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Always start with BIG WHY?

As pharmacist community, we can use concept of Reason of Change Theory then help patient using cognitive theory.

Reason of Change theory.

Since she had awareness to losing weight, as pharmacist we can start focus on BIG WHY?, complications of obesity, etc. Pharmacist must create awareness what are complication of obesity, there are limitation in movement, mostly treatment of illness is losing weight, etc. After patient agree/realise to make things happen, we can start with cognitive theory concept.

Pharmacist can help in plan short-long term how to losing weight, what are the target to achieve, how to plan diet and make a personal group with patient. Last but least, disciple is more power/sustain than motivation.

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Patients in preparation stage, aware of her importance where wants to lose weight but struggles due to too busy schedule. In pharmacist’s role is to help patient moving from intention to action. Pharmacist need to help setting goal, identify barrier and provide lifestyle advice. Its can helps pts more confident and get prepare for behavior change.

Next stage is action stage, where pharmacist should provide ongoing support, monitor progress, and reinforce success to maintain motivation such as regular follow-ups and encouragement for long-term weight management.

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Name : Ummi

Based on the stages of change model, the patient in the stage of preparation (or determination) phase. The patient express awareness towards the important of losing weight but struggles to maintain due to a busy lifestyle. For my opinion, in this case patient already take small action in losing weight but not sustain to make a change.

At this stage, suitable intervention strategy for next stage behaviour change are :

1) create a suitable and realistic schedule for patient to follow based on busy lifestyle

For example create a healthy and simple meals plan, so that patient can follow the meals plan successfully.

Then patient can plan the schedule for exercise based on current lifestyle

2) patient should review the current bmi and make a realistic target. Be more specific with the target loss, for example a week must have a loss in weight or inch loss

3) give moral support in term of the purpose of the loss and the risk of overweight and obesity

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Name: Melati

In my opinion, the patient is at Preparation Stage since he/she has already tried to lose weight but cannot maintain it due to his/her busy schedule.

My role as a pharmacist is to help the patient move confidently into Action stage with practical and achievable support.

My suggestions for the patient will be:

1. Acknowledgement - acknowledge his/her efforts and give him/her compliments to build motivation.

2. Behavioral support - suggest him/her to find a friend or family member who can join the physical activities.

3. Recommend Evidence-Based weight management products - I will counsel on the safe use of weight-loss medications or supplements such as Orlistat

4. Monitor the patient progress - Regularly track weight, BMI, and waist measurements. I can also suggest him/her any mobile apps related to fitness and health that can help him record the progress.

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Patient was in the state of preparation:

As she mention she already started doing intervention but struggle to maintain due to busy lifestyle.

1. Identify her problem in maintaining her weight reduction journey

-what is her BMI? what category overweight/obese type 1/2/3? how many kg increase by month?

- is it because of tight work schedule? what is her current job -office work/retail setting? is there any free time she can do exercise.

- is it because she had difficulty in controlling her calories intake? any bad habit - like to eat sweet drinks etc

- is there any underlying medical condition (diabetes/PCOS if female/hypothyroid/MDD?)

- is she currently on any medication that significantly increase her weight? (insulin/antipsychotic/hormone pills)

2. Assess her knowledge regarding healthy weight reduction

- is she aware the complications of being obese

- did she tried modify dietary intake - calories counting, proper meal timing,mindful eating, healthy food, cut sugar, drink plenty of water?

- did she tried doing any physical exercise - brisk walk/running/gym?

- did she try modify her lifestyle - quality of sleep? what is her stress level?

3. Educate patient for healthy weight management

-Set a relevant target for patient to achieve by how many months/year?

-calories counting- reduction by diet + exercise

Treatment programmes should target

› Decreasing overall dietary intake

› Increasing physical activity

› Decreasing time spent in sedentary behaviour

› Addressing sleep behaviour

-recommend health supplements that can help for weight management:

- l-carnitine -fat metabolism/ decrease appetite

- green tea extract - fat oxidation

- oat beta glucan (fiber)- for satiety/ lower cholesterol/low glycemic index

4. Monitoring progress

-provide self monitoring diet

-follow up every 2-3 month/when patient refill supplement.

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According to The Stage of Change theory, patient is at contemplations state. She is aware of her condition but still undecided to make next move. At this stage, pharmacists can probe more questions so that patient know her main challenges.

For example : her curent diet, her current work that require her to stay late at night/sedentary lifestyle, is there any social support from families and friends, excuses no time to cook healthy food, difficulties to do exercise. So then pharmacist can tailored effective strategies in assisting her weight reduction.

Pharmacists can build pt's confidence at this stage with evidence based of weight reduction benefits ie reduce CVS risk, bp reduction, glucose control, better appearance etc.

Pharmacists can guide patient with SMART goal and follow up with them every months.

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Based on theory of  Stages of Change Model, the patient currently in a contemplation phase as patient is aware of the importance of losing weight but struggles to maintain it due to a busy lifestyle.

Proposed intervention strategies:

The next stage is Preparation Phase. The pharmacist needs to:

1) Explain on the importance of losing weight and complication of obesity.

2)Counsel patient on therapeutic lifestyle changes:

·Aim for 30 minutes of brisk walking for 5 days or more per week

·Advise on calorie and portion control

·Focus on a healthy diet rich in fruits & vegetables

3) Encourage patient to find an online support group that have the same goal and mindset to lose weight

4)Follow up or refer to the dietitian if necessary

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Patient is at stage preparation or determination. She mentioned struggle to maintain losing weight, so she probably has done few small steps. Proposed intervention strategy:

Set a target weight and when to achieve it. Must be realistic.

Block a timeslot for exercising, maybe daily or weekly

Join support group

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Nama: JANE DOE

Answer: .................................