Client Consultation Applying the Principles of Nutrition to a Physical Activity Programme

Learning outcomes Explain the importance of informed consent Describe the information that needs to be collected to offer nutritional advice to clients Describe different formats for recording nutritional information Explain/interpret different methods that can be used to measure body composition/health risk in relation to weight Explain the legal and ethical implications of collecting nutritional information Explain how to sensitively divulge collected information and ‘results’ to clients Explain how to apply the principles of goal setting when offering nutritional advice Explain when people other than the client should be involved in nutritional goal setting Access and make use of credible sources of educational information and advice in establishing nutritional goals Explain how to translate nutritional goals into basic healthy eating advice that reflects current nutritional guidelines Explain the need for reappraisal of clients’ body composition and other relevant health parameters at agreed stages of the programme Identify the barriers which may prevent clients from achieving their nutritional goals Explain how to apply basic motivational strategies to encourage healthy eating and prevent relapse Describe the different stages in the Prochaska & DiClemente model for change

Informed consent It is important to obtain client’s informed consent before collecting nutritional information. Inform the client about: What information you wish to collect How it will be used

Information to be collected Useful information includes: Age, gender, weight, height Occupation Lifestyle Health status Current dietary intake (food diary) Food likes and dislikes Exercise/activity levels – current and history Exercise/activity likes and dislikes Goals and motivation

Recording nutritional information Different formats for recording nutritional intake/information include: Food diary Discussion (recall)

Measuring body composition and health risk Weighing scales Bioelectrical impedance Body mass index (BMI) Anthropometric measurements (e.g. waist circumference) Advantages and disadvantages?

Legal and ethical implications When collecting and storing personal information you need to consider: Data protection act Register of Exercise Professionals (REPs) ‘code of ethical conduct’ Confidentiality Sensitive issues: previous/current health problem previous/current dietary habits/beliefs

Divulging results It is important to divulge collected information and ‘results’ to clients in a sensitive manner: Privacy Communication style Empathy

Goal setting Negotiate SMART goals: Specific Measurable Achievable Realistic Time-framed Short, medium and long-term periods

Goal setting You then need to translate nutritional goals into basic healthy eating advice that reflects current nutritional guidelines.

Other people who should be involved in goal setting If the client has a dietician due to a specific condition If the client has a carer Other practitioners Partner Other family members

Renegotiating goals You should be able to renegotiate goals i.e. taking a break from the programme rather that deal directly with injury and illness which should be referred to a qualified practitioner You need a high level of understanding of healthy eating guidelines and strategies to maintain motivation throughout the change process and develop and establish positive behaviour patterns

Credible sources of information When establishing nutritional goals with clients you need to access and make use of credible sources of educational information and advice: NHS Choices – www.nhs.uk/livewell British Heart Foundation – www.bhf.org.uk Weight Concern – www.weightconcern.com Department of Health ‘Change 4 Life’ Campaign – www.nhs.uk/change4life

Reappraisal of progress Reappraise the client’s body composition and other relevant health parameters at agreed stages of the programme

Measuring progress Choose the most appropriate method of measurement based on your clients goals and motivations: To weigh or not to weigh? Skinfold calipers Bioelectrical impedance BMI Tape measure Food diaries and journals

Barriers to achieving goals Potential barriers could include: Lack of time Lack of money Child care Lack of motivation Lack of education

Strategies to overcome barriers These are individual to the client Discuss with your client what would help them, not what you think Provide resources, guidance and support to their individual needs Consider what ‘stage of change’ the client is in

Assessing readiness to change A model for change

Pre-contemplation Strategies At this stage people are not seriously considering the possibility of change. An example of a person in this stage may be someone who is overweight but does not have any real desire to reduce his or her body fat. Strategies Education via media Raise general awareness Raise the issue Encourage the client to contemplate the change for themselves

Contemplation This is the stage where people become aware of or acknowledge the existence of a problem. They are seriously considering the possibility of change but need to weigh up the pros and cons as to whether they take any action or not. Strategies – Appropriate Interventions: Build client confidence in their ability to make a change Encourage them to think about the pros and cons of changing and the implications of staying in their current situation.

Preparation Most people in this stage will make a change within the next three months. However, they are still in the decision-making process and don’t like to be hurried into action Strategies – Appropriate Interventions: Develop their skills to help them change. Help them set ‘SMARTER’ goals

Action People actually start to make changes (first 6 months). Strategies – Appropriate Interventions: Help client to reassess their goals often and keep their plan on track Give encouragement Help client learn to cope with difficult situations or potential problems Help client to maintain a positive environment and possibly help them to build a ‘support network’ (of friends and family)

Maintenance People attempt to continue with or sustain the progress that they achieved during the action stage (6–12 months). Strategies - Appropriate interventions: Help client to see warning signs and prevent relapse before it happens Re-evaluate and set new goals Review positive aspects of new behaviour Help client to recognise high risk situations (that may threaten their chances of reaching a stable, safer lifestyle) and make changes accordingly

Relapse Revert back to their previous behaviour or fail to stick to their plan of action. Strategies - Appropriate interventions: Help client to understand why it happened Explain that relapse is quite normal Encourage client to learn from their mistakes and start again

Termination Broken their old habits and formed new ones (12 months onward) New patterns of eating are established Find that they no longer have to think so carefully about their food choices as they naturally select foods that help the achieve their goals, i.e. weight loss/maintenance