Lowering Cardiometabolic Risk Begins With Change
Approximately 39% to 49% of the world’s population has overweight or obesity. Additionally, about 62% to 76% of people around the world have overfat, or excess fat that poses a hazard to one’s health.1
There are several contemporary factors related to overweight, obesity, and overfat that contribute to the risk for cardiometabolic syndrome, according to Eileen O’Grady, PhD, RN, NP-BC, certified nurse practitioner and wellness coach. These factors include physical inactivity, poor nutrition and food choices, neglecting self-care, and avoiding crucial conversations with physicians about cardiometabolic risk and how making lifestyle changes can improve this risk.
Consultant360 spoke with Dr O’Grady, who recently presented “Putting the Patient First: Motivating Your Patients to Lower Cardiometabolic Risk” on October 20, 2017, at the Cardiometabolic Risk Summit in Dallas, Texas.2
Consultant360: What are the stages of the human change process?
Eileen O’Grady: It really begins with resistance. We often don’t acknowledge this, but change tends to begin with no interest in changing. Then, something sparks us to move out of that mind-set.
Next, we enter into contemplation, which is the stage of ambivalence. This is likely the most common stage for patients with cardiometabolic syndrome. During this time, they often want to change, but at the same time, they do not want to change. They may have tried in the past and failed, or they may have a low level of self-efficacy, or the belief that they do not have the capacity to actually change. It is similar to having one foot on the brake, and the other on the gas. Patients can stay stuck in the contemplation stage for decades.
Once a personal motivator has been activated, patients move through the preparation and action stages much more quickly. When the change becomes habitual, the new behavior does not require any thought. Habits, or automated actions that require minimal cognitive load, are the ultimate goal.
When patients reach the stage of maintenance, they may need new strategies to continue their new habits. They may need to remain vigilant about keeping old habits from creeping back in, and they may need to have a plan in case of a short-term slip or a long-term relapse.
C360: Why are some patients hesitant or resistant to lifestyle changes?
EO: For the most part, it is due to a lack of self-efficacy (the belief that they can’t be successful in changing), or they may not yet have identified a strong personal motivator.
It is long and hard to undergo sustained lifestyle change, and it cannot happen without a “jet pack” of motivation. This type of motivation can often be excavated by a clinician through questions such as, “If you stay on this course, what will your future be like?” Hitting rock bottom or pain points often work, too, but this scenario can sometimes be hard for clinicians to create.
C360: What barriers do practitioners face in motivating their patients to make these changes?
EO: A lack of time is a common barrier. Giving advice in the early stages of change is often counterproductive, because it can drive patients deeper into resistance. Moreover, , many practitioners only engage with patients in the same way, by giving advice /expertise, regardless od their stage. So Stage mis-matching is a barrier. Preparation or action, the later stages of change is s really the only time when advice is useful in lifestyle change.
An office visit alone is often not very conducive to change, and practitioners may lack the infrastructure for supporting patients through lifestyle changes. This includes having access to programs with coaching, which have the best evidence for intentional changes in adults.
C360: What strategies do you use to overcome these barriers? How do you motivate your patients?
EO: For the most part, motivation comes from excavation, which includes asking powerful questions and identifying patients’ highest priorities in life. Often, patients will not realize that their health or a large weight loss is their number one priority, and they will often act as if it is a peripheral one.
In my practice, I help patients place their highest life priorities at the center of life, and align their actions with their priorities. I often suggest to patients that anybody who watches their day-to-day life and actions is able to see what their highest priorities are. When they realize that they are not acting on their highest priorities, it creates an existential distress. This kind of distress can often be relieved by aligning patients’ core values with their actions.
Additionally, having a pain point, such as a hospitalization, a new level of disability, or even an unflattering photo can serve as “jet fuel” for change.
C360: What conversations should practitioners have with their patients in order to help initiate the process of change?
EO: Practitioners should ask patients about their priorities, what they long for, and what is most important to them. Then, they can acknowledge what each patient wants, and ask how they can help them achieve those goals.
C360: Are there certain skills that patients should learn in order to change their health behaviors?
EO: Practitioners can often identify patients’ character strengths that may be evident in one part of their life, and help them use it on their health journey. For example, if a patient has a strong love of learning, they could unleash that ability and learn more about nutrition: how to deal with cravings, the impact of sugar on the brain, and so on.
Using strengths from other parts of a person’s life where they are successful can be very effective. For example, with a businessman who knows how to close a deal—how can that be used to achieve a 100-lb weight loss? There is a treasure trove of science from industrial psychology, human resources, positive psychology, and other fields on the science of goal setting and goal attainment that can be implemented in the health care realm.
—Christina Vogt
References:
1. Maffetone PB, Rivera-Dominguez I, Laursen PB. Overfat and underfat: new terms and definitions long overdue [Published online January 3, 2017]. Front Public Health. https://doi.org/10.3389/fpubh.2016.00279.
2. O’Grady E. Putting the patient first: motivating your patients to lower cardiometabolic risk. Presented at: Cardiometabolic Risk Summit; October 20-22, 2017. Dallas, TX. https://cardiometabolicrisksummit2017.sched.com/?iframe=no.