Question 3
Weight loss appears to plateau for most interventions around 6 months. In the discussion they mentioned that the focus on weight loss must eventually turn to weight loss maintenance. If you were counseling a patient on weight loss, how would you change your focus/education once the patient had achieved some weight loss in order to help them maintain their weight loss?
posted by Steph @ 4:42 PM
12 comments
12 Comments:
If research shows that most weight loss occurs in the first six months, and then there is generally a lapse in success- that is when you would need to re-evaluate your plan and make adjustments accordingly. I think that you should keep the patient on whatever kind of plan you had them on (as long as they were successful with that plan initially). The little changes that you need to make can be found by continuously looking at their daily patterns and habits to find areas for them to work on. This can be done with the patient, so that they are able to see what areas they are doing a really good job with (always encourage them so that there are no lapses!) and also what areas still need improvement (face it- there is always something in everybody’s lives that we could do better at!). Setting and re-setting goals with the patient involved will help keep them striving for that next level of health, thereby maintaining their current weight, or even losing additional weight.
I would emphasize that weight loss may lessen once they reach their weight set point and not to be discouraged by this. If they realize this before it happens or early into that stage, they might be less disappointed and thus less likely to give up and regress to old lifestyle and eating habits. I would focus on maintaining eating and exercise habits that they enjoy (this is key) and feel they could maintain for life. I would also encourage them to try new foods and new forms of exercise to keep from getting bored and to continue to challenge their body so they don’t get too “comfortable” with any one workout.
Changing behavior is often easier than maintaining that behavior change, so we prepare them with the skills to manage their weight loss. This is through the key players in maintenance: diet and exercise. We use the basic principles such as commitment to low-fat diet (healthy fats), eating breakfast regularly, frequent high levels of daily activity, and frequent self-monitoring and we build on them. This could be with goals, short term and long term, new recipes, new activities, ideas to keep them interested. Instill in them that it is a life long journey and that the struggle with weight does not disappear once they have reached their goal weight. Must be honest with them, explain that there will be hard times, but that you will work together to keep them motivated and to keep the weight off. One thing that I would encourage is writing down everything they eat, not always to analyze, but to keep them aware of what is going in their mouth. Hopefully, this will also help them self-monitor and met their short and long term goals.
Once the patient has reached their peak of weight loss, I would discuss with them how to maintain their weight loss. I think patients find it easier to start a diet regimen until they reach their peak point, but then they return to their old habits hoping that the weight they lost will stay off. However, discussing simple tips on how to maintain their weight loss through the diet and exercise regimens that were discussed with the patient previously will help to maintain the weight loss. Also suggesting to the patient to look up new healthy recipes to incorporate into their diet or new exercising techniques can also help keep the new lifestyle more feasible and interesting.
Shanell-
You make a great point that there are many people or patients that will follow a diet/lifestyle changes until they reach their desired weight or until they stop losing weight then revert to their old habits. This could be due to thinking their weight problem is "solved" and now they think they can do whatever they want or it could be that they become frustrated and give up. Whatever the reason, it is our job as their dietitian to encourage and emphasize maintenance.
At the point of weight loss maintenance the patient already has a clear understanding of healthy food choices. From here I would reiterate and emphasis the importance of healthful eating and the other benefits besides weight loss that can come from these healthy foods. I would also explain that the healthy food choices tend to contain antioxidants, a decreased fat content, etc to help decrease the incidence of heart disease, diabetes, hypertension, etc. I think this would help the patient to realize that even though they may not be losing significant amounts of weight they are helping themself to be healthy. This may give them motivation to continue eating by healthy guidelines.
First off, I think it is important to mention that even though the weight loss is starting to level off and loss is not happening quite as quickly, it is still important to make sure that you are encouraging the clients. Sometimes when you make drastic changes, you see that you are able to fix it relatively quickly (lets face it 6 months is not a very long period) and it is still easy to continue old habits, especially if you think that you worked hard and a little cheating is okay. So, I think that it is extremely important for these clients to continue to focus on weight loss (if not at IBW) as well as moving this attention to maintaining the hard work they have completed thus far. Encouraging your clients is the best motivation because they really have worked hard during the first 6 months, why let them give up now! I think it is great to give them new ideas to be able to continue/maintain weight loss such as giving them suggestions on physical activity during time periods that you could normally remain idle (ex: jumping jacks during commercial breaks) or giving them a new healthy food option to try for the week! Many times, I believe, it is the lack of researching our resources of maintaining the weight loss that lapses us back into old habits!
Vanessa- you had a very good point about being honest with the patient up-front about weight plateaus and potential slows in weight loss that will likely occur throughout their venture. If they know this upfront, I would think that they would be much more likely to remain encouraged during that time and continue working on their good habits rather than falling off the bandwagon and returning to their old habits.
I would focus with the client on the importance of maintaining small goals throughout. For example if someone wants to lose 50lbs then I would also suggest setting smaller weight loss goals that are achieved over time. Also, at that point of 6 months might be when a person needs extra support. This would be a good time for a follow up appointment where goals are reevaluated and challenges are addressed. It would also be a good time to discuss new ideas for weight loss to break up the monotonous behavior that may have developed over the past 6 months.
Jo
I agree with your tips for keeping active; jumping jacks, squats, etc during tv commercials. It looks as if we are all aware of educating our pts. that baby steps, small realistic goals, really do work. We have to keep are pts. motivated. Sometimes giving them different goals to work towards lets them focus on achieving the small goals and decreases their discouragement. For example, giving a month of little daily goals to focus on such as: Monday drink 8 eight oz. glasses of water, Tuesday park the car in the back of the parking lot etc.
Jo
I agree with your tips for keeping active; jumping jacks, squats, etc during tv commercials. It looks as if we are all aware of educating our pts. that baby steps, small realistic goals, really do work. We have to keep are pts. motivated. Sometimes giving them different goals to work towards lets them focus on achieving the small goals and decreases their discouragement. For example, giving a month of little daily goals to focus on such as: Monday drink 8 eight oz. glasses of water, Tuesday park the car in the back of the parking lot etc.
Karlie,
I agree that after the plateau, you definitely need to make adjustments to the weightloss plans. This could be because their metabolism is changing and they need to adjust their caloric intake or focus on different portion sizes. I also think it a wonderful idea to work side by side with your clients and not just always do the explaining, but let them explain to you where they think that can improve!
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