Bariatric Times - June 2008 - (Page 12)

12 Practice Management Perspective Bariatric Times • June 2008 In the multidisciplinary team, THE NURSE IS THE KEY PATIENT CONTACT AND THE NEXUS FOR COMMUNICATION between team members. longer periods of exercise.21, 22 Three 10-minute walking sessions can seem far more achievable than a single 30minute session. The exercise specialist should guide patients toward small, achievable goals, such as adding one minute to a 10-minute walk, climbing one extra flight of stairs on the way to work, or adding 100 steps at a time to a day’s total. Pedometers are one of the most useful tools as individuals increase their physical activity. By increasing physical activity in small increments over time, patients are able to achieve longerterm goals of 10,000 daily steps or 175 minutes of movement/day— without frustration or a sense of failure. The crucial point is that patients should be encouraged to increase their physical activity throughout the day in any way possible, using a variety of lifestyle changes and planned exercises. THE BEHAVIORAL THERAPIST: MENTALLY PREPARING THE PATIENT Failure to maintain diet and exercise modifications may occur when a patient is not mentally prepared for long-term interventions. Many people participating in a weight loss program for the first time are nervous and afraid, which can promote resistance to change. Behavior therapy provides the mental preparation and structure that can help patients manage obstacles and identify and achieve their goals.23, 24 Motivational interviewing (MI), a directed, client-centered counseling style developed by Miller and Rollnick, recommends that caregivers roll with resistance.25 For example, statements demonstrating resistance to change should not be challenged by the clinician, but rather used as momentum to further explore the patient’s views.26 Using this strategy, behavioral therapists can gently approach the reasons for the resistance to necessary lifestyle changes (e.g., previous failures, lack of time, lack of knowledge, and an unsupportive environment) and address them directly. MI behavior counselors can use this theory to guide clients toward awareness of discrepancies between current behavior (e.g., late-night binging, sedentary lifestyles) and their goals, such as lower weight or increased health.26 As treatment progresses, individuals learn to work through their resistance on their own, and eventually come to define their own problems and solutions. After the benefits of losing weight have been firmly established, targeted goals must be created. Patients commonly set unrealistic “goal weights,” greatly overestimating the amount of weight they can feasibly lose and maintain; many are unaware that losing only 5 to 10% of initial body weight can significantly decrease the severity of obesity-related risk factors, includ- http://www.calomist.com http://www.calomist.com

Table of Contents Feed for the Digital Edition of Bariatric Times - June 2008

Bariatric Times - June 2008 Endoluminal Treatment Options for Morbid Obesity: Devices and Techniques for Natural Orifice Approaches The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers Acute Bleeding after Gastric Bypass Editorial Message Contents ASMBS: 25 Years Editorial Board Surgical Site Infection In The Morbidly Obese Patient: A Review Consultant's Corner The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation Volume Matters Journal Watch Advertiser Index

Bariatric Times - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.