Assessment of Patient Motivation

Assessment of patient motivation is a prerequisite for weight loss therapy. Weight reduction in the clinical setting represents a major investment of time and effort on the part of the health care team and expense to the patient. For these reasons, motivation for weight loss should be relatively high before initiating clinical therapy. At the same time, it is the duty of the primary care practitioner to heighten a patient's motivation for weight loss when such is perceived to be of significant benefit for risk reduction. This can be done by enumerating the dangers associated with persistent obesity and by describing the strategy for clinically assisted weight reduction. For patients who are not motivated (or able) to enter clinical weight loss therapy, appropriate management of risk factors (e.g., high serum cholesterol, hypertension, smoking, and type 2 diabetes) is still necessary. Sustained weight reduction may facilitate control of cardiovascular risk factors and delay the onset of type 2 diabetes.

Rationale: Assessment of the patient's motivation for treatment by the practitioner is important in the decision to initiate a weight loss program. The following factors must be evaluated:

• Reasons and motivation for weight loss—What is the extent of the patient's seriousness and readiness to undergo a sustained period of weight loss at this time? What is the patient's current attitude about making a life-long commitment to behavior change?
• Previous history of successful and unsuccessful weight loss attempts—What factors were responsible for previous failures and successes at weight loss or maintenance of normal body weight?
• Family, friends, and work-site support—What is the social framework in which the patient will attempt to lose weight, and who are the possible helpers and antagonists to such an attempt?
• The patient's understanding of overweight and obesity and how it contributes to obesity-associated diseases—Does the patient have an appreciation of the dangers of obesity, and are these dangers of significant concern to the patient?
• Attitude toward physical activity—Is the patient motivated to enter a program of increased physical activity to assist in weight reduction?
• Time availability—Is the patient willing to commit the time required to interact with health professionals in long-term weight loss therapy?
• Barriers—What are the obtacles that will interfere with the patient's ability to implement the suggestions for change?
• Financial considerations—Is the patient willing to pay for obesity therapy? This may include having to pay for travel to the medical facility, time lost from work, and paying for professional counseling that is not covered by insurance.

One of the most important aspects of the initial evaluation is to prepare patients for treatment. Reviewing patients' past attempts at weight loss and explaining how the new treatment plan will be different can encourage patients and provide hope for successful weight loss. It is helpful to discuss the proposed course of treatment and describe necessary behaviors, such as keeping diaries of food intake and physical activity.

Finally, given the social stigmatization that obese patients often feel, even from health care professionals, the initial evaluation is an opportunity to show the patient respect, concern, and hope (550).  A patient who has shared feelings about being overweight and previous attempts to lose weight with a sympathetic listener may be more willing to consider new ideas and information. A partnership in which the patient feels supported and understood can help to sustain the necessary motivation for the difficult task of weight loss and maintenance (551, 552).