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Healthy Weight Management Toolkit

The Healthy Weight Management Toolkit offers family planning providers resources to address healthy eating, physical activity and weight issues with family planning clients.

On this page:

Helping Clients Maintain a Healthy Weight

As health care staff, we have a role in helping our clients stay as healthy as possible. When it comes to obesity prevention, encouraging healthy eating and active lifestyles are necessary for all clients, regardless of weight. Because time is limited during visits and because obesity prevention is not the top priority for family planning providers, a brief intervention is often one quick step that can help move clients toward healthier behaviors.  Family planning services are often the only contact a client has with health care providers.

Funded in part by a U.S. DHHS-OPA grant.


The Importance of Obesity Prevention in Family Planning

Over the past several decades more and more people have become overweight or obese. This is true for both females and males in every age group and economic sector. Although obese individuals can lead a healthy life, from a public health perspective, obesity prevalence is a significant risk factor for a host of chronic diseases that can decrease quality of life and possibly shorten the life span.

For obese women of childbearing age; social stigma, academic and job discrimination, and unhealthy dieting practices are well documented. Yet in our work, reproductive health consequences add an additional and immediate concern. More women of reproductive age are at a higher weight than ever before in history; resulting in irregular menstrual cycles, infertility, and pregnancy and childbirth difficulties.

In Oregon, nearly half of women (47%) entered pregnancy overweight or obese presenting risks to both mother and child. In addition, women who begin pregnancy overweight or obese are more likely to gain more weight than recommended.

Risks Associated with Obesity during Pregnancy

Mother:

  • Hypertension
  • Gestational diabetes
  • Pre-eclampsia
  • Complications with labor and delivery
  • Increased likelihood of C-section
  • Increased risk of death
 

Child:

  • Macrosomia
  • Increased risk of death
  • Increased risk of birth defects, particularly neural tube defects, such as spina bifida
  • Children born to mothers who are overweight or obese, and/or have diabetes/gestational diabetes, are at increased risk to be overweight or obese themselves.

Creating a Respectful Environment for all Clients

Just about everyone has experienced some anxiety with a clinical appointment.For those who are overweight or obese, these feelings can be magnified. There is often a sense of shame and failure associated with being overweight, and for many people, weight creates a barrier to accessing or receiving adequate health care. Providers are extremely important in breaking down those barriers and making clients feel secure in the clinic environment.  The first step is to create an environment that is friendly for all clients, regardless of size or ability, increases comfort, reduces anxiety, and increases the chance of follow-up care.

Adapting the Office Environment for Overweight and Obese Clients*

  • Waiting rooms should have several sturdy armless chairs.
  • Sofas in the waiting area or in consultation rooms should be firm and high enough to ensure clients can easily rise.
  • Posters, printed materials, and magazines should depict a variety of body shapes.
  • The weight of clients should be done in a private area.
  • Weight should be recorded silently without comments (positive or negative).
  • Have clients who are resistant to being weighed stand on the scale backwards, so they do not have to look at the results.
 
  • Extra large examining gowns should be available to accommodate clients, or you can let women leave their top clothing on, unhooking their bra for a breast exam.
  • Examining tables should be wide and bolted to the floor or wall so the table does not tip forward.
  • A sturdy stool assists large patients in getting on the examination table.
  • Several sizes of blood pressure cuffs should be available. Using too small a cuff can result in false readings.
  • Longer needles and tourniquets should be available.

*Adapted from the Centers for Obesity Research and Education 


Using BMI as a Screening Tool

BMI is the most user friendly method to screen for overweight and obesity because it is quick, inexpensive, and non-invasive. BMI cannot diagnose obesity. The best use for BMI is to watch trends over time. Calculate client BMI at each visit and use the current BMI to compare to past visits.

To calculate BMI you must have an accurate weight and height for your client. Two methods for calculating and interpreting BMI are listed below. These should be used for people 20 years and older. If you have a client who is under 20 years old, you should use the children and teen BMI calculator.

1. Calculating and interpreting BMI using an online BMI calculator.

The BMI calculator is simple to use. There are now apps available for the calculator.

BMI calculator for adults - use for people 20 years and older

2. Calculating and interpreting BMI using a BMI chart.

See the Resource Section for printable English and Spanish BMI charts. Numbers on the chart correspond to the following categories:

<18.5 Underweight
18.5 - 24.9 Normal
25.0 – 29.9 Overweight
30 and above Obese

3. Screening Adolescents

It is important to use the child and teen BMI calculator and BMI-for-age growth chart for screening anyone under the age of 20 and older than two.

When screening adolescents, follow these steps:

  • Weigh and measure height.
  • Input the required information (including the client’s birthday) into the Child and Teen BMI Calculator.
  • Review the calculated BMI-for-age percentile and results (see table below). Unlike the adult BMI number, the BMI number for children and teens is both age- and sex-specific and must be interpreted using the BMI-for-age percentile.
  • Use the CDC BMI-for-age growth chart. Translate the BMI number into a  percentile for a child’s or teen’s age and sex.

Weight Status Category

Percentile Range

Underweight

Less than the 5th percentile

Healthy weight

5th percentile to less than the 85th percentile

Overweight

85th to less than the 95th percentile

Obese

Equal to or greater than the 95th percentile

The categories used in this table are based on expert committee recommendations.

4. Comparing the client’s BMI to previous visits

Determine if BMI is outside the normal range or if the client’s BMI has changed since the last visit(s). If BMI increased and BMI is now outside of a healthy weight range, work with the client to identify possible reasons for the increase and solutions to prevent further weight gain. If the client’s BMI has decreased to an underweight level, refer them to a primary care provider.


Brief Interventions: Definition and Best Practices

The term “brief intervention” can be defined as an intervention that is limited in time, often to less than five minutes per session, and is focused on bringing about behavior change. Evidence shows that brief interventions can lead to at least short-term changes in behavior and body weight if they:

  • are delivered by practitioners trained in motivational interviewing,
  • are tailored to individual circumstances,
  • incorporate behavioral techniques, especially self-monitoring,
  • focus on both diet and physical activity, and
  • encourage the individual or patient to seek support from other people.

Motivational interviewing should be used to help assess the client’s concern about their weight status and their readiness to change behavior. During future visits, follow-up can be done with the client to see if they are making progress toward changing the behavior that they identified.

Steps for Assessing Clients’ Weight and Using Brief Interventions

  • Calculate a BMI at each client visit (See Using BMI as a Screening Tool section). Remember there are separate calculators for adults and adolescents.
  • Determine if the BMI falls outside the normal range.Compare BMI calculations from previous visits, if available, and determine if the client’s BMI has changed.
  • Ask your client how they feel about their weight, physical activity, nutrition, and health.
  • Ask for permission before talking to your client about weight and proceed if your client agrees.
  • If a client’s BMI changed from the last visit, ask your client what caused the change. Congratulate healthy changes and ask what your client could do to change unhealthy behaviors.
  • Share your concern if a client is overweight or obese. If a client’s BMI is below normal or if weight gain has increased rapidly, your client should be referred to a primary care provider.
  • Ask for permission before talking to your client about weight and proceed if your client agrees.
  • Ask your client how they feel about their weight, physical activity, nutrition, and health.
  • Ask about eating and physical activity behaviors, stress, and adequate sleep.
  • Encourage your client to identify one simple change they could make to decrease excess calorie intake and/or increase physical activity or improve their lifestyle – this could include decreasing stress or getting adequate sleep. See the Brief Intervention Topic Ideas section for a list of suggestions.
  • If a client has been steadily gaining weight, focus efforts on encouraging him or her to maintain weight rather trying to lose weight.
  • Encourage your client to set goals and keep track of progress.

What is Healthy Weight Management?

  • Healthy weight management is distinct from “weight loss” in that it is life-long and focused on health, not short-term numbers. Healthy weight management is NOT about getting down to “normal weight.”
  • Everyone should aim to adopt healthy nutrition habits, exercise habits, sleep habits and stress-management techniques.
  • Halting weight gain is a successful outcome.
  • If overweight or obese, once weight is stabilized, set an appropriate goal of 5-10% weight loss over 6 months, followed by stabilization.
 

Talking with clients about healthy weight management.

  • Do not focus on BMI, pounds to lose or calories. Focus on behavior changes. People can be fit and healthy at any size.
  • Talk about healthy behaviors with every patient – pick one behavior to bring up each month.
  • Work with your clients to set realistic behavior change goals that are specific and gradual.
  • Help your clients set goals. Positive goals are easier to achieve than negative goals (it’s easier to start something than stop something).For example,
    • “I will choose water instead of other beverages at least 3 times a day” instead of “I will stop drinking soda.”
    • “I will march and do arm exercises whenever I watch TV” instead of “I will stop watching TV.”
  • Work on your own healthy weight management every day.

Brief Intervention Script for Addressing Weight with Clients

Step 1: Ask permission

Can we take a few minutes to discuss your health and weight? Proceed with the intervention if the client agrees.

Step 2: Share BMI

Your BMI is ______. Do you have any questions about BMI and how it relates to your health?

Questions to consider asking:

  • How do you feel about your health?
  • How do you feel about your weight?
  • Is there anything you would change to be healthier?
  • What do you think is keeping you from making some of those changes?
  • What do you think would help you make some of those changes?
  • What are your ideas about how you can be more active? What are your ideas about how you can eat better?

Step 3: Assess readiness

How ready are you to take the next step to make a change to improve your health?  On a scale of 0-10, with 0 being not ready at all and 10 being completely ready, where are you?

  • Not ready (0 - 3)  What might make you more ready?
  • Getting ready (4 - 6)    What might your next steps be?
  • Ready (7 - 10)     What is your plan?

Step 4: Close 

Summarize patient’s ideas/perspectives/identified next steps.


Brief Intervention Topic Ideas

  • Pay attention to the beverages you consume. Aim to drink only water and unsweetened coffee and tea.
  • Start an exercise regimen or increase what you are doing to one hour, five days a week and include strength training.
  • Find ways to manage stress that do not include food.
  • Eat breakfast every day (see client resources for a printable, quick, healthy breakfast idea handout).
  • Shop wisely. (Eat before you go to the grocery store. Shop around the perimeter of the grocery store for the foods you purchase, limit processed foods, and look at food labels.)
  • Eat at home and limit eating out.
  • Eat more plant-based foods: fruits, vegetables, whole grains, and beans.
  • Work to reduce stress through relaxation exercises, meditation, and focusing on gratitude and joy.
  • Aim for 7-9 hours of sleep every night.
  • Grow a garden if you have space.
  • Sit down and eat meals as a family or with others.

Not Just a Matter of Personal Responsibility
Social-Ecological Model: Healthy Eating and Active Living in Family Planning

In public health we like to talk about the social-ecological model of change. The concentric circles, known as the spheres of influence, are important factors for changing social norms. In current society, low-nutrient, calorie dense food and drinks are accessible and affordable. Physical activity opportunities are limited and doing things with friends most often centers around eating. To make lasting change and shift our cultural norms, change must occur within each of these spheres of influence. Let’s try it using family planning clinics as a model for healthy eating and active living.

At the individual (client) level: Our clients can be given the opportunity to identify weaknesses in their diet or activity patterns. The spheres of influence surrounding them should support efforts to make positive behavior change.

At the interpersonal (provider) level: You are an important role model both within the clinic talking with clients and in the community. Whether or not you are at an ideal weight, you can model healthy eating and physical activity choices.

 At the organizational (clinic) level: The clinic environment can be welcoming to all clients regardless their size. Set an example of healthy living by implementing worksite wellness programs. Worksite policies can limit unhealthy food and beverages and set policies against unhealthy food marketing within the clinic. Clinics can encourage active transportation by providing bike racks. For additional healthy worksite policies, see Wellness@Work

At the (community) level: Communities can support healthy eating and physical activity. Encourage clients to visit local farmers’ markets, cook meals for family more often than eating out, and use available walking paths. Family planning staff can collaborate with public health advocates to write grants supporting community innovations and designing public health media campaigns.

At the (policy) level: We can support our clients in making good choices and  becoming advocates for policy that provides better access to healthy foods and greater opportunities for physical activity for everyone regardless of income.


Resources

This section includes both web-based and pdf resources.

Client Information

Go to the Healthy Weight Management is for Everyone guide section and the Resources section for additional client educational materials.

Yale Rudd Center

Talking to your doctor about your weight – Resources for Overweight Patients

Oregon Women’s and Reproductive Health Program

Interactive pamphlets that address specific nutrient deficiencies while providing examples of healthy food choices.

4 Things You Should Know About Nutrition and Birth ControlEnglish | Spanish

MyPlate

Provides key messages and food lists from the USDA Choose My Plate website. (The new symbol Choose My Plate replaces the Food Guide Pyramid.) MyPlate encourages more plant-based foods in the diet: fruit, vegetables, grains, protein (from plant or animal sources) and dairy food groups.

14 things to do to manage your weight in a healthy way


Create Your Own Resource List

  • Gyms/fitness centers including YMCA/YWCA.
  • National programs, such as Weight Watchers, Overeaters Anonymous.*
  • Public swimming pools.
  • Community, school, and community college programs related to health, fitness, and weight management.
  • Hospital programs related to fitness and weight management.
  • Walking and bike trails.(Give maps to clients.)
  • Parks and Recreation Office resources, classes, and programs.
  • Stress-management or stress reduction tools or groups.
  • Weight management web sites.
  • Ideas for organizing neighborhood exercise activities.
  • Local farmer’s market schedule.
  • Referral information for national nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP)**, WIC, or the National School Lunch Program.
  • Community garden information.

*National Program Descriptions

Weight Watchers uses an integrated approach that combines smarter eating, healthy habits, exercise and a supportive environment. Visit their website to find a meeting, learn about an on-line program, and get information about costs.

Overeaters Anonymous is an anonymous 12 step program that includes an "eating plan," mentoring, and support. Visit their website for meeting sites, events, organization information, and contacts.

Curves is designed for women and offers3X/week 30 minute organized exercise + weight management classes.

**SNAP was formerly known as Food Stamps.


Food Insecurity, Hunger and Obesity

Oregonians face dual challenges: obesity and hunger

The co-existence of hunger and obesity continues to garner media, research, and advocacy attention. Oregon State University Extension Service examined the research to provide an overview of this seeming paradox: How can a person be hungry and obese?


Healthy Weight Management is for Everyone! Guide

“Healthy Weight Management is for Everyone!” / “Controlar Nuestro Peso de Forma Saludable es Importante Para Todos”

Health care providers, nurses, health educators and other clinic staff  can use the guide when counseling clients. Healthy Weight Management is for Everyone was developed as part of the Vida Entera y Sana (Whole and Healthy Life) Project at La Clinica del Carino Family Health, Inc. in Hood River, Oregon. The book is available in both English and Spanish. Most Oregon family planning clinics  have a copy of the book. It can also be downloaded at:

English version  | Spanish version

Healthy Weight Management is for Everyone tools

Healthy Weight Management Diagram

El Diagrama de Controlar el Peso de Una Manera Saludable

Pros and Cons List

Lista de Pro y Contra

Exercise Idea List

Lista de Ideas Para Ejercicio

My Exercise Calendar

Mi Calendario de Ejercicio

Shopping Guide

Cuando va de compras

Are you really hungry - magnet

De versa tiene hambre

My Worksheet for Controlling Stress and Other Strong Emotions

Mi Hoja de Como Lidiar con el Estres y Otros Problemas de la Vida

I Value Myself - magnet and sticker Valoro me salud

Blank Food and Exercise Log

El Registro en Blanco de La Comida y el Ejercicio

 

Food and Exercise Checklist

El Registro para La Comida y el Ejercicio

Pedometer Instructions

Instruciones para un marcapasos

Parents

Padres

Kids  This water bottle belongs to…..(sticker)

Este bote de agua es de.....(sticker)

It’s fun to play (sticker)

Jugar una hora al dia (sticker)

Exercise Prescription

Receta de Ejercicio

Weight Management Progress Note

Weight Monitoring Log  

El Grafico Para Ver el Cambio de Peso

BMI Chart – English

BMI Chart - Spanish


Motivational Interviewing and Stages of Change

Yale Rudd Center

Motivational interviewing for diet/exercise and obesity

Examples of motivational interviewing techniques

Weight Watchers

Are You Ready?Stages of Change and Weight Management


Preventing Weight Bias

Yale Rudd Center for Food Policy and Obesity

Online Toolkit : Preventing Weight Bias: Helping Without Harming in Clinical Practice This toolkit, with downloadable files, is designed to help health care providers across a variety of practice settings with easy-to-implement solutions and resources to improve delivery of care for overweight and obese patients. The resources are designed for busy professionals and customized for various practice settings. They range from simple strategies to improve provider-patient communication and ways to make positive changes in the office environment, to profound ones, including self-examination of personal biases.

Weight Bias in Health Care Video

Weight Bias in Health Care – Video Discussion Guide


Shared Oregon Resources

Protocol and Brochure Samples

Local agencies shared these resources. They include protocol examples and educational materials. You can adapt them to fit your particular clinic or community needs.

Public Health Education Protocol - Union County Center for Human Development, Inc.

Education Topic

        Definition

                   Plan

Nutrition

Consultation/information provided regarding nutrition that promotes health and prevents disease.

May provide brochure 4 Things You Should Know about Nutrition and Birth Control. Download at www.healthoregon.org/fp.

Provide key messages and food lists from the U.S. Department of Agriculture’s Choose My Plate website: http://www.choosemyplate.gov/ The Choose My Plate model replaces the Food Guide Pyramid. 

If using Depo-Provera, make sure to counsel about the importance of calcium intake!

If an eating disorder is revealed or suspected, encourage the client to get help and ask them how we could help them when they visit the health department. Provide information regarding visiting nutritionist and mental health provider.

La Clinica del Carino Family Health Care Center, Hood River, OR

La Clinica del Carino Family Health Center materials are written in low-literacy English and Spanish. You can download materials from the La Clinica web site.

Our Path to Good Health / Nuestro Camino a Buena Salud
A 20-week curriculum for healthy weight management, with a guide to implement the curriculum and use it to launch a formal or informal health promoter program for weight management. Separate English and Spanish documents.

"The Beautiful Women Have Figured It Out!” / “Tienen Razón las Bellas Mujeres!
A simple health information and recipe book which promotes healthy weight management. It was created by health promoters for use in the community. Bilingual books.

Breastfeeding Cards: Simple, low-literacy laminated cards with instructions on how to pump and store breast milk for new mothers who need to return to work. Four cards are bilingual; one card is separate English and Spanish.

"Methods of Preventing Pregnancy" / "Métodos Para Prevenir el Embarazo" a double-sided, tri-fold pamphlet on birth control options with pictures. Must be printed double-sided on 11"x14" paper.

Spanish and English What can we do to manage our weight? handouts.