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How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective...

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Much Public debate around Food, Nutrition, 'diet' People are sometimes confused about what is 'healthy' and 'unhealthy' Increasing problems of obesity – 50% adult popoulation in UK predicted to be obese by 2050 Food isn't just about weight loss And is not just as straightforward as calorie in vs calorie out – a whole multitude of factors affects what and how much we eat and how our bodies process this energy. Get people thinking about how food affects the body and brain We might know what a 'healthy diet' is, our patients often don't.
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How to Deliver Effective Lifestyle Advice Aim • To equip you with the ability to deliver effective lifestyle advice to patients. Why? • Patients, the NHS and wider economy are facing a obesity a lifestyle-related chronic disease crisis. • Despite this, multiple studies report that healthcare professionals do not feel equipped to deliver effective lifestyle advice to patients. Today • Discussion about the components of a healthy lifestyle, specifically diet and exercise. • Teaching about specific communication techniques which can be used to help patients adopt healthier behaviours.
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Page 1: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

How to Deliver Effective Lifestyle AdviceAim• To equip you with the ability to deliver effective lifestyle advice to patients.

Why?• Patients, the NHS and wider economy are facing a obesity a lifestyle-related chronic disease crisis.• Despite this, multiple studies report that healthcare professionals do not feel equipped to deliver effective lifestyle advice to patients.

Today• Discussion about the components of a healthy lifestyle, specifically diet and exercise.• Teaching about specific communication techniques which can be used to help patients adopt healthier behaviours.

Page 2: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Why Talk about Food?

Page 3: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Why Talk about Food?Much Public debate around Food, Nutrition, 'diet'

People are sometimes confused about what is 'healthy' and 'unhealthy'

Increasing problems of obesity – 50% adult popoulation in UK predicted to be obese by 2050

Food isn't just about weight loss

And is not just as straightforward as calorie in vs calorie out – a whole multitude of factors affects what and how much we eat and how our bodies process this energy.

Get people thinking about how food affects the body and brain

We might know what a 'healthy diet' is, our patients often don't.

Page 4: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Typical Western Diet

Large meals high in refined grains, red meat, unhealthy fats, and sugary drinks

play one of the largest roles in obesity.

Foods lacking in the Western diet:

[Pictures of whole grains nuts and fruits and vegetables]

seem to help with weight controland also help prevent chronic disease.

Page 5: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Outline1. Fats

2. Protein

3. Carbohydrates

4. Fibre

5. Simple take home messages for Doctors

6. Simple take home messages for Patients

Page 6: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Fats

Low fat diets have long been advised as the key to a healthy diet / losing weight

But the evidence just isn't there!

Good clinical trials show that patients following a moderate or high fat diet lost just as much, and often more, than those on a low fat diet

Low fat diet also offers no benefits for disease prevention over a higher fat diet

Page 7: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Fat Facts Low fat diets are often high in refined carbohydrates

many 'diet' products have higher sugar content

The Type of fat is more important than the amount:

– Monounsaturated and Polyunsaturated:• Not linked to weight gain• Reduced risk of heart disease and diabetes• Plant oils, Nuts, Fish

– Trans and Saturated fats:• More likely to cause weight gain• Increase LDL & decrease HDL• Are inflammatory• Processed foods, red meat, dairy products

Page 8: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

ProteinHigh protein diets

– Show better weight loss in short term trials– Perform equally well as other diets longer-term

The Type of protein has other health implications:

BAD: GOOD:

Red and processed meat:High intakes are associated with increased Diabetes, Heart Disease and Colon Cancer rates

Fish, Nuts, Poultry, Pulses

Page 9: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Reasons why Protein can help weight loss

1. More satiety– People tend to feel fuller than after eating

carbohydrate or fat

2. Greater Thermic effect– Takes more energy to metabolize and store

protein than other macronutrients

3. Improved Body Composition– Helps people hang onto lean muscle, which then

improves the energy-burned side of the energy balance equation

Page 10: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Carbohydrates'Quality' more important than quantity

The refining process removes the fibre and turns grains into rapidly digested carbohydrate:

Exampls: White flour, bread, rice, pasta, breakfast cereals etc.

Potatoes and sugary drinks act the same

Rapidly absorbed, fast and furious rise in blood glucose and therefore Insulin.

Page 11: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Effect of Refined Carbohydrate on the Body?

Short term: Hunger spikes and over eating

Longer term: Weight gain, Diabetes and Heart disease

Conclusion: Stick to whole grain carbohydrates and avoid sugar

Page 12: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Is the part of the plant that the gut is unable to digest.

Found in fruits, vegetables, whole grains and legumes.

1. Helps control blood sugar levels and quickens satiety

2. Lowers cholesterol levels

3. Helps maintain bowel health

4. Normalizes bowel movements

5. Aids in achieving healthy weight

Fibre

Page 13: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

1) Think Good fats rather than No fats

2) Protein can help weight loss – stick to healthy proteins Eg. Nuts, Fish, poultry

3) Carbohydrates: Stick to wholegrains ie. Wholewheat flour/pasta/bread, brown rice, whole oats etc.

4) Avoid Sugar

5) Fibre Fibre Fibre!! For weight loss and health

6) Drink plenty of water (2L/day). Avoid sugary drinks, including fruit juice!

Summary

Page 14: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Take home messages for Doctors Keep it simple!

Talk in the positive – tell patients what they can eat rather than what they can't

'Diet' is a loaded word – Phrase your questions in a way that your patient will understand.

Food is about more than just weight loss - You can talk to any of your patients about what they eat, not just those that are overweight.

Be non judgemental – everyone is where they are for a reason

Healthy diet can prevent weight gain and chronic disease

Page 15: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Increase Vegetables – Half fill plate

Increase fibre – veg, fruit, whole grains, legumes

Reduce sugar / sugary drinks

Choose minimally processed foods (trans fats, sugar, salt)

2L water/day – avoid sugar sweetened beverages

Swap don't stop eg. Brown for white, fruit for sugary snacks, unsaturated for saturated fats.

Not all fat is bad, some are essential! Stick to 'Healthy fats'

Take Home messages for Patients

Page 16: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Thank You

Page 17: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

References Willett WC, Leibel RL. Dietary fat is not a major determinant of body fat. Am J Med. 2002;113 Suppl 9B:47S-59S.

Melanson EL, Astrup A, Donahoo WT. The relationship between dietary fat and fatty acid intake and body weight, diabetes, and the metabolic syndrome. Ann Nutr Metab. 2009;55:229-43.

Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-73.

Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41.

Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial. JAMA. 2006;295:39-49.

Field AE, Willett WC, Lissner L, Colditz GA. Dietary fat and weight gain among women in the Nurses’ Health Study. Obesity (Silver Spring). 2007;15:967-76.

Furtado JD, Campos H, Appel LJ, et al. Effect of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart Trial. Am J Clin Nutr. 2008;87:1623-30.

Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294:2455-64.

Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122:876-83.

Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia. 2009;52:2277-87.

Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. Am J Clin Nutr. 2011;94(4):1088-96

Aune, D. et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617

http://www.mayoclinic.org/fiber/ART-20043983.

Page 18: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

The Benefits of Exercise

"If exercise were a pill, it would be one of the most cost-effective drugs ever invented“

Dr Nick Cavill – Oxford University

Page 19: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Play Dr Mike Evans’ 23.5 hours video, available on YouTube

Page 20: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

The Benefits of Exercise• Up to a 35% lower risk of coronary heart disease

and stroke.• Up to a 50% lower risk of type 2 diabetes.• Up to a 50% lower risk of colon cancer.• Up to a 20% lower risk of breast cancer.• A 30% lower risk of early death.• Up to an 83% lower risk of osteoarthritis.• Up to a 68% lower risk of hip fracture.• A 30% lower risk of falls (among older adults).• Up to a 30% lower risk of depression.• Up to a 30% lower risk of dementia.

Page 21: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

How Much Exercise?Current NHS Guidelines:

• At least 2 hours 30 minutes of moderate-intensity aerobic activity (enough to raise the heart rate and break a sweat) such as cycling or fast walking per week

and

• Muscle-strengthening activities on 2 or more days a week that work both the upper and lower body.

Page 22: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Aerobic Activity

• 2 hours, 30 minutes per week. • Recommended to split this so that the individual is

active on at least 5 days each week.• Activity can be broken down into chunks of just 10

minutes.• For example, walking fast, cycling, playing football,

running, pushing a lawn mower etc.

Page 23: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Sedentary Behaviour

• Sedentary behaviour (sitting or lying) for adults is associated with obesity, all-cause and cardiovascular mortality, diabetes, some types of cancer and metabolic syndrome.

Reducing Sedentary Behaviour• Take regular breaks to get up and walk around.• Reduce screen time.• Walk part of the way of bus or car journeys.

Page 24: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Strength Training • Positive effects on the musculoskeletal system

and functional ability. Prevents osteoporosis, positively affects insulin sensitivity, resting metabolic rate, glucose metabolism, blood pressure and body fat which decreases risk of diabetes, heart disease, and cancer.

• Virtually all the benefits are obtained in two 15 to 20min training sessions a week.

• Sensible resistance training involves controlled movements for each major muscle group and does not require the use of very heavy resistance.

Page 25: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Examples of Strength Training

• Lifting weights (or heavy shopping, tins of food!).

• Working with resistance bands.• Body weight exercises such as press-ups, sit-

ups and squats.• Heavy gardening, such as digging and

shovelling.• Yoga

Page 26: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

NEPA

• Non-Exercise Physical Activity• Instead of specifically going out to exercise,

patients can build it into their day.

Examples of NEPA:– Walk/cycle to work– Get off the bus a stop early and walk the remainder– Take the stairs instead of the lift/escalator– Standing instead of sitting.

Page 27: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Exercise and BMI• Exercise is the end in itself, it does not have to

be associated with weight loss to be beneficial.

• Professor Blair study:– death rate for those who are thin but unfit is twice as

high as counterparts who are obese and fit.– Across every category of body composition, unfit

individuals have a much higher death rate than those who are fit.

– Fitness provides protection against early mortality no matter how much you weigh.

Page 28: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Exercise on Prescription• GP’s can prescribe exercise. Patients are

referred to a local fitness centre for a number of sessions supervised by a qualified trainer.

• May be free or at a reduced cost.

• Dependent on local commissioners.

• Discharge summaries!

Page 29: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Summary• Exercise is hugely beneficial.• Only 30 minutes per day is required.• Both strength training and aerobic exercise

are effective.• Limit sedentary behaviour wherever possible.• Do not get hung up on BMI – Exercise is the

end in itself.• Use NEPA to make time for exercise.• GP’s can prescribe exercise, so ask them to!

Page 30: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Exercise – Just Do It!

Page 31: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

References• www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx• www.youtube.com/watch?v=aUaInS6HIGo• Department of Health. Physical Activity Guidelines for Adults 19-64. 2011.• Seguin R, Nelson ME. The benefits of strength training for older adults. Am

J Prev Med. 2003 Oct;25(3 Suppl 2):141-9.• Lee DC, Sui X, Artero EG et al. Long-term effects of changes in

cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 2011 Dec 6;124(23):2483-90.

• www.nhs.uk/Conditions/stress-anxiety-depression/Pages/exercise-for-depression.aspx

• Department of Health. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. March 26, 2010.

Page 32: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Communication Techniques for Behaviour Change

Page 33: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Aimso Understand the importance of effective communication

o Build some first steps of behaviour change techniques

o Stimulate interest to develop these skills further

o To help you be effective in your work

Specifically:

o Very Brief Interventions

o Patient Engagement

o Specific communication techniques

Page 34: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Your Experiences?How frequent?

Good?

Bad?

Why?

Page 35: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Very Brief Intervention

Video

Page 36: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

The EvidenceBrief Interventions in Excessive Alcohol Use

• Cochrane Review of brief interventions in alcohol use (21 Randomised controlled trials with 7,000+ participants).

Conclusion: • Brief interventions consistently produced reductions in alcohol consumption. • (Mean difference: -41 grams/week, 95% CI: -57 to -25)

Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007 Apr 18;(2)

Page 37: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

The EvidenceBrief Interventions in Smoking

• Cochrane Review of brief interventions in smoking (41 trials with 31,000+ participants).

Conclusion: • Brief interventions resulted in a significant increase in the rate of quitting.• Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%.

Physician advice for smoking cessation. Cochrane Database Syst Rev. 2013 May 31;(5)

Page 38: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

The EvidenceBrief Interventions in Weight Loss and Physical Activity

• RCT’s currently ongoing in Oxford and Cambridge.

Commerical Weight Loss Services (such as those that GP’s can refer to)

• Randomised control trial comparing weight loss of patients who experienced a commercial weight loss service vs. those experiencing standard care.

Conclusion:• Participants in the commercial programme group lost twice as much weight as did those in the standard care group. • Mean weight change at 12 months was −5·06 kg (SE 0·31) for the commercial programme versus −2·25 kg (0·21) for standard care.

Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. The Lancet, Volume 378, Issue 9801, Pages 1485 - 1492, 22 October 2011.

Page 39: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

GP Behaviour

Percentage of GP’s who:• Checked smoking status ~100%

• Gave advice to quit ~30%• Gave assistance to quit ~3%

Conclusion:• Lots of room for improvement!

Page 40: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

How To Deliver a Brief Intervention

1) Ask

1) Advise

1) Act

Page 41: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Examples of VBI’s in Different Issues

SmokingAsk• Do you smoke?

Advise• NICE: Advice should be “Sensitive, appropriate, non-confrontational”.• What do you know about the effects of smoking?• Smoking is harmful for x, y, z reasons.• With the right support and treatment it can be much easier to stop smoking.

Act• Would you like me to put you in touch with the NHS stop smoking service?• Or if you are in Secondary Care you can access the Trust’s smoking cessation service.

Page 42: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Alcohol and/or DrugsAsk• Do you use alcohol and/or drugs?• For Alcohol use, use AUDIT or AUDIT-C tool (NICE Clinical Knowledge Summary, 2011).

Advise• NICE: Advice should be “Sensitive, appropriate, non-confrontational”.• What do you know about the effects of alcohol and/or drugs?• Alcohol and/or drugs are harmful for x, y, z reasons.• With the right support and treatment it can be much easier to stop or reduce your consumption.

Act• Would you like me to put you in touch with a specialist who can help you cut down or stop?• Or if you are in Secondary Care you can ask the patients GP to refer in the discharge letter.

Page 43: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Overweight/ObesityAsk• In this case it would be to measure the patient’s BMI.

Advise• NICE: Advice should be “Sensitive, appropriate, non-confrontational”.• What do you know about the effects of overweight / obesity?• overweight/obesity is harmful for x, y, z reasons.• With the right support and treatment it can be much easier to lose weight.

Act• Would you like me to refer you to a weight management support service?• This service may be a weight management provider e.g. Weight Watchers, depending on whether the local Clinical Commissioning Group funds it.• In primary care, you can prescribe exercise.• Or if you are in Secondary Care you can ask the patients GP to refer in the discharge letter.

Page 44: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Conclusions about Brief Interventions

• A focus on how to change seems more effective than why change support.

• A simple way to do this is to give information about the benefits of taking up support.

• Ask• Advise• Act

Video

Page 45: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Engaging your patient

o Why bother?

o How to

o Example scenarios

Page 46: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Why is it important?o Building good relationship

o Patient takes ownership of problem

o And ownership of the solution

o Their responsibility – more likely to make a change

o Reduce the risk of patient becoming defensive

o Especially important in chronic conditions and lifestyle changes

Page 47: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Video http://gpcpd.walesdeanery.org/index.php/motivation/social-behavioural

Page 48: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Simple Structure

o Reality: Find out where they are now?

o Goal: Where would they like to be?

o Barriers: Is there anything stopping them?

o Options: What are their options? Offer your own only if they can’t think of any

o Action planning: Where do you go from here?

Page 49: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Arnsteins LadderTell

Sell

Consult

Co-create

Empower

Advantages?

Disadvantages?

Page 50: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Weight loss

o Tell: You need to lose weight / lose weight!

o Sell: You need to lose weight because…

o Consult: I’d like to refer you to weight watchers, is that ok?

o Co-create: Are you happy for us to discuss your weight today?

o Empower: Would you like anything done/do anything about your condition?

Page 51: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Useful Qs/Action planning

“Is there anything stopping you…?”

“Imagine if this was not longer a barrier… what could you do?”

“What will you do after today?”

“By when?”

''When's a good time to start?'‘

“Who do you need to tell to keep you accountable?”

Get them to be specific!

Page 52: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Summary of Engagement Strategies

Think about your consultation style.

o Tailor it to your patient and the clinical situation. o Move up and down the ladder as necessary.

o Think how best to ‘Sell’ the change you feel would benefit the patient

o Structure your consultation - moving them through from where they are now to what they will do.

o If you want your patient to change, they need to be engaged!

Page 53: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Specific Tools1) Diary keeping (Prompt self-recording)

• Ask the patient to keep a diary of the behaviour they are trying to change.

• e.g. alcohol consumed each day or amount of daily physical activity.

• Can be paper-based or using change for life ‘drinks tracker’ app for alcohol.

Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction 2012:107, 1431–1440. 

Page 54: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

2) Prompt Commitment

• If the patient makes a commitment to a behaviour change during the consultation (rather than ‘thinking about it’) they are more likely to be successful.

Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction 2012:107, 1431–1440. 

Page 55: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

3) Implementation Intentions

• Patients are more likely to succeed if they commit to where, when and how to act compared to committing to act in general.

• E.g. I will go for a run in the park on Tuesday at 7pm.

JAMA Intern Med. 2013;173(6):458-464.

Page 56: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

4) Abrupt Quitting

• Advise patients to stop smoking abruptly rather than cutting down and then attempting to quit.

• People who practiced abrupt quitting are significantly more likely to be abstinent at 4 weeks and 6 months.

British Heart Foundation. Rapid Reduction Trial. Currently being written up.

Page 57: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

5) Be Persistent

• Of those who accepted smoking cessation treatment, whether they were initially prepared to quit or not had no influence on whether they were successful.

• Therefore, offer smoking cessation support even if the patient is not initially prepared to quit.

Page 58: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

Summary of Specific Communication Tools

• Try to elicit a prompt commitment.• Help the patient to decide where, when

and how to act.• Encourage the patient to record their

behaviour (diary keeping).• In smoking, encourage them to stop

abruptly rather than cutting down first.• Be persistent in offering smoking

cessation support.

Page 59: How to Deliver Effective Lifestyle Advice Aim To equip you with the ability to deliver effective lifestyle advice to patients. Why? Patients, the NHS and.

SummaryVBI:

1) Ask “Do you Smoke”

2) Advise “Do you know it’s easier to quit with support?”

3) Act “Can I refer you to the stop smoking service?”

Use language to Engage your patient in their own health

Deploy specific tools

Refer to someone who is better at this than you!


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