The global rise in obesity has generated interest in nutrition and behavioral
therapies as care processes for managing obesity and related co-morbidities. Growing
evidence supports the use of nutritional consultation and intensive behavioral therapy to
reduce risk factors associated with obesity. The World Health Organization
recommends that the delivery of interventions should be of appropriate intensity and
sustained over extended periods of time while noting that even modest changes in risk
factor levels may achieve substantial public health benefits. Obesity guidelines provide
recommended steps for identifying risk status, matching treatment to risk assessment,
and implementing weight loss intervention strategies. A highly collaborative process of
care, which focuses on the nutritional and lifestyle management of obesity and selected
co-morbidities, is known as medical nutrition therapy (MNT), when provided by a
registered dietitian, or as nutrition therapy when provided by other disciplines.
Behavioral therapy approaches that focus on collaborative decision making include
motivational interviewing and the 5 A’s behavioral counseling steps. Motivational
interviewing, which includes open-ended questions, reflective listening, affirmation and
summarization, helps individuals address their concerns about making lifestyle changes.
The 5 A’s steps generally include: Ask/Assess: ask about/assess behavior and health
risk(s); Advise: personalize behavior change advice; Agree: collaboratively select
goals, Assist: use behavioral techniques to aid in achieving agreed-upon goals and
Arrange: schedule follow-up. Training programs can help health professionals develop
nutrition and behavioral therapy skills and address bias and discrimination. Weight
management approaches and priorities will vary by the risk status and health care
settings.
Keywords: 5A’s, behavior, diabetes, diet, dietitian, global health, intensive
behavioral therapy, medical nutrition therapy, MNT, motivational interviewing,
nutrition therapy, obesity, overweight, wellness.
