial education, they need encouragement, reassurance, and also need to be reminded how to go about a healthier lifestyle.
Naturally, I have to support the Lap-Band system for weight loss. This surgical approach provides very healthy rates of weight loss, and has very limited complications. I would want to make sure that the surgeon had good credentials, and that he had a multi-disciplinary staff composed of nurses and dietitians to help these patients along with their food choice and behavioral modifications. While the Lap-Band obviously helps restrict the patients portion sizes, they also need help from professionals to follow different lifestyle modifications to be completely successful- this is where the multidisciplinary team would come into play in patient care. This approach would obviously be for the morbidly obese patient; for patients who may not qualify for such a radical intervention, I would look through different behavioral modification programs with the patient or simply refer them to another RD specializing in wellness and weight loss. To ensure that my counseling sessions were successful for a patient with Diabetes, I would definitely give them the initial education session. Explaining the etiology of the disease and the effects of food and activity on blood glucose levels may help to motivate patients to take ownership of their condition. Then with the follow-up sessions, I would set apart time for re-education, discussion of previous goals and attainment, and new goal setting for diet, behavioral modifications and activity levels.
I don't know that I have specific weight loss programs that I would recommend and I am skeptical to recommend surgical treatment without first making every attempt to lose weight in a more natural way. I would however encourage good communication with the members of the ICAN program and get their feedback on what they think would help them best achieve their weight loss goals. Sometimes the simple act of having to be accountable to a weigh in group or an RD is enough to motivate someone. There are numerous weight loss programs available for obese patients and diabetics now I think it would be best to talk with the client and direct them based on their individual needs.
Annie-
I definitely agree. I think you should discuss different things with the patient to determine their “style” and level of motivation to make lifestyle alterations. I think that different programs can be highly effective for different people- but you have to make those personalities match!
At this time I am not familiar with other programs. However, if I felt a patient needed extra support I would help them find that. I would certainly make sure that whatever program I sent them to, that the people running it were qualified to handle the situation. I would hope that I would meet the needs of the clients in our counseling sessions. I think for that to be successful you need to provide continuous support whether through meetings frequently or even over the phone or email. It is also important to tailor the counseling sessions to the individual. As we all know what works for one person may not work for another, to be successful you have to take into account who the client is and how you can help them change!
Steph-
I completely agree that patient success is largely influenced by continuous support as well as individualized counseling sessions. As an RD, it's important to realize that there is no one cookie-cutter method that will work for all patients and that we have to be flexible and creative in finding ways to help the patient succeed.
I think that the client attitude towards weight management would be the route I take towards suggesting a program or not. If I believe that my client can be complient to my education sessions and try to follow my advice at home, I do not think that they should have to pay extra for another program unless they absolutely wanted to! There are many other options to weight loss management, those programs supported by the medical field, surgical procedures, and other programs (ie, support groups) that are not guided by medical staff. Like I said before, I am not really sure that I would push a program on my clients unless they showed interest in utilizing other resources. If that was the case, I would find out as much information about the program in order to help the client be able to make a well thought out decision. I would hope that with the support and motivation of myself, these patients would not have to look to other resources, unless it was to just talk to someone who is maybe going through the same experiences. In that case, then I could be the one that is the knowledge/education source when questions or trouble occurs.
I think group support is very important in weight loss treatment. Individuals within the ICAN program can support each other along with the dietitian leading discussions. By having a group of people in the same situation as themselves, it makes for a comfortable environment. The group can discuss struggles with their weight loss as well as motivate each other to continue on within the program. If someone within the program would not like group support, I would also suggest individual counseling sessions. I think that being able to discuss everything they have to go through will help motivate them and validate their reasons for continuing their weight loss goal. I would not recommend surgical treatment for weight loss right away, although this particular treatment for weight loss should be on a case-by-case basis.
Karlie,
I liked to how you said that you would allow for re-education in your counseling sessions. I think that it is very important for the client to grasp the entire concept of the disease and by discussing the background mroe than once, it will allow the client to learn even more about their disease.
First off, I would suggest nutritional methods rather than surgery. I think too many people jump to surgery as the answer even before trying to reduce calories and more intense exercise. I don't know if I would suggest one certain type of treatment for each patient because each person will require a different method of support to be successful in their goal of weight loss/lifestyle changes. I would just encourage a patient to join a program that works for them and keep me informed about the progress they are making as well as whether or not they feel this program is helpful for them. I think any program that helps someone achieve their goal in a healthy way can add to the ICAN program.
I would need to gather more information on the patients' lifestyle, current readiness for change and past attempts at weight loss before I would recommend any surgical approach. With any surgery there are complications and with bypass often an entire "overnight" lifestyle change that the patient must be truly ready to cope with. People often just have the end result in their mind but forget the long struggle in between. Even with surgery, there is an often loong struggle that can encompass not only the patients' weight loss but a change in their body image, their relation to food, etc.
Ultimately, for every patient, one must consider what "fits" while keeping their health and well being in mind.
Lauren-
I agree that too many people jump into surgery, rather than put in some effort and lose weight by changing eating habits and their lifestyle. And all patients will require different treatment plans to be successful!
Shanell,
I completely agree that patients will require group support in order to be successful. People gravitate towards others in their same situations because they share a common goal and can relate to the different difficulties that they are going through. Through group support people are able to reassure the changes they are experiencing as well as to help urge them along to success!
Shanell,
I like how you referred to motivational factors that clients may be looking for with other people in the group. I know that sometimes when clients are talking to us in the back of their minds they are probably thinking that we don't understand what they are going through! When they are placed in a group situation, however, they have the support of each other which is sometime the best motivation. These people mostly likely will form bonds that will help them, especially in the beginning, become motivated to lead healthier lifestyles!
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