Assessing the Patient's Readiness to Change An attempt to initiate lifestyle changes when the patient is not ready usually leads to frustration and may hamper future weight-loss efforts. Assessment includes patient motivation and support, stressful life events, psychiatric status, time availability and constraints, and appropriateness of goals and expectations. Readiness can be viewed as the balance of two opposing forces: (1) motivation, or the patient's desire to change; and (2) resistance, or the patient's resistance to change. A helpful method to begin a readiness assessment is to "anchor" the patient's interest and confidence to change on a numerical scale. . | Chapter 075. Evaluation and Management of Obesity Part 3 Assessing the Patient s Readiness to Change An attempt to initiate lifestyle changes when the patient is not ready usually leads to frustration and may hamper future weight-loss efforts. Assessment includes patient motivation and support stressful life events psychiatric status time availability and constraints and appropriateness of goals and expectations. Readiness can be viewed as the balance of two opposing forces 1 motivation or the patient s desire to change and 2 resistance or the patient s resistance to change. A helpful method to begin a readiness assessment is to anchor the patient s interest and confidence to change on a numerical scale. Using this technique the patient is asked to rate his or her level of interest and confidence on a scale from 0 to 10 with 0 being not so important or confident and 10 being very important or confident to lose weight at this time. This exercise helps to establish readiness to change and also serves as a basis for further dialogue. Obesity Treatment The Goal of Therapy The primary goal of treatment is to improve obesity-related comorbid conditions and reduce the risk of developing future comorbidities. Information obtained from the history physical examination and diagnostic tests is used to determine risk and develop a treatment plan Fig. 75-1 . The decision of how aggressively to treat the patient and which modalities to use is determined by the patient s risk status expectations and available resources. Therapy for obesity always begins with lifestyle management and may include pharmacotherapy or surgery depending on BMI risk category Table 755 . Setting an initial weight-loss goal of 10 over 6 months is a realistic target. Figure 75-1 Treatment algorithm. This algorithm applies only to the assessment for overweight and obesity and subsequent decisions on that assessment. It does not reflect any initial overall assessment for other conditions that the physician .
