Chapter 10: Initial Interview And Client Screening Flashcards
Goal of any assessment
develop safe and effective exercise program
Behavioral assessment should revolve around
Gather information to create program to meet client needs
Potential contraindications for weight loss: 3
Depression
Current major stressors
Uncontrolled binging
Meal-replacement, support groups, diet books, increased exercise are examples of _ treatment for overweight persons
Self-help
Commercial based franchises - coaches present program to clients
Nonclinical treatment
Treatment is provided by licensed professionals and typically affiliated with a hospital or university
- used to treat complicated or severe cases of obesity
Clinical treatment
_ mandates specific requirements for all centers promoting rapid weight loss
Rapid weight loss = lbs per week
Loss of _ % of body weigh after the se one week of participation
Truth in dieting regulation
More than 1.5 to 2 lbs per week
More than 1%
Under _ the consumer has the right to:
Ask questions about health risks of program, nutritional content, psychological support
Know the price of treatment and services
Know the program duration that is being recommended for you
weight loss consumers bill of rights
Guidelines for _:
All clients must be screened for medical and psychological conditions that make weight loss inappropriate
Clients must be classified by excess body weight and overall health risks
Care should be given by trained individuals
The Michigan Guidelines
Criteria for _:
Match btwn program and consumer
Soundness and safety of program
Outcomes of the program
Nutrition board for the institute of medicine IOM
Low-fat diet
Physical activity
Lifestyle change
For weight loss up to _ lbs
IOM step 1
*for weight loss of up to 10 lbs
Commercial weight loss
Intensify self help efforts
Support/ education
IOM step 2
Primary care physician
Monitor / supervise treatment efforts
Treat comorbid disease
IOM step 3
Very low calorie diets
Medication
Psychotherapy
Surgery
IOM step 4
Minimum expectations of a credible weight loss approach
Standards of care
IOM and NIH recommend reassessments:
Beginning of weight-loss
End of weight loss
Every 6 months during maintenance
_ is greatest with low calorie diets and rapid weight loss
Gallbladder disease
4 components of a successful program
Long term weight loss
Improvement in obesity related factors
Improved eating habits and physical act
Monitoring of adverse effects that might result from the program
Waist circumference strong indicator of abdominal obesity
Men
Women
Men: 40 inches or greater
Women: 35 inches or greater
Force of the heartbeat and the resistance of the arteries to the pumping action of the heart
Blood pressure
Must use an appropriate sized cuff as overweight clients …
Falsely elevated BP readings when standardized cuffs used
Normal BP
Prehypertension
Hypertension
120 / 80
120-139 / 80-89
140-159 / 90-99
Average resting HR
Normal range
_ may slow resting and non-resting HR
72 bpm
60-100 bpm
Beta blockers
_ % of body weight loss over six months is recommended
10%
IOM recommends weight loss goal of _ over the first 6 months
10%
Treatment can be cumulative or incremental
Stepped care
Medications that can hamper weight loss
Psychotropic drugs
Antidepressants, anxiety, mood stabilizers
Weight regain within one year
Within 5 years
2/3
All weight is regained
Anorexia- refusal to maintain _
At least 85% of ideal body weight
Only eating disorder where weight loss is appropriate
* when accompanied by ongoing psychotherapy
Bulimia
_ therapy may help clients with binge eating disorder
Cognitive behavioral therapy
Clients participating in self guided activity should complete…
For low to moderate exercise only
PAR-Q
Risk classification
Step 1
Identify CAD risk factors
Risk classification
Step 2
Perform risk classification based on CAD risk factors
Risk classification
Step 3
Determine need for medical exam/ clearance
HDL negative risk factor
HDL = 60mg/dL or higher
4 components of physical fitness
Aerobic fitness
Flexibility
Muscular strength and endurance
Body composition
Positive risk factor
+1
Age
Men 45 and older
Women 55 and older
Positive risk factor
+1
Family history heart attack, coronary revascularization or sudden death
Father:
Mother:
Father: before age 55
Mother : before age 65
Positive risk factor
+1
Smoking (3)
Current smoker
Quit within last 6 months
Exposure to second hand smoke
Positive risk factor
+1
Sedentary lifestyle
30 minutes activity
3 days week
For at least 3 months
Positive risk factor
+1
Obesity - BMI, waist
BMI 30 or greater
Men 40 inches
Women 35 inches
Positive risk factor
+1
Hypertension
SBP 140 or greater
DBP 90 or greater
Currently on antihypertensive medications
Positive risk factor
+1
Dyslipidemia
LDL
HDL
Medication
LDL 130 or greater
HDL less than 40
Lipid lowering medication
Positive risk factor
+1
Dyslipidemia
Serum cholesterol
200 or greater
Positive risk factor
+1
Prediabetes
Fasting plasma glucose
Impaired glucose tolerance
Fasting plasma glucose 100 or greater
140 or greater
Risk classification
Low risk
Medical exam?
LESS than 2 risk factors
No
Risk classification
Moderate risk
Medical exam?
2 or more risk factors
Exam required for vigorous exercise
Risk classification
High risk
Medical exam?
Symptomatic or known disease ( heart murmur)
Exam. Required for all types of exercise
_ suggests that a complicated period of psychological prep needs to precede true readiness to commit to lifestyle change
TTM transtheoretical model of behavior change
Behavioral assessment process must start by
What functions are being served by existing behaviors?
Sarah!
Assessing Negative behaviors
2
Identify how client benefits from negative behaviors
Identify triggers
Goal of behavioral assessment is to identify connections between behaviors and
Antecedents and consequences associated with behavior
Lear in approach in which behaviors are influenced by consequences
Operant conditioning
Undesirable behavior performed too often
*example
Behavioral excess
Unhealthy eating habits
Desirable behavior not performed often enough
*example
Behavioral deficit
Physical activity
Behavioral excess
Behavioral deficit
Sarah!
Eating out of boredom after dinner
Studying after dinner
1st step in functional assessment
Identify target behaviors - dietary and physical activity
2nd step in functional assessment
Identify situations that trigger or prevent goal behaviors from occurring
_ often outweighs the willingness to make a lifestyle change
INSTANT GRATIFICATION
3rd step in functional assessment
Gather preferences of clients
Best positive reinforcement to create for client
Enjoyment and mastery
4 th step in functional assessment
Determine past attempts and outcomes of previous lifestyle modification
