Motivational Interviewing - Unhealthy Eating

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Transcript - Motivational Interviewing – Unhealthy Eating

(Music playing in the background over opening text on screen.)

Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle

(DR. VALLIS stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)

Text on screen:
Dr. Michael Vallis
Queen Elizabeth II Health Sciences Centre
Dalhousie University

DR. VALLIS: Unhealthy eating is a significant risk factor for obesity and chronic disease. But when it comes to actually changing their eating behaviours, many people are ambivalent to doing so. That is, they have conflicting feelings on the issue. In this scenario, you’ll see a doctor-patient interaction in which the patient expresses a high degree of ambivalence toward healthy eating. When she takes the time to think about her weight, blood pressure and lipid levels, the patient becomes concerned and would like to change her eating habits to improve her health. But when she isn’t thinking about her health - when she’s simply living life on a day-to-day basis - the pleasure of eating and the role food plays in relieving stress makes eating healthy difficult to achieve. To help patients recognize their ambivalence toward healthy eating, physicians should draw on the full range of motivational interviewing techniques. By using the 5As - ask, assess, advise, assist and arrange - in combination with the 5Rs - relevance, risks, rewards, roadblocks and repeat - physicians can better understand why a patient eats unhealthy foods, and then make realistic recommendations to help improve their health over the long term.  

(Background music)

Text on screen:
Addressing the Risk Factors for Chronic Disease:
Unhealthy Eating

(A male doctor and female patient are interacting in an examining room.)

DOCTOR: Deena, now that we’ve established there’s been some increase in your blood pressure and your weight since our last visit, I wonder if I could ask you some questions to see if you’re interested in making some changes in your lifestyle that would improve your health?

PATIENT: You’re not going to give me a lecture, are you?

Text on screen:
Ask

DOCTOR: Not at all. I don’t want to make a judgment and I don’t want to give a lecture. I just wanted to know whether you’re concerned about your health and if you’re interested in making some changes.
 
PATIENT: Well, I am concerned about my weight. Over the past few months, my eating’s gotten out of control.

Text on screen:
Assess / Relevance

DOCTOR: What about you eating do you consider to be a problem for your weight and blood pressure?

PATIENT: I’d say it’s eating junk food at night when I’m watching TV.

Text on screen:
Assess

DOCTOR: Do you know the reasons for doing that?

PATIENT: Mostly because I’m bored and it’s been really stressful lately.

Text on screen:
Assess / Risks

DOCTOR: That makes sense. We know that eating is a real source of pleasure. Given that it’s harmful to your health, do you think that you’re ready to make changes to your pattern of stress eating in the evening?

PATIENT: Yes, I think I really need to. But I’m not too sure how successful I’ll be.

DOCTOR: Could I make some recommendations?

PATIENT: Sure.

Text on screen:
Advise / Rewards

DOCTOR: We know that processed foods, such as junk food, are full of salt, sugar and fat, but we also know that it’s important to manage stress. I wonder if there are some other things that we could look at that would help you manage stress, rather than eating. Is that something we could help you with?

PATIENT: That makes sense. Any ideas?

Text on screen:
Assist / Roadblocks

DOCTOR: What about watching less TV? Or how about having a rule of not eating in front of the TV set? Or perhaps there are other ways of dealing with what’s causing you stress. Perhaps you might journal, or talk to a friend? Or doing something physical to distract you? I wonder if there’s things in that past that have helped you to deal with stress that you’ve found helpful.

PATIENT: I think that might work. Last year, when we got new family room furniture, we didn’t eat on it and that was helpful. I could try journaling. I have a friend who does that and she finds it helpful.

Text on screen:
Arrange / Repeat

DOCTOR: Why don’t you give that a try? I’ll follow up with you on the next visit. I think making these realistic changes will really help make a difference in the long run. I wonder if there are some things that you could do when you leave here that will help you in making these changes?

PATIENT: Well, I think if the whole family got involved, it would really help. I saw a lecture series at the local grocery store where there’s a dietitian involved. I think l might try that.

DOCTOR: Good idea. Let’s chat more about this on our next visit. And let me know how I can support you in this.

PATIENT: Okay. Thank you.

(Background music up. Fade to black.)

Text on screen:
THE COLLEGE OF FAMILY PHYSICIANS OF CANADA LOGO

Production of this video was made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.