DEFINITION OF BEHAVIORAL COUNSELING

There are several health behavioral change models that are currently practiced. These change models
can be applied to altering behavior in physical activity and diet. One such model is the social
learning model, which is concerned with a person’s attitude toward change. This change model has
been found to have an effect on cognitive, interpersonal, and environmental factors, which in turn
have influenced behavior [42].
To apply this change model to physical activity and diet behavior, individuals proceed through
a series of steps: self-monitoring, self-analysis, self-management, and replacement of unhealthy
behavior [41]. The self-monitoring step typically includes keeping a food diary. The self-analysis
step includes the discussion of reasons for amounts of food intake during the day. During the selfmanagement
step, the individual identifies certain moods and clues that indicate a need for excess
food. The last step — the replacement of unhealthy behavior, such as eating high-fat foods — is
the most challenging step. During this last step, adding incentives to replacing the unhealthy
behavior is shown to increase success.
Another factor addressed in the social learning model is the management of stress. With
successful management of eating and physical activity, overweight individuals increase self-confidence
in their ability to gain control over specific behaviors [41]. This would, in turn, reduce their stress
level. Self-efficacy states that the greater the perceived ability to maintain a behavior, the greater
the actual occurrences of that healthy behavior. Thus, positive self-efficacy with diet and physical
change is a very important factor in weight management. Self-efficacy also influences the treatment
of depression and the reduction of stress — both psychosocial factors that affect obesity.
Behavioral therapy has been shown to be effective even when done briefly [41]. The Worcester
Area Trial for Counseling in Hyperlipidemia study is an example of how brief counseling can
provide positive results in weight loss [41]. During the study, physicians were given 8 minutes with
each patient. Study patients received either counseling alone (control) or counseling combined with
handouts and questionnaires concerning dieting (treatment) while in the waiting rooms [6]. A year
later, treatment patients were found to have lost 2.3 kg more than the control and, as a benefit of
that loss, to have lowered their cholesterol by 3.8 mg [41].
Several other techniques, such as contracting, have been identified to improve self-care and
manage weight. Contracting is the actual writing down of patient goals. Also, providing the patient
with small, controllable tasks is another way to allow for success that helps sustain motivation. Finally,
it is extremely important to give feedback to the patient, to establish a social support group, and to
keep track of the patient’s commitment [41]. Remember, though, that the key is to identify the patient’s
specific problems to correctly assess which techniques to employ. It is the physician’s responsibility
to ask the patient to identify barriers to changing eating or physical activity behaviors.
Along with social support, another important aid is using a team approach in physician intervention.
Not only should the primary care physician be involved but also nurses, psychologists,
dietitians, and social workers. Such a team is necessary because behavioral interventions tend to
require relatively large amounts of professional time [41].