Motivate your patients to change their lifestyle

NEW ORLEANS — When it comes to lifestyle change in patients with metabolic syndrome, they have a slim chance in a fat world, according to Lynda H. Powell, PhD.

“[Lifestyle change] is boring. It’s about deprivation, and patients don’t want to do that,” Powell said at the 56th Annual American College of Cardiology Scientific Sessions 2007, held here.

The importance lies in long-term sustained success. According to Powell, only 33 of 100 patients maintain successful BP control; lipid-lowering success is found in 17 of 100; and weight loss success – with the most dismal results – occurs in 10 of 100 patients.

Changes to basic paradigms that are common in clinical practice can help promote more enduring lifestyle change.

The first paradigm is that health education is necessary and sufficient. This tenant of clinical practice is built on the belief that physicians will advise people about lifestyle change. However, Powell said that although health education is necessary, it is not sufficient.

“You can tell people things until they’re blue in the face, and they will nod and will be polite to you and walk back out into their toxic environment and not have changed one thing,” said Powell, professor of preventive medicine, medicine, psychology and pharmacology and chair of the department of preventive medicine at Rush University Medical Center.

Powell suggested simplifying and repeating goals instead of encouraging adherence to all evidence-based guidelines. Physicians ask patients to do a variety of things, but it goes in one ear and out the other, she said.

“People have trouble making all those changes at once, but if we can get one change firmly entrenched in their minds, it will cause a ripple effect and inspire other changes.”

Physicians should repeat their simple message several times during a visit, have the nurses repeat it, put it on posters around the office and on bills and stationary, for example.

Coping peers

Patients may be the best agents of change in the long-term, not doctors and nurses.

“People with the disease can be empathetic in ways that doctors can’t,” Powell said. Coping peers —people who have the same disease — and group treatment are two examples of this.

At Rush, the health care staff uses retired people who are coping peers to do long-term follow-up calls to patients once a month to sustain behavior change. Data show that group treatment is helpful because people see themselves in other people’s stories and vicariously experience their successes and failures, Powell said.

Also, physicians should encourage patient discovery, such as self-assessment in the waiting room. Powell and colleagues conducted a focus group for lower socioeconomic groups with poor adherence and found that patient discovery was beneficial.

Motivations to enjoy life should be stressed, instead of motivations to avoid disease, Powell said. Most people live in the moment, and she suggested fun activities that patients are more likely to engage in, such as bowling and dancing.

“We need to loosen up with regard to physical activity recommendations,” she said. – by Katie Kalvaitis

For more information:

• Powell L. Motivating your patients to change their lifestyle. Symposium #657. Clinical Management of Metabolic Syndrome Symposium. Presented at: The 56th Annual American College of Cardiology Scientific Sessions 2007; March 25-27, 2007; New Orleans.