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management of obesity and prevention

Pattern recognition, also known as heuristics or intuitive thinking, is an innovative approach to counseling.2 Pattern recognition is familiar to diabetes clinicians when reviewing the relationship between a patient’s blood glucose, meals, and medication administration. Adjustments in meals and medications are made after reviewing a patient’s blood glucose patterns. For obesity care, diet, physical activity, and behavioral counseling are adjusted based on a patient’s lifestyle patterns. This is the basic premise underlying this new counseling method. Figure 1 depicts a lifestyle patterns organizational chart showing the seven lifestyle patterns in each of these three dimensions.3

The overall goal in weight loss counseling is to help patients consume fewer calories and eat more healthfully. However, patients have different obstacles in their way. Lifestyle pattern identification helps to identify behavioral obstacles. Some people travel a lot and depend on restaurant food for their meals, whereas others eat healthfully during the day but become nighttime nibblers when they are relaxing at home. Identifying a patient’s particular struggles when it comes to eating will help clinicians focus their counseling. How and when a patient eats can be as important as what and how much they eat.

Regarding exercise, knowing the recommended exercise guidelines for general health, weight loss, and weight maintenance is important, but it does not help personalize this information to patients sitting in a clinic office. Some patients may want to exercise but do not have the time, whereas others are all-or-nothing type exercisers, and still others have a functional limitation that affects their ability to exercise. Knowing the attitudes and motivations behind your patients’ struggles with becoming more active gives clinicians a clearer picture of how to help each particular patient.

By taking a previously validated 50-item questionnaire, patients find out, for example, if their eating pattern is that of a Meal Skipper, a Convenient Diner, or a Hearty Portioner; if their exercise pattern is that of a Couch Champion, an All-or-Nothing Doer, or an Uneasy Participant; and if their coping pattern is that of a People Pleaser, a Fast Pacer, or an Overreaching Achiever.4 The qualitative lifestyle pattern names help clinicians connect quickly with patients. “You pegged me,” is a frequent comment clinicians hear when using this approach. And feeling understood is often the springboard for an empathetic and therapeutic clinician-patient relationship.