TABLE 4

Fifteen-Minute Obesity Prevention Protocol

StepSample Language
Step 1. Assess
    Assess weight and height and convert to BMI
        Provide BMI informationWe checked your child's BMI, which is a way of looking at weight and taking into consideration how tall someone is. Your child's BMI is in the range where we start to be concerned about extra weight causing health problems.
        Elicit parent's concernsWhat concerns, if any, do you have about your child's weight? “He did jump 2 sizes this year. Do you think he might get diabetes someday?”
        Reflect/probeSo you've noticed a big change in his size and you are concerned about diabetes down the road. What makes you concerned about diabetes in particular?
    Assess sweetened beverage, fruit, and vegetable intake, television viewing and other sedentary behaviors, frequency of fast food or restaurant eating, consumption of breakfast, and other factors(Use verbal questions or brief questionnaires to assess key behaviors) Example: About how many times a day does your child drink soda, sports drinks, or powdered drinks like Kool-Aid?
    Provide/elicit
        Provide positive feedback for behavior(s) in optimal range; elicit response; reflect/probeYou are doing well with sugared drinks. “I know it's not healthy. He used to drink a lot of soda, but now I try to give him water whenever possible. I think we are down to just a few sodas a week.” So, you have been able to make a change without too much stress.
        Provide neutral feedback for behavior(s) not in optimal range; elicit response; reflect/probeYour child watches 4 hours of television on school days. What do you think about that? “I know it's a lot, but he gets bored otherwise and starts picking an argument with his little sister.” So, watching TV keeps the household calm.
Step 2. Set agenda
    Query which, if any, of the target behaviors the parent/child/adolescent may be interested in changing or which might be easiest to changeWe've talked about eating too often at fast food restaurants, and how television viewing is more hours than you'd like. Which of these, if either of them, do you think you and your child could change? “Well, I think fast food is somewhere we could do better. I don't know what he would do if he couldn't watch television. Maybe we could cut back on fast food to once a week.”
    Agree on possible target behaviorThat sounds like a good plan.
Step 3. Assess motivation and confidence
    Assess willingness/importanceOn a scale of 0 to 10, with 10 being very important, how important is it for you to reduce the amount of fast food he eats?
    Assess confidenceOn a scale of 0 to 10, with 10 being very confident, assuming you decided to change the amount of fast food he eats, how confident are you that you could succeed?
    Explore importance and confidence ratings with the following probes:
        BenefitsYou chose 6. Why did you not choose a lower number? “I know all that grease is bad for him.”
        BarriersYou chose 6. Why did you not choose a higher number? “It's quick and cheap and he loves it, especially the toys and fries.” Reflection: So there are benefits for both you and him.
        SolutionsWhat would it take you to move to an 8? “Well, I really want him to avoid diabetes. My mother died of diabetes, and it wasn't pretty; maybe if he started showing signs of it; maybe if I could get into cooking a bit more.”
Step 4. Summarize and probe possible changes
    Query possible next stepsSo where does that leave you? or From what you mentioned it sounds like eating less fast food may be a good first step, or How are you feeling about making a change?
    Probe plan of attackWhat might be a good first step for you and your child? or What might you do in the next week or even day to help move things along? or What ideas do you have for making this happen? (If patient does not have any ideas) If it's okay with you, I'd like to suggest a few things that have worked for some of my patients.
    Summarize change plan; provide positive feedbackInvolving child in cooking or meal preparation, ordering healthier foods at fast food restaurants, and trying some new recipes at home.
Step 5. Schedule follow-up visit
    Agree to follow-up visit within x weeks/monthsLet's schedule a visit in the next few weeks/months to see how things went.
    If no plan is madeSounds like you aren't quite ready to commit to making any changes now. How about we follow up with this at your child's next visit? or Although you don't sound ready to make any changes, between now and our next visit you might want to think about your child's weight gain and lowering his diabetes risk.