Practice
This knowledge check is designed to help you reflect on and apply the concepts presented in this module. Please respond thoughtfully to each question. Your answers will be saved and reviewed by faculty. The knowledge check is not graded, but your responses will help faculty assess understanding and identify areas that may benefit from additional clarification or support.
Patient: Mary
Mary has an BMI of 33 and hypertension. She would like to reduce her blood pressure and improve her energy levels.
How would you use the 6 A's framework during a visit with this patient?
question 1
What could you say to ask permission to talk about weight? Write down a few ideas.
The answer is: “It looks like your blood pressure is under control, but we need to continue the lisinopril. Would you like to discuss your weight today, and consider how we could work together on weight loss to lower your blood pressure?”
question 2
How could you assess the patient’s weight severity and her management goals? Write down a few ideas.
Ask: “What is the single most important thing you want to achieve by losing weight?”
To assess severity in this patient with hypertension, you could check for end-organ damage using an ophthalmic exam, check serum eGFR, or check for urine proteinuria.
question 3
What could you say to advise weight loss? Write down a few ideas.
Here is a sample response: “Losing 5%–10% of your body weight can improve health, help control your blood pressure, and may reduce the number of medications needed to control your blood pressure. We can discuss what goals feel realistic and meaningful to you.”
question 4
What could you say to agree with their perspectives and goals? Write down a few ideas.
Here is a sample response: “I’m hopeful we can meet your goals to reduce medication use and feel more energetic.”
In addition to or instead of words, use encouraging nonverbal cues that communicate listening and agreement.
question 5
What could you say to assist with a weight-loss plan? Write down a few ideas.
Here is a sample response: “I would like to refer you to a local dietitian who can help you to put your DASH diet into action. We can also work together to set achievable goals for increasing your activity level. Would you like to set a specific goal for activity over the next 2 weeks?”
question 6
What could you say to arrange longitudinal care for the weight loss plan? Write down a few ideas.
Here is a sample response: “Please keep track of your food and activity over the next 2 weeks, until you have your first visit with your nutrition consultant. Keep track of what you eat, when, how much, and why. This information can help us tailor support to your needs. If you would like to do this on your smartphone, I can suggest apps to try.”
Reflection
Before viewing the lived experience video, please reflect on the kind of care you aspire to provide for patients living with obesity.
reflection
What words, actions, and attitudes would help a patient feel respected, heard, and supported? How do you want your future patients to experience conversations about weight, health, and care?
Now, please watch the video below (7:29 min.) to hear one woman’s experiences with being stereotyped and shamed because of her weight during an important medical appointment.
Self-assessment
question 1
You see a patient who has gained substantial weight since their last visit. The patient's weight is affecting their overall health, but they do not bring up the topic. What is the best approach to proactively discuss weight concerns?
Broach the subject of overweight and obesity by respectfully asking for the patient’s permission to discuss their weight. With their consent, ask about any recent changes or stressors to explore potential contributors to the weight gain, while avoiding judgmental or stigmatizing remarks.
question 2
You see a patient with obesity who has expressed frustration about their weight and its impact on their health. How can you best respond to address the patient's concern?
This response acknowledges the patient’s challenges with empathy and emphasizes collaboration. It asks the patient for permission to talk about weight with a patient-centered approach to finding solutions, while avoiding judgmental language.
Item D was not the correct answer as the provider begins asking a disease-related question before inquiring if the patient wants to talk about concerns related to weight.
question 3
A 45-year-old patient with a BMI of 35 reports a sedentary lifestyle, high-stress job, diet rich in processed foods, and frustration about previous weight-loss attempts. What key elements would you review in the patient's history to guide the development of an effective obesity treatment plan?
These elements help uncover specific factors influencing the patient’s weight, such as lifestyle, potential barriers to weight loss, and any underlying psychological and medical factors contributing to obesity. This approach considers the patient’s unique preferences, social environment, and medical conditions to tailor an individualized treatment plan.
question 4
A 50-year-old woman presents for a 6-month follow-up visit for hypertension. She reports no new medical problems other than a 15-lb. weight gain. She has tried to prepare more healthy meals but cannot lose weight. Her physical activity is limited to walking her dog three times a day, gardening, and household work. She asks for weight loss assistance. Her only medication is hydrochlorothiazide, 12.5 mg daily. Vital signs:
Height: 64 in.
Weight: 179 lb.
BMI: 31 kg/m2.
Waist circumference: 35 in.
Blood pressure: 128/82 mm Hg
Heart rate: 86/min.
Laboratory study results are normal.
What is the next best step?
Ask the patient to self-monitor by tracking her diet and physical activity. This will help her to engage in reflection, identify her dietary patterns, introduce restraint, and provide you with more information to establish nutritional and activity goals.
A handout and general information are less helpful until you complete her weight history by determining her current diet and exercise habits.
Self-monitoring alone may be sufficient for her to lose weight. If not, it will be helpful to inform selection of a dietary approach and setting of ISMART activity goals.
question 5
You are advising a patient with a BMI of 35.5 kg/m2, type 2 diabetes, and hyperlipidemia on making a nutritious meal choice during their lunch break. Considering their health goals to reduce risk related to adiposity-related diseases, which option would be the most nutritious choice from the following lunch options?
This option provides a balanced mix of lean protein, healthy fats, and complex carbohydrates. Salmon is rich in omega-3 fatty acids, quinoa adds fiber and protein, and the olive oil dressing provides heart-healthy fats.