Brief Nutrition Counseling for Obesity—15 Minute Version

Steps in Behavioral With more time available, your approach can include more patient
Counseling input and should involve negotiation of goals.
Assess From WAVE Nutrition Counseling Tool
Food intake and diet http://bms.brown.edu/nutrition/acrobat/wave.pdf
habits in the context
of health risks W=Weight Review BMI, blood pressure, blood sugar, lipids to screen for
Metabolic Syndrome.
Current physical
activity A=Activity Conduct physical activity assessment.
Ask about moderate physical activity? Goal—30 minutes/day or more
Readiness to change
behavior V=Variety Complete diet assessment using one of the following:

• Diet recall “Please tell me what you had to eat and drink yesterday,
including snacks and liquids.” Clarify amounts and preparation. Review
intake with patient.

• Diet assessment questionnaire, such as REAP, completed by patient

and reviewed by provider with answer key.
http://bms.brown.edu/nutrition/acrobat/REAP%206.pdf
http://bms.brown.edu/nutrition/acrobat/reapmdkey.pdf

Goal—adequate variety and moderate quantities based on Food Pyramid

and Dietary Guidelines for Americans
http://www.nal.usda.gov/fnic/dga/index.html

E=Excess Review food intake for amounts of added fats, fried foods
sweetened drinks, desserts, and alcohol.

Goal—small amounts of foods or drinks high in sugars, fats, and alcohol

Goal—less than 4 meals eaten out/week
Advise You might say:
Give clear, specific, “Your BMI is higher than recommended for good health. Weight loss
and personalized will reduce your risk of chronic diseases like heart disease and
behavior change diabetes, and will reduce stress on your joints, making it easier for
advice you to do the activities that you enjoy.”

For patients taking medication for hypertension, diabetes, or lipids:

“Diet choices are important even if you are taking medication since
eating carefully helps the medicine do a better job. With diet change
and weight loss, you may be able to save money by cutting down on
the amount of medicine you take.”

For patient NOT ready to change behavior, add:

“I’d like to help you when you are ready to make changes in your diet
and activity.”
Agree For patient NOT ready to change behavior:
Collaborate with “Is it okay if I ask you again at our next visit?”
patient to select
treatment goals and Agree on 2 to 3 goals with patient ready to change behavior, such as:
methods • instead of skipping breakfast, eat toast and peanut butter
• walk for 30 minutes after work
Base goals on • use diet soda
readiness to change
behavior Other possible actions:
• Recommend food and exercise records to monitor changes, if patient
willing.
• Refer for Registered Dietitian visit.
Assist • Provide hand-outs and web resources, based on patient interest and
Help patient acquire need.
knowledge, skills, and • Provide lists and recommendations for community resources (exercise
support for behavior and diet programs, health clubs, etc.).
change
Arrange Follow-up appointments
Schedule follow-up