Motivation is “a person’s expressed degree of readiness to change”¹

A person must be READY to make a change, or it simply won’t happen. And it doesn’t happen overnight. Even if a person says, “I suddenly decided to do it,” the groundwork leading to the decision to change may have been laid over many months or even years.

Applying the framework of Rollnick, et al.¹ to weight loss, the two key factors that can increase motivation to change are 1.) raising a person’s appreciation of the IMPORTANCE of weight loss and 2.) increasing a person’s CONFIDENCE that (s)he can make the necessary changes to lose weight.

Let’s assume you are trying to help someone named “Terry” to lose weight. You first need to know how much importance Terry gives to losing weight. Start a casual conversation with Terry that eventually leads to a question, such as “On a scale of 1 to 10, how important is it for you to lose weight right now?” As you proceed with this discussion, keep these important points in mind:

• Rapport. You need to establish a rapport with Terry. Explain that you want to learn more about Terry and the context in which (s)he is living. To “break the ice,” encourage Terry to describe, in detail, a typical day. Ask Terry to include the meals and snacks eaten and work-related and leisure time physical activity. Allow Terry to do most of the talking. As you listen, note Terry’s level of stress, family support, resources or anything else that seems relevant to Terry’s life and feelings.
• Sensitivity. Weight is a sensitive issue. Tread softly and take great care to choose words, ask questions and frame the discussion so that Terry is not offended.
• Feelings. Through your discussions, Terry’s feelings will inevitably emerge and must be sensitively addressed. It is essential to create a safe environment for Terry to express feelings freely. A professional trained in weight loss counseling will know how to handle those feelings.
• Trust. At first, Terry may be hesitant to trust you. For example, if you are overweight, Terry may think, “Who are you to counsel me?” If you are normal weight, Terry may wonder, “How could you possibly understand my plight?” Both of these sources of distrust must be addressed sensitively and honestly. Ultimately, Terry will decide if the chemistry is right and if trust can be built between you.
• Respect. If you do not respect Terry, you are NOT in a position to help. So listen carefully to your own choice of words and attitudes for signs of respect. If you can not help Terry build and maintain self-respect, chances are you can not move forward. If you discern that Terry lacks self-respect, that is a foundational issue for you to address together.
• History. You need to learn where Terry has been and how that experience has shaped Terry’s current attitudes, feelings and behavior. It is possible that a history of verbal, mental, physical or sexual abuse is associated with Terry’s weight, so you should be prepared for some difficult and highly sensitive topics to emerge. Obesity may be a consequence or a cause of Terry’s experiences, and may have some positive as well as negative value for Terry.
• Time Course. People who are overweight often want RAPID weight loss. To build the time course of Terry’s weight gain, start by asking “How much did you weigh when...” By identifying milestones like graduations, marriage or the birth of children, you can attach dates to specific weights. It may be useful later in showing how weight gain often builds slowly over time and how weight loss and improved health also change slowly and incrementally over time.
• Listen. Be prepared to give 100% of your attention to Terry and to stop at frequent intervals to make sure you have heard correctly and that you understand not just the notes of the song, but the melody.
• Agenda. Setting the agenda and identifying topics for discussion is a responsibility of both parties. But Terry should be the one to identify priorities and to choose a topic when (s)he feels ready to discuss it.

Once rapport is established and you understand the importance of speaking with Terry in a sensitive and constructive manner, you can begin to explore Terry’s feelings and aspirations about weight. Frame the discussion about weight in terms of health and well being. Do not make moral judgments.

Here are some questions that you may wish to ask:

1. At what age did Terry become overweight? (See time course discussion above.)
2. Has Terry ever attempted weight loss in the past?
   If yes:
   • Did Terry actually lose weight? How many pounds?
   • Why was it important to lose weight?
   • What strategies led to Terry’s weight loss?
   • What factors are responsible for Terry regaining weight?
   • How does Terry feel about the weight regain?
   • How important is it to Terry to lose weight now?
   • How confident is Terry that weight loss is possible at this time?
   • What is happening in Terry’s life now? Is this a good time to consider trying again to lose weight?
   • Did physical activity play a role in Terry’s previous weight loss efforts?
   • If so, what types of activities (team sports, partner activities like tennis, or solo activities like walking, biking, swimming) did Terry participate in?
   • Does Terry understand the role of physical activity in weight loss and weight maintenance?
   If no:
   • How does Terry perceive her/his weight?
   • Does Terry consider that there are benefits to being overweight? (i.e., does overweight offer Terry some type of emotional protection?)
   • Does Terry consider that there are negative consequences – physical, social or emotional – of being overweight?
   • Was Terry physically active when younger? If not, why not?
   • What types of activities (team sports, partner activities like tennis, or solo activities like walking, biking, swimming) does Terry prefer?
3. What is Terry’s weight-related health status?
   • Clarify the definitions of overweight and obesity in terms that Terry can understand.
   • Does Terry know her/his BMI or body fat percentage?
   • Does Terry know the health risks associated with that BMI or body fat percentage? Consider using the Shape Up America! e-Guidance for the Treatment of Adult Obesity to help assess Terry’s weight-related health risk.
4. What is Terry’s attitude toward food?
   • Is food playing an emotional role in Terry’s life?
   • What does it mean to Terry to reduce or limit food intake?
   • Do certain foods have special meaning to Terry?
5. What is Terry’s attitude toward physical activity and exercise?
   • Is there any association of physical activity with punishment?
   • Does Terry associate any particular activities with joy or pleasure?
6. How has Terry’s weight affected her/his sex life?
   • Is Terry’s “significant other” neutral, turned off or turned on by Terry’s weight?
   • Will weight loss jeopardize Terry’s relationship?
   • How is Terry’s weight influencing other family dynamics?
7. How has Terry’s weight affected her/his work or vice versa?
   • Is weight affecting Terry’s promotion prospects?
   • Is there any aspect of Terry’s work that is exacerbating weight gain?

Monitor Terry’s status frequently – both the stage of change, as well as feelings – by asking questions. It is helpful to ask questions so that the response covers a range. For example, “On a scale of 1 to 10, how do you feel about....” You can use the response to continue your discussion. Also, you can ask the same question again at the end of a discussion in order to gauge progress.

If these discussions go well, you should have a clear picture — from Terry’s perspective — of how and why Terry gained weight in the first place and how it has impacted Terry’s life. Use the knowledge gained to help you move forward in your weight loss discussions with Terry. Next month, we will continue with how to increase motivation by building the importance of weight loss and building confidence in your ability to lose weight.

There are two key domains of authoritative parenting that were identified: 1.) maternal sensitivity, which was evaluated by means of videotaped interactions between parent and child, and 2.) maternal expectations for self control, which were evaluated by means of a questionnaire. An authoritative parent had to score well in both domains, meaning that she was sensitive to her child but had high standards regarding her child’s behavior.

Maternal sensitivity required good scores in three areas: the presence of maternal attention and emotional support, respect for the child’s autonomy and the absence of hostility. These elements are explained below:

1. Support. The supportive parent offers attentive and consistent emotional support and recognizes the “child’s successes, no matter how small.” In addition, the supportive parent “displays confidence in the child’s efforts....”
2. Respect for Autonomy. If a child misbehaves, the respectful parent will redirect the child without undermining the child’s self respect. In a “negotiation” with the child, the mother may insist that her “course of action be followed, but the parent continues to acknowledge the child’s perspective in this interaction.” This would contrast with the parent who “is intrusive and forceful in controlling the child.”
3. Hostility. The non-hostile parent “shows no sign of rejection” of the child. “The parent may not be supportive but does not put down the child in any way.” In contrast, the hostile parent “does not show warmth and is easily irritated by the child.”

Maternal expectations for self-control might be better understood as setting clear “standards of behavior” for the child. Eleven key questions were used to evaluate maternal expectations. Those questions asked, “How often do you expect your child to...”

1. sit or play quietly (or refrain from interrupting) while adults are having a conversation?
2. be agreeable about an unexpected change in plans?
3. accept a new babysitter or caregiver without complaint?
4. be patient when trying to do something difficult?
5. go to bed without a hassle?
6. refrain from interrupting when you are on the telephone?
7. show self-control when disappointed?
8. stay in bed once put to bed?
9. be on “best behavior” when you are in public (e.g., church, store, bus, or train)?
10. wait his or her turn without fussing?
11. control anger outbursts (e.g., no kicking, biting, scratching)

In this study, “authoritative” parents set high behavioral expectations for children, but remained respectful of the child’s perspective and of developing autonomy. This style of parenting contrasted with permissive, neglectful or authoritarian (dictatorial) parenting styles, all of which were associated with a higher risk of obesity than the authoritative parenting style.

INGREDIENTS:

• 1 1/2 cups bread crumbs
• 2 eggplants
• 2 tomatoes, diced
• 1/2 cup green bell pepper, diced
• 1/2 cup onion, diced
• 1/3 cup celery, diced
• 1/8 Tbsp. salt
• 1/4 Tbsp. black pepper
• 2 Tbsp. fresh parsley, minced
• 2 Tbsp. parmesan cheese
• Vegetable cooking spray

DIRECTIONS:

1. Preheat oven to 350º F. Cut eggplants in half lengthwise. Scoop out and save the flesh, leaving the shells 3/8-inch thick. If necessary, trim a small piece off the bottom of each shell so it won't tip over. Set aside.
2. Coat large skillet with vegetable cooking spray. Chop up reserved eggplant and add to skillet. Add tomato, bell pepper, onion, celery, salt, and black pepper. Place skillet over medium heat; cover and cook about 5 minutes, until vegetables are tender.
3. Remove skillet from heat. Stir in bread crumbs and parsley. Spoon mixture into the hollow eggplant shells. Arrange stuffed shells in a shallow baking dish coated with vegetable spray. Sprinkle 1 1/2 tsp. Parmesan on top of each shell. Bake for 25 minutes, until filling heats through and top is golden brown.

Nutritional analysis per serving: 269 calories, 9 grams protein, 3 grams fat, 52 grams carbohydrates, 1 milligram cholesterol, 9 grams fiber, 419 milligrams sodium

Source: 5 A Day recipe http://www.cdc.gov/nccdphp/dnpa/5aday/recipes