There is often a struggle to get patients enrolled—and keep them engaged in—lifestyle-change programs. Here is how to help patients to remain committed to lifestyle changes.
Physicians often struggle with engaging patients with prediabetes in lifestyle-change programs, although the goal is to help prevent type 2 diabetes. Patients also might not be enrolling in programs after being referred or even drop out after they start.
“Sometimes we don’t convey the messages that are most likely to be motivating,” said Kate Kirley, MD, a family physician and director of chronic disease prevention at the AMA. “Physicians tend to spend a lot of their time on health consequences, risks, negative-sounding issues and things that are really far off for the patient.”
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and healthcare organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.
Here are some tips to help physicians encourage patients with prediabetes to start—and stick with—key lifestyle changes.
While it is important to convey the health consequences associated with prediabetes, it might not be the impetus for the patient.
“Something that might be more motivating in the short term could be losing weight,” said Dr. Kirley. “That is a goal of a diabetes prevention program—to lose weight.
“Patients are much more likely to engage with that idea than a much more abstract idea of avoiding diabetes down the road,” she added.
Physicians should try to understand from the individual patient what matters to them and what they care about in the very near future. That is what likely will encourage patients to engage in a lifestyle change program.
“For example, patients may feel that they do not have enough endurance to keep up with their grandchildren,” said Dr. Kirley. “Focusing on being more interactive with the little ones as a tangible, near-term goal will enable patients to more effectively engage with a lifestyle-change program because now it is tied to a goal that matters to them.”
Patients sometimes do not understand the changes they need to make for their health. This is when physicians need to set concrete targets for their patients.
“We have heard this from some research, that patients sometimes get this ill-defined counseling from their doctor and what they are expecting is to walk away with a specific goal and they don’t always get that,” said Dr. Kirley. “If you leave a patient to do it on their own, they might imagine a goal that is actually way more aggressive than it needs to be and something that sounds unachievable.”
With lifestyle-change programs, the goal is 5 percent weight loss. Unfortunately, if you ask many patients what they need to do, they will say, “I need to lose 50 pounds.”
“Sure, that might be helpful for their health, but it is not a realistic goal and that may be getting in the way of their taking action because they think they have to climb a mountain and really they just have to walk up a smaller hill,” said Dr. Kirley.
Having a clear conversation on small, short-term goals will sound more manageable to patients than they thought it would be.
“To the extent possible, involve family and friends or people who might be able to support a person in making lifestyle changes,” said Dr. Kirley.
As for lifestyle change programs, it is important for the organizations behind them to think carefully about who they employ as coaches. “Find a coach that will engage patients,” Dr. Kirley advised.
“While it might not be essential to have someone who knows a ton about nutrition, it is probably more important to have someone who is really good at engaging people, making the program fun and interactive,” she said.
“The program should not be solely didactic and completely run by the coach,” she added. “It should be a group effort with opportunity for sharing and participating. This will get patients to come back.”