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An experimental Canadian training program for obesity care professionals yielded positive results by bringing the full power of behavioral science to obesity-management counseling. As Michael Vallis, PhD, R. Psych, of Dalhousie University in Halifax, Nova Scotia, and Tiffany Shepherd, PhD, R. Psych, of Nova Scotia Health Primary Care, explained in , 28 licensed obesity clinicians were trained in the nuanced art of identifying and supporting patients who had indicated they were ready to change.

Aimed at doctors, nurses, physiotherapists, and dietitians, the program is a step toward rectifying the lack of available training in core competencies of behavioral change counseling, Vallis and Shepherd explained.

Behavioral change, they noted, is layered and complex: the behavior change taxonomy organizes 93 modification interventions within 16 domains.

In the following interview, Vallis reviewed the details of the program.

What was the impetus for the study?

Vallis: Most patients with obesity are managed according to a scientific clinical model: expert diagnosis followed by appropriate medical treatment. But obesity requires long-term behavioral change, and clinicians have very little training in this. They're taught to be the experts in a defined provider-patient relationship, to diagnose and prescribe, but to help those with obesity you have to be collaborators.

Each patient is different and needs to be understood and supported as an individual. You can't just make a recommendation to a patient, set a goal, and then say, "I'm done." This is where psychology-based counseling training can help. How do we support patients over time who want to change?

What was the model?

Vallis: Although there already were brief training sessions available – workshops or webinars, for example – they just didn't carry the day. We wanted to dig deep and create a comprehensive model to give non-psychologist providers the confidence, skills, and competence to really understand individual patients, assess their readiness for change, and help them overcome barriers.

This program was something like a cross between a graduate course and a lecture series. It involved 25 weeks of synchronous online sessions, each lasting an hour and a half and organized into awareness, competency, and confidence phases.

The approach capitalized on the principle of repetition and relevance – that is, repeating the learning material three times at each phase, allowing learners to rehearse skills in a manner that supported integration of new skills into their existing skills and develop self-efficacy in the use of skills.

Under the supervision of two senior psychologists, the sessions involved didactic presentations and discussions, as well as peer-to-peer role-playing, demonstration of newly learned skills and, very importantly, both supervisor and peer-to-peer corrective feedback in a safe and comfortable setting. We gave participants lots of opportunities to practice and gave them the opportunity to put their own flavor on it.

One of the core competencies was assessing patients' readiness to make changes, asking key questions and listening to the answers, and presenting the care provider as a collaborator.

And the outcomes?

Vallis: The positive results were really reassuring, and we were not surprised, since most clinicians already have the necessary skills; they just need to be tweaked.

In post-training objective assessment of competency training, for example, we found that participants achieved moderate to high skill in all aspects of behavior change counseling. They also reported frequently incorporating the acquired skills into their clinical practices, particularly with regard to change-based relationships, readiness assessment, and intervention.

Individual interviews confirmed the value to learners of a safe place for corrective feedback and the opportunity to teach learned skills to peers. The qualitative data were also very positive. Participants said things like. "You can't unlearn this stuff – once you learn it, you can't go back."

What characteristics correlated with high competency?

Vallis: The features related to a high level of competence were the ability to listen and really hear the individual patient as well as the amount of time a participant was willing to spend in a supportive way. Patients want the doctor's advice, but they don't want to be told what to do.

Any follow-up plans for the research?

Vallis: We're hoping maybe to develop a briefer version for those who don't have the capacity to dig deeply themselves but do often work with others who can. This program could be taken apart into smaller elements that might be raised one at a time with patients in 2 or 3 minutes per consultation.

Moving forward, this program will be fully integrated into Obesity Canada's But large-scale training will require building a cohort of supervisors to provide corrective feedback and streamlining training via self-directed modules and competency self-assessment.

Read the study here and expert commentary about it here.