Coming across setbacks is completely natural when we’re making substantial changes to our lifestyle. Clinical Physiologist Sonya Tsancheva shares effective ways to support your patient when they encounter setbacks.

Maintaining healthy weight has many health benefits and can positively impact many clinical issues. It is a process made up of complex sets of behaviours that require thought, consistent planning and sustained motivation. To maintain healthy lifestyle, one needs to have the physical and psychological ability and social and environmental opportunities to do so.

Overweight patients, and patients with obesity, have lost many pounds throughout their lives. However, their efforts in achieving and maintain a healthy weight can be affected by many different factors, some of which are often outside of their control but contribute to or cause their struggle with weight.

For example, deprived areas have a higher percentage of fast food restaurants and outlets. If someone trying to lose weight happens to live in such environment, their efforts to change their diet are likely to be made more difficult, especially if they must travel further afar to buy healthier food options and there is inconvenient, infrequent or unreliable transport. Overweight and obesity are associated with social stigma, social isolation and mental ill-heath, all of which are associated with poverty and deprivation. Healthcare professionals are therefore encouraged to keep in mind the heterogenic causes of overweight and obesity and approach supporting their patients with empathy and understanding.

Additionally, it has been well documented that people who are overweight or obese 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. Healthcare professionals should express empathy and understanding 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 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?

Be curious with your patients about their previous attempts of weight loss. Open questions such as “Tell me about your previous experience of weight loss” is enough to reassure the patient to share their story and experiences. 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 is disempowering and have a negative effect on engagement.

Once the patient has told their story, you can empathically reflect on what you 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, you affirms the person’s efforts, building on their sense of 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” must be avoided. Instead, maintaining an empathic stance and reflecting on what your patient has told you communicates that you have listened attentively and understood the patient’s reality.

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

People’s circumstances and context change over time. What was helpful or unhelpful in the past might no longer be relevant. 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.