The ‘non-diet’ approach involves eating when you are hungry, eating what you really prefer to eat, eating consciously, and stopping when you are full. In this way, we eat in response to physical needs and gain satisfaction from eating in our physical, emotional and spiritual realms.

This approach to teaching dietary behavior change works beautifully with Motivational Interviewing because the work is client centered. When we teach conscious eating, we focus on helping clients discover their own hunger, fullness and satisfaction signals, all of which are intensely personal experiences. Using MI, we guide our clients through a process of learning about physical hunger and fullness sensations.

It’s important to note that the ‘non-diet’ approach may not be appropriate for all who need to change their eating habits. It requires both the ability for insight and the willingness to forgo immediate gratification in order to learn about true hunger and satiety.

Tip for Teaching the ‘Non-Diet’ Approach: Try thinking about these ideas in terms of three questions. You are thinking about eating. Stop, and ask:

* Am I hungry, physically hungry?
* If yes, what do I really want to eat?
* How much of this food do I need to be satisfied?

Remind your client (and yourself!) that the answers are very personal and unique to each individual. You might be able to tell others how these internal experiences feel to you, but not how they might feel to someone else. Working with your clients, you embark on an investigation into their experiences of hunger and satiety. Each client leads his or her own journey, with you, the counselor, as a guide.

The MI guiding style puts a premium on evocation - the act of eliciting from clients their questions and concerns in setting the agenda for a health education session. The more the practitioner allows the client to set the agenda, the more likely is it that the material covered will be greeted with open ears.

However, there are always moments when the clinician must bring up a difficult topic, one that the client is, at best, reluctant to discuss. These topics vary from profession to profession. Pediatricians, for example, list these among their difficult topics: domestic violence, second hand smoke, untreated parental depression, obesity, harsh parenting, and the overuse of antibiotics.

We are always challenged to maintain rapport during these difficult consultations, and effective clinicians keep their message short and simple. MI teaches the advantage of using brief discussions which are more about listening than about delivering a compelling dose of information.

Here are six (6) simple steps:

1. Introduce the topic and goal of the conversation.
2. Ask permission to proceed. If necessary, gently impose.
3. Deliver no more than three (3) simple, jargon-free facts: an ear opener, a simple fact, and a confidence builder.
4. Elicit a response.
5. Listen, listen, listen. Use reflective statements to acknowledge patient concerns.
6. Summarize and affirm.

A pediatrician using MI might handle a conversation about second hand smoke like this:

Step 1: I like talking to all of my patients about second hand smoke and their children’s health.
Step 2: I know this is not your favorite topic, but please bear with me for a few short minutes.
Step 3: Ear Opener + Simple Fact + Confidence Builder:

3a. When kids are exposed to second hand smoke, it’s like they are themselves smoking.
3b. Kids exposed to second hand smoke have more frequent illnesses and sometimes fail to grow as well as their peers.
3c. When it comes to second hand smoke, anything a parent does to reduce exposure helps; quitting is the best but any changes are positive.

Step 4: What do you think?
Step 5: You are concerned about your child’s asthma, but you don’t feel ready to quit right now.
Step 6: So, your plan is to smoke outside and use nicotine gum for those long car trips. I appreciate how seriously you’re taking this.

These six (6) simple steps will help create an opportunity to address just about any difficult topic. Since behavior change is more a function of motivation than education, try to keep the message simple and listen well to the patient’s response.