New health and weight counseling messages
The new approach to weight and health involves shifting the focus from weight loss and thinness to encouraging people of all sizes to become healthier. Employee health professionals can use the following ideas and recommendations when counseling workers.
Key messages to be communicated:
* Focus on overall health improvement (lower blood pressure, normal blood glucose, feelings of fitness) instead of on weight loss or "ideal weight."
* Suggest increased physical activity levels in daily life, with a focus on enjoyable activities. It's best to start slowly and build up gradually.
* Recommend eating a variety of grains, vegetables, fruits, and low-fat foods that are enjoyable and part of one's usual way of eating; counsel against calorie-restricted or drastic diets. The idea is to make changes in small steps and then to maintain the healthier way of eating.
* Encourage workers to learn self-acceptance and self-respect, regardless of size.
Source: Adapted from Health and Weight at Kaiser Permanente: A Discussion Paper (Oakland, CA: Northern California Kaiser Permanente Regional Health Education; 1995). See Editor's note at end of main article for ordering information.
New practices for handling weight-related issues
The following practice recommendations can be useful to employee health professionals who wish to take the new approach to counseling employees about their weight.
* Weighing -- Ensure privacy, adequate scale capacity, and respectful staff attitude if weighing is necessary.
* Discussing weight -- If you believe weight is related to the worker's medical condition (hypertension, diabetes, elevated lipids, heart disease, etc.), ask whether the worker wishes to discuss weight. If so, assess overall health status, family history, past weight loss attempts, weight fluctuation, and whether weight is a problem for the worker. Readiness for lifestyle change is the worker's choice. If the worker is being seen for a condition unrelated to weight, do not discuss weight.
What you can say [to assess the person's interest in discussing weight]: "Have you ever tried to lose weight before? What have you tried? What happened?"
* "Ideal weight" -- Even if people eat well, are active, and show overall health improvement, they may still weigh more than the "ideal." Promote the idea that a stable weight is a healthy weight. Help workers learn to cope with weight prejudice in society. Ensure that personal protective equipment and examination gowns are available in sizes to meet the needs of large people.
What you can say: "Even if you do all this, you may still be a large person, but you can still be healthy. Though it's hard to do, if you can let go of the idea of being thin and accept your body size as it is, the reward can be that you'll begin to feel better overall."
Source: Adapted from Health and Weight at Kaiser Permanente: A Discussion Paper (Oakland, CA: Northern California Kaiser Permanente Regional Health Education; 1995). See Editor's note at end of main article for ordering information.
New ways to address lifestyle issues
Employee health practitioners can follow these new recommendations for helping employees make lifestyle changes.
* Exercise -- Advise the worker to begin being more active for enjoyment. Help identify and overcome barriers to increased activity. Identify activities the person can do to get started. The goal is being more active over the long term.
What you can say: "Tell me about how active you are. Has there been any activity you've enjoyed in the past? What do you think you could do tomorrow? Even five to 10 minutes to get started is beneficial."
* Eating -- Encourage workers to "eat well" in response to internal hunger and satiety cues, and to enjoy a variety of foods. Advise against drastic calorie reductions. The goal is to find a way of healthier eating that can be maintained long-term.
What you can say: "Dieting is an unhealthy way to lose weight for the long term. Most people gain the weight back. Repeated cycles of losing and regaining weight may be more unhealthy than staying at your current body weight. I'd like to spare you another cycle of weight loss and regain. I recommend not getting started with another diet. Eat more vegetables and fruits -- at least five servings a day are recommended -- and work on ways to cut down on high-fat foods. Don't skip meals or starve yourself."
* Follow-up and referral -- Arrange for regular follow-up to reinforce the process of change. Support and encourage all positive efforts regardless of their effect on weight. Refer worker to appropriate support services (physical therapy, mental health, nutrition, etc.).
What you can say: "Let's talk about how your plan to start walking three mornings a week [or other specific activity] worked out when I see you again."
"Since we last met, what challenges have you faced in walking three mornings a week [or other specific activity]? How did you overcome them?"
"Here's a brochure I'd like you to look at. You might find these suggestions helpful for becoming more active or learning more about eating well."
"Make an appointment for the new Health and Weight workshop [or whatever healthy lifestyle classes you might offer]. The workshop will give you some good information about exercise and eating well and help you decide what you can do next. You'll meet others who are trying to make some of the same changes you're working on."
Source: Adapted from Health and Weight at Kaiser Permanente: A Discussion Paper (Oakland, CA: Northern California Kaiser Permanente Regional Health Education; 1995). See Editor's note at end of main article for ordering information.
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