Shape Up America! Newsletter
Ready? Get Set! Go!
by Barbara J. Moore, PhD
Our July 2006 issue began a multi–part series on
getting motivated for weight loss. It presented the
of change that a person moves through in order
to lose weight. Most people fall into the
“contemplation” stage of weight loss, meaning they
are thinking about losing weight but are not ready
to take action. So, this month, we focus on how to
begin a discussion to motivate change.
Part II: Are You Ready to Lose Weight—or Just Thinking About It?
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
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
questions and frame the discussion so that Terry is
- 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
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
- Respect. If you do not respect Terry,
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
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
- Time Course. People who are overweight
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
- 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
- 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:
At what age did Terry become overweight? (See time
course discussion above.)
- Has Terry ever attempted weight loss in the
- Did Terry actually lose weight? How many
- Why was it important to lose weight?
- What strategies led to Terry’s weight loss?
- What factors are responsible for Terry regaining
- How does Terry feel about the weight regain?
- How important is it to Terry to lose weight
- 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
- 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
- Does Terry understand the role of physical
activity in weight loss and weight maintenance?
- 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
- 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?
- 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
- 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
- What is Terry’s attitude toward food?
- Is food playing an emotional role in Terry’s
- What does it mean to Terry to reduce or limit
- Do certain foods have special meaning to
- What is Terry’s attitude toward physical
activity and exercise?
- Is there any association of physical activity
- Does Terry associate any particular activities
with joy or pleasure?
- 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
- How is Terry’s weight influencing other family
- How has Terry’s weight affected her/his work or
- Is weight affecting Terry’s promotion
- 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.
Parenting Styles and Overweight: A Commentary
by Barbara J. Moore, PhD
The journal Pediatrics published a study by
Rhee, et al.1 asserting that different
styles can increase or decrease the risk of
childhood obesity. One frustrating aspect of the
study is that it focused on maternal parenting
skills and offered no insight into paternal
parenting skills or paternal/maternal interactions
that might influence childhood obesity.
Nonetheless, our goal here is to describe the
“AUTHORITATIVE” parenting style that was associated
with the lowest risk of childhood obesity.
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
- 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....”
- 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.”
- 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
- sit or play quietly (or refrain from
interrupting) while adults are having a
- be agreeable about an unexpected change in
- accept a new babysitter or caregiver without
- be patient when trying to do something
- go to bed without a hassle?
- refrain from interrupting when you are on the
- show self-control when disappointed?
- stay in bed once put to bed?
- be on “best behavior” when you are in public
(e.g., church, store, bus, or train)?
- wait his or her turn without fussing?
- control anger outbursts (e.g., no kicking,
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.
International Walk to School Day
On October 4 and throughout the month, millions of
children and adults around the world will walk to
school for a purpose—to promote health, physical
activity, safety and concern for the environment.
Now in its 10th year, International Walk to
has involved over 3,000 schools across the US and
nearly 3 million walkers in 36 countries. Children,
parents, teachers and community leaders are
encouraged to join together for a day (October 4),
week (October 2-6), or month of walking. For more
information and tips on how to organize, promote and
register for International Walk to School
Recipe of the Month
Eggplant soaks up oil like a sponge. To cut down on fat and calories, try baking, broiling, grilling, or microwaving eggplant instead of frying. This baked Stuffed Eggplant recipe provides just 3 grams of fat per serving.
- 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
- 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.
- 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.
- 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
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Editor: Adrienne Forman, MS, RD