Psychological approach to addressing Obesity in Pregnancy'

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Psychological approach to addressing Obesity in
Pregnancy.

• Maureen Frilingos
• Clinical Psychologist

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Obesity in Pregnancy

• Obesity Definition
• Long-standing entrenched behaviours
• Co-morbid psychological problems
• What role does eating play for woman?

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Obesity in Pregnancy

• How can a relatively brief consultation/contact
  trigger an enduring change in health behaviour?

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Obesity in Pregnancy

• How should a healthcare practitioner approach
  this subject?
• The way you talk to a pregnant woman about her
  health can significantly influence personal
  motivation for behaviour change no-one is
  completely unmotivated.

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Obesity in Pregnancy

• Should you
• Explain what the woman could do differently in
  the interests of her/her babys health?
• Advise and persuade her to change behaviour?
• Warn what will happen if she doesnt?
• Take time to counsel her on how to change her
  behaviour?
• Refer her to a specialist?

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Motivational Interviewing

• Motivational Interviewing (MI) is a technique
  initially developed as a brief intervention for
  problem drinking. It has been found to be
  successful in a range of health problems, where a
  key issue is behaviour change and where patient
  motivation is a common challenge.

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Motivational Interviewing (MI)

• MI is a clinical style aimed at eliciting
  patients own motivations for making changes in
  behaviours in the interests of their health.
• It involves guiding more than directing, dancing
  rather than wrestling, listening at least as much
  as telling
• MI involves a collaborative partnership between
  the patient and clinician

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Motivational Interviewing (MI)

• Aims to activate patients own motivation and
  resources to make changes connecting health
  behaviour change with their own values, concerns,
  reasons and arguments for change
• Requires a degree of detachment for outcomes.

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Motivational Interviewing (MI)

• MI works by activating the patients own
  motivation for change and adherence to treatment.

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Motivational Interviewing (MI)

• Ambivalence

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Motivational Interviewing (MI)

• Communication Styles
• Guiding
• Directing
• Following

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Motivational Interviewing (MI)

• Guiding
• Being a tutor, a resource for the patient,
  recognising what is possible, offering
  alternatives from which to choose-
• I can help you to solve this yourself

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Motivational Interviewing (MI)

• Directing
• You take charge implies an uneven relationship
  with regard to knowledge, expertise, authority.

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Motivational Interviewing (MI)

• Following
• Listening predominates - suspending your own
  agenda, giving full attention to understanding
  the individuals experience.

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Motivational Interviewing (MI)

• A pattern that can be evident in health care, in
  both practice and management, is where the
  balance of communication is more likely to be
  directing.
• In discussions of patients lifestyles and
  behaviour change it is crucial to engage the
  patients own motivation, energy and commitment.
  Thus a guiding style is more appropriate.
• Be prepared to modify/change your communication
  style in response to the individual.

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Guiding, MI and Behaviour Change

• A guiding style is particularly well suited to
  helping people make behaviour changes paying
  attention to how to help the patient make her own
  decisions about behaviour.

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In MI guiding is

• Specifically goal-directed the practitioner has
  a specific behaviour-change goal in mind and
  gently guides the patient to consider why or how
  she might pursue that goal
• Pays particular attention to certain aspects of
  the patients language and actively seeks to evoke
  their own arguments for change

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Asking, Informing and Listening

• Asking
• How much do you smoke each day (directing)
• What would it take for you to stop smoking
  (guiding)
• How have you been in the last few weeks?
  (following)
• Informing
• Your best option is to take this medication
  (directing)
• Changing your diet would help medically, but how
  does that feel for you? (guiding)
• Yes, its a common experience to feel that in
  pregnancy (following)
• Listening
• So you understand whats going to happen now, but
  you want me to tell you more about what will
  happen later on (directing)
• Youre feeling concerned about your weight, and
  you are not sure where to go from here (guiding)
• This sounds as if it has been a shock for you
  (following)

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Asking, Informing and Listening

• Attune yourself to change talk - recognize and
  affirm it when you hear it.
• Attitudes and Behaviours
• Helping people accept new information

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Informing

• Telling what has happened
• Explaining what is going to happen or what may
  happen
• Clarifying what something means
• Breaking bad news
• Sharing evidence
• Obtaining informed consent
• Mastering a task such as using a medical device
• Giving advice

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Informing

• How difficult can it be to give patients
  information?
• What if the information you provide does not
  match the patient's hopes or expectations?

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Informing

• Do not overload patients
• Provide simple information in chunks
• Be careful about using jargon and technical terms
• Check back to ensure that the patient has
  understood

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Factors affecting interest in and ability to
absorb and follow up on information

• Bewilderment.
• Passivity.
• High emotion.
• Mood and distraction.

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Informing Within MI

• Ask Permission
• Providing information with permission from the
  patient is fundamental use of a guiding style.
• Resistance

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What about situations in which you might feel
impelled to give information

• Announcing.
• First choice.
• Prefacing.

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• Reference
• Motivational Interviewing in Health Care
• By Stephen Rollnick, William Miller and
  Christopher Butler.