Nutrition Counseling

5 Questions for Patients Reluctant to Change

When I first became a dietitian, I had a glamorous idea of what providing nutrition education and counseling might look like. I envisioned working with patients who were motivated, ready to change, and interested in everything I had to say. Fast-forward to today, and I now know this was an unrealistic outlook. No matter what your career path is as an RD, at some point you’ll likely be faced with clients or patients who are reluctant to change.

Some people are set in their ways and don’t want to change their eating habits. For others, the food they eat may be the only constant in their lives, so the notion of making a change can sound scary and overwhelming. While it’s extremely important to be empathetic with these individuals to establish trust, there are strategies to help them determine on their own how to overcome barriers. Reframing our approach can be as simple as asking them specific questions that get them thinking differently and help motivate change. The following are five questions you may consider asking clients in these situations.

1. What does it mean to you to be healthy? We can’t have a blanket definition for the term “healthy” because every person has a different idea of what it means to them. Understanding what healthy means to your patients will help guide you in making recommendations that are specific to them and that they feel they can accomplish.

2. If you had to make one change to your diet today, what would it be, and why? There will be some patients who tell you there’s nothing they would change. However, narrowing it down to just one change can make lifestyle modifications less overwhelming for them. Even if they don’t make the change right away, it still helps to “plant a seed” and encourage them to decide what changes may make sense for them to initiate on their own. In addition, asking them “why?” will help them contemplate why making the change is important to them.

3. How does it make you feel when you’re told you need to make a change to your diet? This question opens the door to talking about emotional barriers to overcoming diet changes. Asking this helps dietitians learn whether clients are overwhelmed, frustrated, angry, sad, and/or unmotivated. Understanding the feelings that clients have about making a change is important so dietitians can further individualize their recommendations based on the clients’ sentiments. For example, a client is sad because they’ve been told they have to eliminate some of their favorite foods from their diet. In this situation, you can help the client figure out a more healthful way to prepare their favorite foods, or educate them on reducing portion sizes and eating in moderation rather than eliminating the foods entirely.

4. What would you need to do to make a change to your eating habits? In some instances, clients may want to make a change but lack the resources to do so. By asking this question, a client may tell you they don’t know how to cook, and thus you can refer them to a cooking class. You may learn that a client has a limited food budget and needs a referral to services that will help ease their financial burden. This question also may help you gauge whether clients need more education or counseling to get to a place where they feel comfortable enough to make a change.

5. If I told you making a change to your diet was a necessary part of your treatment (along with your medications), would that make you think about it differently? Food and diet aren’t typically the center of attention when it comes to overall health. Some clients diligently take their medications and go to their doctor appointments, but they don’t think of food as a priority in their treatment plan. Asking this question may help clients reframe their thoughts around food as a necessary part of their treatment, which may boost motivation.

All of these questions are open-ended and can be used as part of a motivational interviewing approach. They enable patients to lead counseling sessions and identify barriers and solutions on their own. In addition, these questions challenge patients to think critically about their eating habits and what changes they can realistically make in their current situation. Asking questions such as these also helps establish trust and enables dietitians to make more personalized recommendations because they’re taking the time to learn their client’s story.

You may come across clients who are just unwilling to change no matter what questions you ask, and that’s OK. It’s important to not take this personally. Continue to use your motivational interviewing skills in follow-up appointments, and it’s likely that the patient will come around.

What questions would you add to this list?

— Brianna Tobritzhofer, MS, RD, LD, is the nutrition program manager for Open Arms of Minnesota, a nonprofit organization that cooks and delivers medically tailored meals to individuals living with life-threatening illnesses. She also authors her blog, Fresh Fit Flourish, which focuses on nutrition, food, and lifestyle.

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