Danielle Davis 1

Client Project Phase 2

Expectation of treatment:
1

What changes? G. Goodness stated exercise and to become more active. I

decided to administer a PAR-Q to assess his readiness. He answered no for 6 out
of 7 questions, but yes to item #5, so seeing a physician before becoming very
active was recommended. Since G is ready to exercise, he could still benefit
from light activity or just simple modification of his sedentary habits. For
example, walking on the treadmill while watching television is one of his SMART
goals. After the PAR-Q, I adjusted it from 30 minutes to 10 minutes, and as he
achieves success, he should safely work his way up to 30 minutes.

Which changes? G again stated exercise. I had to probe a bit more, and he then
stated substitutions and different foods. I think volumetrics could be very useful
for G. He had success with portion control on Weight Watchers, but regained
weight after he stopped. Substituting nutrient dense foods for energy dense
foods may aid G as a way of life versus being on a diet.

What will change? My general health and the way clothes fit was his original
answer. G is aware of his health issues, but he is very reserved when he speaks
about why he needs to lose weight aside from his perception of his body size. I
had to keep prompting G, and finally he said, Life would be easier, everyday
things, for example, less pain in joints (ankles and feet). I was surprised to hear
him speak about pain. I had assumed he had some difficulty, but at the time,
this was the first I had heard him say it. I had administered the PAR-Q after
asking these questions.

What do others think about your weight? Its too much. Too too much. I dont
know whats more specific than that. While he is aware about his size, but he
doesnt show a negative affect toward it. For example, in the first phase when I
told him his BMI was 39 and that he was morbidly obese, he was not surprised.
G is very receptive to any information I provide him with, but theres usually not
a big response behind it. I think I was expecting more of a response, but this is
something G has been dealing with for some time.

Will family/friends be supportive? Can you identify saboteurs? G didnt think so.
In fact, he wondered what kind of question was this, and seems to disbelieve
that there are people like that. I explained to him that for others, weight loss
sometimes changes power dynamic in relationships, so people may sabotage
weight loss goals as means of maintaining power. G thought that this was
messed up. We both reflected on how lucky he was since he couldnt think of
anyone who would do that. I think this makes it easier for G to accomplish his
weight loss goals seeing that he already has social support from his friends and
family.

Handling saboteurs? G had no answer when I first asked, even with further
prompting G said that this didnt apply to him. Recalling the first phase, G said
that weight loss wasnt his top priority, so his other priorities and daily obstacles
seem to be bigger problems for him. G isnt his own saboteur either, but he
does need redirection to keep him engaged.

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Client Project Phase 2
7

Losing weight for yourself or someone else? G quickly answered for himself. I
thought he may have said his wife or his children when I asked, Anyone else?
But, he did not. I think that speaks to his focus. Talking with G, I do believe that
his family is supportive of his goals, but the change really is for him. He seems
to be in the preparation stage. He is setting up to make some lifestyle changes,
but he doesnt express a high level of engagement that is sometimes reflected in
the action stage.

What may interfere with success? G believes his schedule. Its a combination of
lack of planning and time. I feel Gs low energy level is also an obstacle. He is
usually tired from driving from place to place as well as just general fatigue from
the work day. Sometimes, when I was asking him questions, I felt that he was
preoccupied or low on energy.

Clients Weight goals: G would like to lose 50 pounds in one year. Its
approximately %17 of Gs body weight. Hes given himself a reasonable timeframe;
it works out to a little less than a pound a week.
I mentioned to the G that even 5-10% loss of body weight would also reap some
health benefits, and he thinks that is doable as well, so perhaps this can be a minigoal on his way to losing 50 pounds.
Stage of Change: He is at the preparation stage. While I questioned Gs level of
engagement, I do not question his motivation: to lose weight for himself. Upon
starting this project, I feel G has gone from the contemplative to preparation. When
I asked him about body perception and when I told him his BMI, G was well aware
and considering to take steps to improve his diet. He has also begun the SMART
goal he selected shortly before this assignments deadline.
Signs of Success: G wants to be able to cross his arms without resting them on
his stomach as well as not to have to move the steering wheel out of the way of
his gut.
SMART GOALS:
1) Starting Sunday, I will work out on my home treadmill for 10 minutes while
watching television, on Sunday and Tuesday nights for one month.
o
o

I will set a reminder on my iPhone so that I can receive an alert to

start my treadmill workout while enjoying a television program.
I will keep the treadmill clear of clothing or miscellaneous items.

Barrier: G stated he had some pain in his joints. Upon administering a PAR-Q, he
stated that he does feel pain occasionally. My intention was to start him with and
half hour, but I think 10 minutes increments would still be beneficial. Once he
achieves that goal, duration and frequency can be adjusted to Gs needs. Another

Danielle Davis 3
Client Project Phase 2
barrier is Gs energy level, if he is feeling tired, exercising in the evening will be
harder for him. Thats why I suggested he pair exercise with television.
2) On Sunday evenings, I will identify fast food choices, from my mobile app or
from a pre-reviewed list, which are 500 calories or less to have at lunch for
Monday and Tuesday for three weeks.
o
o
o

I will select from fast food choices provided by the RD or through use
of a mobile app, and select 3 items that are 500 calories or less that I
would like for lunch.
I will install an app, such as MyFitnessPal or Noom Fitness Coach, on
my phone so I can look up the nutritional information.
I will set a reminder on my IPhone to make sure I do not skip lunch.

Barrier: G is often surrounded by fast food, or fast food is the only food available.
He may pick choices that arent similar to his selection. Or, he may delay eating
while on the job and opt for something more convenient.
3) Starting Monday, I will substitute at least 8 ounces of a caloric beverage
(such a sweetened iced tea, soda, juice or any caloric or sugar sweetened
beverage) with water or seltzer at lunch and dinner, Monday to Friday, for two
weeks.
o
o

On Sunday, when I am shopping at the supermarket, I will buy seltzer

or water to take with me.
Before I go to bed, Sunday to Thursday, I will pack my water/seltzer
with my belongings for the next day.

Barriers: If G doesnt go shopping at the beginning of the week, he may not have
the seltzer. As stated, G ingests a large of amount of liquid calories, so only
halving/diluting water does not fully eliminate intake of sugar sweetened beverages.
G also seems to dislike the idea of drinking water by itself, so he may not use water
as a substitute.
G chose goal #3. It is a modification technique I had learned while training with
City Harvest; by creating a healthy soda out of fruit juice and seltzer, students in
the nutrition education course would take in less sugar.
G also expressed interest in the treadmill, but felt he could stick with the seltzer
better.
Little research on reduction of SSB with non-caloric beverages is currently available,
but there is a study in the Mississippi Delta that used the Healthy Eating Index (HEI2005) to show how a theoretical reduction of 50% and 100% of SSB for tap water in
a 2011 kcal diet can lead to a respective reduction of 5% and 11% of total dietary
kcal intake (2).
Program chosen: Weight Watchers Online, For Men

Danielle Davis 4
Client Project Phase 2

Has database of nutritional information on restaurants and recipes

Customizable meal plan
Promotes physical activity
Mobile App
Access to 2 week menu plan (Simple Start)

http://www.weightwatchers.com/betterformen/index.aspx
Weight Watchers is a behaviorally weight loss program that includes four
central components: a food plan, an activity plan, a behavior modification
plan that includes cognitive restructuring and group support. WW promotes a
nutritionally balanced, moderate energy deficit diet, and regular physical
activity for a weight loss of 1-2 pounds/week. During the study time frame,
WW offered the Momentum plan, which encouraged consumption of filling
foods like lean proteins, dairy, whole grains, and fruits and vegetables, and
used the POINTS system to facilitate adherence to a hypocaloric food plan.
Behavioral skills such as self-monitoring and goal-setting were encouraged
and members were provided with booklets to record food intake and physical
activity. (1).

Out of the diets I would have liked to see G select it came down to the
Mediterranean diet, The Ultimate Volumetrics Diet or a meal replacement program.
G wasnt sure about diets, but kept reiterating the idea of substituting healthier
items and swapping out others, such as his full fat yogurt for low-fat yogurt.
Signing up for the online component does give you access to the mobile and app
tools, and seeing that D is already tech savvy (hes an IT specialist), that this option
would be easier for G. It is also appropriate because G has had success with this
program in the past, but he has yet to experience some of its newer programs such
as Points Plus programs or the 2-week menu plan, Simple Start. Unlike Atkins,
Weight Watchers does encourage physical activity, albeit a lot or a little; G wants to
be more active, but he should to start at a light pace to minimize injury. Seeing that
WW is based on energy density and he had success, I suggested it to G and he
thought the online version would be doable.
WW does have an added, cost, but if he purchases the 3-month program, the cost is
approximately $5/week. After that, if he chooses to continue without paying, many
recipes and articles are still available for free.
What did you learn?
I learned that even working with someone in the preparation stage still poses a
challenge. G is receptive to suggestions, but his responses or reactions are pithy, or
not as enthusiastic as I would hope it to be. I see that as a call for me to be a bit
more patient.

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Client Project Phase 2
Also, tasks such as choosing a diet or changes hed be willing to make required
more probing than I thought, too. I wanted to be careful to not impose my own
thoughts or beliefs on G about his weight loss when he wasnt forthcoming, so I
tried to encourage and not delegate to him; I didnt want his session to be what I
thought was best. Its awkward to know you have the tools to help them, but not
necessarily the right answers for your client.

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Client Project Phase 2

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Client Project Phase 2

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Client Project Phase 2
References
Pinto, A. M. (2013). Combining behavioral weight loss treatment and a commercial program : A
randomized clinical trial. Obesity, 21(4), 673.

Thomson, J. L., Tussing-Humphreys, L., Onufrak, S. J., Zoellner, J. M., Connell, C. L., Bogle, M. L. &
Yadrick, K. (2011). A simulation study of the potential effects of healthy food and beverage
substitutions on diet quality and total energy intake in lower mississippi delta adults. Retrieved
12, 141,