Woman, 57 years of age, prediabetes, hyperlipidemia, class I obesity and history of gestational diabetes. I’ve been working with her for the past two years. The first year she was very motivated because of her new diagnosis of prediabetes and her weight being what it was. Her son was getting married and she wanted to lose weight for the wedding. We discussed a plan for her. She started a lower carbohydrate meal plan as well as metformin, and increased her physical activity. She tracked her food intake and activity. She lost 25 pounds over the first year. Felt good about how she looked and felt at the wedding. Her numbers, A1C and lipids did not return to normal, but were improved.
During the time she was losing, we started a remote monitoring system through our office. She and I had discussed the many times she had lost weight, and gained it back plus more. She decided to sign up for this program because she was in hopes this could help keep her from regaining her weight this time around.
It’s been a year since the wedding. She has “plateaued” but not gained back her weight. She remains on the remote monitoring system. She wanted to talk with me because “the scale did not move.” She wants to lose more weight.
During our discussion, she said to me, “I was very motivated the first year for the wedding, I need to get motivated again. I want to lose more weight.” I discussed the fact that her not losing is not her fault, and explained how hormones work to fight to gain back the weight she has lost. I also told her we can’t promise a certain number on a scale, yet I praised her for doing so well for this long. She said she felt the monitoring system worked for her because any other time in her life she could not have kept off the weight she lost for a year.
On further discussion, she admitted to not taking her metformin regularly. She takes it first thing in the morning and it makes her nauseated. If she doesn’t want to feel nauseated, which is most days of the week now, she doesn’t take it. When she was losing weight she was taking 500mg ER twice daily.
I told her this could very well be part of the problem. Some people do not tolerate it unless taking it after a full meal. I recommended she resume it, 500mg ER daily after dinner. If in one week, she was not feeling nauseated to increase it to two pills as she was taking in the past. She agreed to that along with continuing to track her food and activity.
Time will tell. If she does not feel well, together we’ll come up with another plan.
Personally, and professionally I was pleased about her call. The way we communicate was an example of motivational interviewing. Allowing the patient to tell me what she thinks, I provide some education and recommendations and allow her to choose what SHE, the patient, thinks will work for HER.
- Listen. Listen. Listen. As the saying goes, if you let patients talk long enough, which doesn’t have to be more than a few minutes, many times they will identify the problem they are having.
- Provide a safe environment. Whether diabetes or obesity management, patients need to feel safe and not judged when talking with their health care provider.
- Know. Know when to intervene and offer education/advice the patient can live with.
- Motivational interviewing with shared decision making is a plan that can work because only the patient really knows what he or she can and will do.
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