1. ….PEIA Weight Management Encounters

2. MNT Encounters Scheduled RD/Client MNT encounters: Initial encounter: 60 minutes, month 2 Follow up encounters: 60 minutes month 4 30 minutes month 6 60 minutes month 13 *If the participant is in Attempt 2 of the program, they will not receive the month 13 follow up encounter as Attempt 2 is 12 months in duration.

3. MNT Encounters Additional visits can be requested when needs arise by contacting the PEIA Weight Management Office Considered on a case by case basis for approval What may be approved? Changes in medical dx Significant changes in nutrition related meds Struggling clients

4. Initial MNT Encounter 60 minutes Review initial intake information to familiarize yourself with your client before contact. When scheduling first encounter, take the time to ask a few questions and get a feel for your client. Double check medical dx Request they keep a food diary for a few days or fill out a food frequency questionnaire (can email it to them) to get a baseline intake to work from.

5. Initial Encounter Follow the Nutrition Care Process Nutrition Assessment Nutrition Diagnosis Nutrition Interventions Nutrition Monitoring/Evaluation

6. Initial Encounter Client Interview: basis of the nutrition assessment Use your Motivational Interviewing skills MI assists clients in gaining awareness of thoughts and feelings that are foundation of behavior. Explores ambivalence; increases motivation for change Put your client in the “driver’s seat”. What are their personal goals and priorities?

7. Initial Encounter Interviewing, continued: True power of change rests within the client. Your job: to draw out the client’s own motivation and skills for change- not to tell them what to do or why they should do it. Lasting change more likely to occur when the client discovers their own reasons and determination for change.

8. Initial Encounter Interviewing, continued Principles Express empathy- see the world through your client’s eyes Support Self-Efficacy- focus on previous successes and highlight skills and strengths Roll with Resistance- “dance” rather than “wrestle” with your client; explore client concerns and invite them to examine new points of view; careful not to impose your own way of thinking Develop Discrepancy- help them discover where they are in relation to where they want to be

9. Initial Encounter Assessment Eval ht, wt, wt history, BMI, WC, Biochemical data, Physical findings Measure or estimate RMR (using Mifflin-St.Jeor at actual BW) and adjust for PA level. Estimate needs for wt loss of 1-2lb/wk. Document client’s food and nutrition hx- baseline diet hx/intake pattern, PA pattern, nutrition and health awareness, food availability and psychosocial or economic issues impacting nutrition therapy

10. Initial Encounter Assessment continued: Assess prescribed meds, OTC supplements and potential for interactions Assess the client’s knowledge base, motivation level and confidence/readiness to change diet and PA Consider co-morbid conditions and need for incorporating other Nutrition Practice Guidelines

11. Initial Encounter Nutrition Diagnosis List and prioritize the nutrition diagnosis (es) using a PES statement (Problem, Etiology, Signs/Symptoms) Most Common Dx for Weight Management: Excessive energy intake (NI-1.5) Excessive oral intake (food/bev) (NI-2.2) Inappropriate intake of fats (specify) (NI-5.6.3) Inappropriate intake of types of CHO (specify) (NI-5.8.3) Inadequate fiber intake (NI-5.8.5) Overweight/Obesity (NC-3.3)

12. Initial Encounter Most common Nutrition Dx, continued Food-Medication interaction (NC-2.3) Food and Nutrition related knowledge deficit (NB-1.1) Not ready for diet/lifestyle change (NB-1.3) Limited adherence to nutrition related recommendations (NB-1.6) Physical inactivity (NB-2.1) Others may apply r/t co-morbid factors

13. Initial Encounter Nutrition Intervention: Individualize the Nutrition Prescription Work with the client in establishing appropriate and reasonable interventions to address the etiology of their nutrition dx. Work with client on appropriate nutrition education/counseling and assist in selecting appropriate behavior therapy strategies (ie: self monitoring, stress management, stimulus control, contingency management, social support, etc)

14. Initial Encounter Intervention continued: Have client assist in setting goals (measurable, reasonable/achievable, timed) Indicate materials provided and resources given/used (ie: items from starter kit, web resources, on line trackers, etc.) Indicate referrals made if any

15. Initial encounter Monitoring/Evaluation Indicators to measure are determined by nutrition dx, etiology, s/s, as well as health care outcomes. Identify nutrition care outcomes to be monitored and/or what they evaluate On follow up should provide evidence that intervention is/is not changing behavior/status

16. Follow up Encounters 30-60 minutes as assigned Re-interview Assessment: Reassess anthropometrics, biochemical data, med changes. Obtain brief diet hx and eval client’s adherence to diet plan/intervention strategies Determine adherence or barriers to learning or implementing behavioral changes Compare expected outcomes and goals

17. Follow up Encounters Nutrition Dx Based on initial encounter, progress and current goals, list and prioritize new or continued diagnosis (es) Use PES statements

18. Follow up Encounters Nutrition Intervention: Reinforce or modify nutrition prescription and assist client in setting behavioral goals focused on the etiology of the problem. Reinforce/modify goals for PA and behavior therapy strategies as appropriate Note materials provided, resources given/used Referrals or requests for follow up labs prn

19. Follow up Encounters Monitoring/Evaluation: Determine client’s understanding of nutrition intervention Any new indicators to monitor?? Compare nutrition care outcome indicators against specified standards- may establish your own comparison criteria as not all clients will be able to achieve goals established by a national standard-document progress or lack thereof

20. Resources to check out Academy of Nutrition and Dietetics Adult Weight Management Evidence-Based Nutrition Practice Guidelines: www.evidencelibrary.comwww.evidencelibrary.com Academy of Nutrition and Dietetics Adult Weight Management Tool Kit Academy of Nutrition and Dietetics Nutrition Care Manual section for Overweight and Obesity http://nutritioncaremanual.org http://nutritioncaremanual.org Academy of Nutrition and Dietetics Nutrition Care Process and Standardized Language www.eatright.org/ncpwww.eatright.org/ncp Pocket Guide for IDNT: Standardized Language for The Nutrition Care Process (now in 4 th ed.)

21. MNT Encounters Questions?? Contact Information: Cathy Shaw, RD, LD RD Program Coordinator PEIA Weight Management Program 304-293-6652 Catherine.shaw@mail.wvu.edu