Working With the Obese Client: Helping Achieve Lifestyle Changes to Meet Their Weight Loss Goals

Saturday, 29 July 2017

Anna Marie Hefner, PhD, MSN, BSN1
Renee Pozza, PhD, MSN2
Tarek I. Hassanein, MD3
Catherine McCoy Hill, MSN1
(1)School of Nursing, Azusa Pacific University, Azusa, CA, USA
(2)Azusa Pacific University, Azusa, CA, USA
(3)Southern Califonia Liver and GI Centers, Coronado, CA, USA

Background and Significance:

Obesity is an epidemic in the United States and worldwide. In the United States, 35% of adults are considered obese and 20-30% of the populations is estimated to have non-alcoholic fatty liver disease (NAFLD) as a result of obesity. There is no current cure, but the literature shows lifestyle modifications for weight loss as the accepted standard of care. The assumption in this study was that participants expressed the desire be healthy and make positive changes in their life. Change theory considers the motivation for change during various stages.Motivational interviewing addresses the process of guiding clients through change.


The purpose of this analysis was to evaluate the use of change theory principles incorporating motivational interviewing on weight loss in obese clients.


This was a retrospective analysis of data from self-selected obese clientsfrom May 2015 to June 2016. A total of 34 clients met the inclusion criteria of BMI greater that 30 and less than or equal to 40. Routine lab tests of liver function tests, CBC, lipid panel, and a Fbroscan to evaluate t liver stiffness were performed at baseline, 6 months, and 12 months. The Nurse Practitioner saw the client every 3 months or more frequently as the client requested or condition of health warranted. Nutritional counseling was provided individually with a Registered Dietician for 30 minutes monthly. Exercise was also encouraged. Both providers utilized motivational interviewing to assist the client to achieve their weight loss goals. Categorical variables were analyzed with descriptive statistics and paired t-tests to evaluate changes in BMI, weight, ALT AST, and liver stiffness. The participant data was retrieved over a year time period.


Between May 2015 and June 2016, 34 patients were identified with a diagnosis of obesity-32 females with a mean age of 47 years and 2 males with a mean age of 35 years. The etiology of obesity from the client's perspective was overeating, stress, poor dietary habits, lack of exercise, and stress of everyday life. The initial laboratory values indicated a mild increase in liver injury tests. The combined initial average weight was 220.5 pounds (range was 175-250 pounds) and at 12 months decreased to 190.9 pounds. Waist circumference was initially 39.7 inches collectively and decreased to 37.9 inches. BMI was initially 36.2 and decreased to 34.21 collectively over 12 months. There was significance in weight, waist circumference and BMI over 12 months(p=.001).

All 34 clients were interviewed individually at 6 months and 1 year for program feedback. Collectively the themes that emerged were 1) the importance of a nutritionist guide how to eat better through portion size and healthy food choices; 2) how to say no; and 3) the tools to help continue on this journey. Clients found the once per month visits with the nutritionist and weighing in was too infrequent. Suggestions made by the clients included 1) weekly weights to increase accountability; 2) included a walking exercise program to receive encouragement and support from others; and 3) continue to have availability of the Nurse Practitioner for questions and concerns.

The dietician discussed monthly the food intake and caloric expenditure of the patient. Though most studies have used a balanced diet with caloric restriction, we focused on the food pyramid and healthy choices of complex carbohydrates and a decrease in fats. Each month the patient would bring in their diet and it was reviewed with the dietician. Suggestions were made for improvement, discussion of exercise patterns and again ways to increase exercise throughout the day. We choose to start small and increase as tolerated.


Obesity is identified as a risk factor for the top five causes of death in the United States-cardiovascular, diabetes, cancer, stroke and kidney disease. Lifestyle modification has been repeatedly shown to achieve modest long-term weight loss. It is critical to identify factors contributing to and maintaining obesity status. Obesity can be moderated or controlled by “behavior change”. However, changing a client’s dietary habits is daunting. Motivational intervewing principles have been successfully used within clinical settings, having a profound potential impact on cardiovascular disease, diabetes, and hypertension.

Most people have the desire to lose weight, and we encouraged them with various suggestions. When a client is allowed to talk, providers actively listen, and reflecting back with what they have heard, there is no more than three minutes to the encounter. Partnering with clients to achieve a meaningful weight loss and investigating novel methods of achieving and maintaining weight loss can we hope to change the tide.

The client’s states motivation is a key factor to success. Contact with providers and a nutritionist provides a structure which the client finds helps with motivation.