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Columns: Enhancing Your Behavioral Toolkit

Weight Management Behavioral Strategies

Buckworth, Janet Ph.D., FACSM

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doi: 10.1249/FIT.0000000000000412
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More than two thirds of American adults are overweight or obese, and the fitness professional can count on having clients who want to manage their weight. Working on fitness goals for any client entails using basic behavioral change strategies, but there are considerations to keep in mind when a client is targeting weight loss.

Fitness professionals should have assessment at the top of their toolbox when working with weight management clients. Basic demographic characteristics to identify are age, sex, ethnicity, household composition, including marital status and number of children and their ages in the home, professional and employment status, and education. Knowing your client is a middle-aged recent immigrant who works long hours as a lawyer and lives with her husband and elderly mother-in-law provides a wealth of information about possible barriers and supports for healthy eating and physical activity. You would want more information about her exercise history, how she manages her time, and any cultural influences on her roles and responsibilities.

Assessing physiological and biological characteristics help the fitness professional tailor strategies to a weight management client’s health status. Height, weight, body mass index, body circumferences, percentage body fat, resting heart rate, and blood pressure can determine realistic outcome goals and progress. Obesity is often associated with other health issues, such as diabetes and joint problems, and any considerations for diet and physical activity because of medication or disease must be determined before proceeding with a weight management plan.

Assessing psychological variables enables identification of personal barriers and supports. Self-concept, motivation for the change, self-efficacy, as well as attitudes and beliefs about diet, exercise, and obesity can have a powerful influence on adoption and adherence to healthy behaviors, as well as the cessation of unhealthy ones. For example, finding that your obese client has very low self-efficacy for losing weight and keeping it off means that strategies to enhance self-efficacy would be important to implement first. If someone has the confidence but needs the knowledge and skills to make healthy dietary choices, your strategies would be very different. Weight management clients also may feel self-conscious about exercising in public. The prevalence of implicit and explicit obesity bias can result in overweight and obese individuals avoiding exercising in public or going to a fitness center because they fear that fit people are judging them about their size. They also can be anxious about not knowing how to use gym equipment or following routines in an exercise class.

The social and physical environmental supports and barriers also should be assessed to understand the context in which clients try to implement behavior change. Family and friends may unintentionally (or intentionally!) create barriers to weight loss that need to be identified and managed. A client might have a spouse who does not like vegetables or coworkers who bring in pastries for everyone each day. This person will have more challenges than someone who is encouraged to join a neighborhood walking club and a spouse who already enjoys healthy foods. The point is, you have to ask about attitudes, beliefs, and behaviors of friends, family, and coworkers related to your client’s new health-related behaviors. If clients feel that they will be on their own in trying to lose weight, the fitness professional can help them identify new sources of support and encouragement. The physical environment also can direct the fitness plan and choice of strategies based on things like neighborhood walkability and location of grocery stores and fitness centers.

When you have a more complete picture of a client, you are starting from an informed base to provide a personalized intervention. This is why self-monitoring is a central strategy in your toolbox for weight management. The fitness professional and the client can review self-monitoring data on diet and physical activity to identify where to start to get the best results. You also can identify supports for positive change, such as friends who exercise regularly, and barriers, such as triggers for unhealthy food choices. For example, if your client eats a pastry each morning at work when he or she gets his or her coffee in the break room, you can suggest bringing his or her coffee and avoiding the break room or bringing his or her own healthy snack. Information from self-monitoring also can point to ways to make small changes that can boost your client’s self-efficacy. For example, you may suggest to a client who has two pieces of toast and two eggs each morning to try replacing one piece of toast with a serving of fruit two to three mornings a week. Success with this small change can feed a sense of mastery, and you also have introduced the practice of substituting something healthy rather than just giving something up.

Self-monitoring also can aid in developing strategies to manage barriers to weight loss by first identifying their obstacles to exercise and healthy dietary choices. If your client can’t manage to get to the gym for a strength training class three times a week, the barrier could be lack of motivation for strength training, unrealistic frequency with his or her current obligations at home, or discomfort being the only overweight person in the class. If you find that he or she is forcing himself of herself to work out because he or she does not enjoy strength training, you can brainstorm about other activities that could be fun and then have him or her try them out.

Goal-setting is another cornerstone of weight management, and principles of setting smart goals have been covered previously in this column (1). Weight management clients need help setting a realistic outcome goal that is supported by progressive behavioral goals for diet and physical activity. Introduce the premise that the excess weight is not the problem, but the result of problems with diet and physical activity. Follow this with a clear message that you are there to help them set and implement reasonable and realistic behavioral goals. Learning goals can come in handy to develop the knowledge and skills for setting task goals. Examples include finding at least one new recipe a week, reviewing the benefits of high-intensity interval training for weight loss, and identifying at least three methods for decreasing sedentary time each day. Task goals should be progressive and created using established nutrition recommendations and guidelines for type, volume, and intensity of physical activity for weight loss.

Motivational strategies for weight management have been applied in several research studies (2) with success. The Self-Determination Theory is a valuable model to use when selecting strategies to foster intrinsic motivation, which is associated with long-term adherence to healthy behaviors. An assumption of this theory is that basic needs for autonomy, competency, and relatedness are universal and drive behavior. Autonomy is a sense of choice or independence in behavioral decisions. Consider that the perception of exercise can be different for overweight and obese clients and sympathize with exercise challenges. Foster opportunities for clients to provide meaningful inputs and have influence on their training program. Consider implementing self-selected intensity exercise regimens and encourage exploration of options and choices in home-based exercise routines. Increase a sense of autonomy with diet through teaching clients about healthier food options, portion control, and mindful eating.

Strengthen competency by teaching skills associated with a fitness program, such as proper form lifting free weights, and providing timely and specific feedback. Weight management clients may be intimidated by the weight room at the fitness center but would welcome learning weight training regimens in mini-bouts they could do at home. Clients also can attend cooking classes and learn about selecting healthier foods in grocery stores and farmer’s markets. Good goal setting is linked to fostering competency in weight management clients through recommending small behavioral changes that can be easily achieved and counter a sense of discouragement from considering how long it can take to lose weight.

The need for relatedness can be addressed by spending time chatting before fitness classes, encouraging reaching out to family and friends, and recommending established groups of others with similar weight management goals. Learning ways to seek and receive social support from family and friends can enhance a sense of relatedness and foster more intrinsic motivation. Formal or informal groups of clients with weight loss goals can be a safe place to discuss challenges and encourage sharing of behavioral strategies. It also is essential that the fitness professional examine his or her own implicit or explicit bias toward people who are overweight or obese to avoid appearance of blame or judgment.

Developing intrinsic motivation for diet and exercise is especially important for weight management clients because someone who needs to lose a significant amount of weight is in it for the long haul. Weight loss through diet and exercise takes sustained effort over many months and even years. It can be easy for weight management clients to get impatient and discouraged, especially when the focus is on the weight and less so on changes in other health indicators. Relapse prevention strategies can help keep clients engaged and successful. Learning to identify and cope with situations that tempt someone to return to unhealthy behaviors is a tool necessary for losing weight and keeping it off. Family gatherings, holidays, vacations, and life stress can all challenge decisions a client has made to practice healthy dietary choices and portion control and to make physical activity a part of each day. The ability to anticipate and cope with high-risk situations will strengthen, but a lapse will inevitability occur when trying to sustain healthy behaviors to support weight loss maintenance. You can help clients weather a relapse through providing time management and relaxation training, confidence building, and stress management, in addition to reassuring them that relapse does not equal failure but an opportunity to reevaluate goals and actions plans (3).

The fitness professional is well positioned to support healthy weight loss and long-term maintenance. Assessment, self-monitoring, goal setting, motivation enhancement, and relapse prevention are some of the tools that can be applied successfully with attention to the physical, psychological, and social context of overweight and obese individuals.

References

1. Buckworth J. Setting strategic goals. ACSMs Health Fit J. 2016;20(6):35–7.
2. Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act. 2012;9:22.
3. Buckworth J. Identifying and managing relapse risk. ACSMs Health Fit J. 2018;22(2):34–5.
© 2018 American College of Sports Medicine.