A guide to preparing a patient to view setbacks as learning opportunities and how to deal with variety of situations.

Maintaining healthy weight has many health benefits and can positively impact many clinical issues. However, it is also something that requires consideration of ability and opportunities to do so, as well as thoughtful and consistent planning and a sustained motivation: complex sets of behaviours and processes that can be truly challenging. Thus, although it might be easy or automatic to slip into assuming that they are not truly motivated or don’t care to lose weight, it is in fact the case that Overweight patients and patients with obesity have lost many pounds throughout their lives, though their efforts in achieving and maintain a healthy weight might have been affected by many different factors, some of which often outside the person’s control. For example, we know that deprived areas have a higher percentage of fast food restaurants and outlets. If someone trying to lose weight happens to live around such environment, their efforts are likely to be made more difficult to sustain/ maintain, especially if they must travel further afar to buy healthier food options and there is a lack of or infrequent transport. Additionally, it has been well documented that people who are overweight or with obesity are perceived as lacking in will power, lazy or as unreliable. Such stigma leads to both external and internalised pressure and perceptions that a person is a failure, social isolation and contributes to mental ill health. Holding such negative perceptions is likely to contribute to a decreased sense of self-esteem and self-efficacy, reducing the motivation to engage in behaviour changes that could lead to successful weight loss. It is not uncommon for people to fall for the pit-falls of negative thought scrips that maintain ill mental health contributing to social isolation, and reduced functioning and wellbeing. Thus, healthcare professionals should express empathy and understanding, rather than impatience and frustration with their patients who appear to struggle with weight loss or other life style behavioural changes they consider vital to improve their health condition.

One such way of doing so is by reframing set-backs as opportunities to learn from experience and using these to help patients build their self-efficacy and self-esteem.

How do we do this?

Health professionals are encouraged to be curious with their patients about previous attempts of weight loss. An open questions such as “Tell me about your previous experience of weight loss” would be enough to encourage the patient to share their story and experience. It is important to give enough time to the patient to tell their story, as well as to refrain from making statements based on assumptions or prior medical knowledge, as this will be experienced by the patient as disempowering and have a negative effect on engagement.

Once the patient has told their story, the health professional should be able to empathically reflect on what they have understood and encourage further understanding into what went well last time for the patient. By making an active choice to pay attention to the achievements a person has made, the health professional communicates affirmation about the person’s efforts, building on their autonomy and self-efficacy.

It would be important to find out what did not go so well in their previous attempts, too, but this should not be extensively explored. Furthermore, words such as “wrong”, “failure” and “failed” should be avoided. Instead the healthcare professional should empathically reflect on what their patient has told them, to communicate that they have listened attentively and understood the patient’s reality.

You have identified previous experience and set-backs. What next?

It is important to remember that people’s circumstances and context change over time. Thus, what was helpful or unhelpful in the past might no longer be relevant. This is another reason not to focus too much on what didn’t go so well last time. Instead the healthcare professional should press on and facilitate a conversation about possible changes in the future. An empathic summary of what the patient has struggled with followed by an open question such as this: “It sounds as though you have been successful with weight loss in the past, but things had got in the way and made things more difficult for you. How do you feel about losing weight now?” would be enough to encourage the patient to focus on thinking about what might be possible now. This will open-up the opportunity to explore options about what can the patient to do help themselves, how they can make use of their resources, and how can the practitioner support them in doing so.

The confidence scale and planning ahead

Once the health professional and the patient have agreed on what the patient would like to do to make changes, the healthcare professional might want to check with the patient about how confident they feel they would be at achieving the set out task or goal. This is important because it helps both the patients and the health professional to measure expectations. Being realistic about what is achievable acts as a preparation about what might happen or what to expect. Guiding the patient to become aware of doubts or things that might get in the away from the outset, can help the patient put forward some planning or think about different options they can make use of, if things do not work out as expected.

Being realistic about what is achievable, planning ahead and identifying different options would all act as “risk plan” as it were, or a buffer for the person to fall back onto if their efforts to lose weight are impacted by factors that are out of their control or come about unexpectedly. Finally, the health professional should also aim to guide the patient to think about identifying things that they enjoy or feel able to do or achieve as this will further build on their self-efficacy and be more enjoyable to engage with.