1. Stages of Change Outpatient case study Daniel Karlstrum

2. Introduction Review Stages of Change Case Study Conclusion

3. Pre contemplation ContemplationPreparationActionMaintenance

4. Pre-Contemplation Patients point of view: ◦No intention to change behavior. Unaware or under-aware of problems Our Goal: ◦To get patient to consider they have a problem

5. Contemplation Patients point of view: ◦Aware of the problem & seriously considering a change, but no commitment to take action Our Goal: ◦To raise awareness of problem by observation of behavior

6. Preparation Patients point of view: ◦Patient intends to change and makes small behavioral changes Our Goal: ◦To encourage these steps and support change process; Commit to make change a top priority

7. Action Patients point of view: ◦Patient decides to take decisive action to change Our Goal: ◦To make action plan suggestions, reinforce changes, provide support and guidance

8. Maintenance Patients point of view: ◦Maintenance Work to prevent relapse and consolidate gains Our Goal: ◦To support continued change and help with relapse prevention

9. Case Study Mr. O is a 38 Year old male veteran interested in losing weight. 69” 202lbs BMI 29.9 DBW: 160-180 %DBW: 112% No physical deficits Pertinent medications: amitriptyline Self Identified Goal weight 180lbs

12. Mr. O Has been unsuccessfully attempting to lose weight for the past 6 months. Typically eats 2 meals per day, the largest being dinner where he eats until he is uncomfortably full. Is the primary cook in his home, but does get some help from his 2 teenage daughters. Over 90% of meals are prepared at home, and eaten as a family Does not follow formal exercise program, and gets little physical activity outside of work and ADLs. Has a pretty good grasp of what he needs to do to lose weight, and has attempted to make changes in the past. Was able to get down to 185lbs, but unable to maintain.

13. Mr. O continued On a scale of 1-10 Mr. O ranked his desire to lose weight as a 6.5, stating that he had a strong desire to lose weight; but, he had other priorities in his life such as taking care of his family. Mr. O weights himself each time he uses the restroom at home, and his weight fluctuations frustrate him. Consumes 100% of his evening meal, and then finishes the food his daughters do not eat of their plates. His lack of weight loss is extremely frustrating What stage of change do you think Mr. O is at?

14. Education Briefly talked about the importance of breakfast in weight loss and that breakfast does not have to consist of “breakfast foods.” Encouraged Mr. O to continue eating meals as a family and continue involving the whole family in preparing meals. Talked about ways to control portion sizes, and overeating: Using smaller plates, drinking water before meals, mindful eating/eating more slowly, waiting 10-15 mins to get a 2nd serving of food, making plates and then putting leftover food away before sitting down to eat etc.

15. Nutrition Diagnosis limited Adherence to Nutrition Related recommendations related to previous lack of success in weight change and lack of social support as evidenced by patient's failed attempts at weight loss in the past.

16. Plan of action Goals ◦Put the scale away and only weigh in once a day (at most), at the same time each day ◦Keep a food journal ◦15 mins of walking with the family after dinner Follow up ◦Follow up visit scheduled for 1 month to assess outcomes of goals and continue working toward weight loss

17. Conclusion It can be difficult to asses the stage of change an individual is in. Sometimes it is important to step back and set smaller goals, even if they seem insignificant to us. Be flexible!

18. References Cancer Prevention Research Center Transtheoretical Model. Stages of change Available at: http://www.uri.edu/research/cprc/TTM/StagesOfChange.htm. Accessed December 30, 2014 Brief Intervention Stages of Change and Motivational Interviewing. Available at: https://www.bcm.edu/education/programs/sbirt/index.cfm?pmid=25042A ccessed December 30, 2014