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Healthy eating and exercise is important for everyone, regardless of their shape and size. In the past, we have focused primarily on promoting these behaviors to overweight students. By operating this way, our students who may not yet be overweight, but have less-than-healthy behaviors, end up falling through the cracks. As a healthcare provider, you serve as the gatekeeper to the Healthy Eating and Active LifeStyles program. You see every student who comes onto center. Your job is to ensure that students are connected with the right people and receive the correct counseling and advice.

The Plan
  • Step 1 -- Evaluate student height, weight, waist circumference, and current behaviors on entry. Student behaviors and interests may be ascertained through a questionnaire and an interview. The nurse who meets students on their initial visit to the health and wellness center or the center physician should be responsible for this initial task.
  • Step 2 -- Develop a referral system between the health and wellness center, recreation, food service, and other departments. Ensure roles are delineated. Student questionnaires should accompany the referral.
  • Step 3 -- Determine a plan for working with students with different needs and interests. You may use this sample plan or customize it as you see fit.
Recommendations

We have provided recommendations for working with students based on their current level of motivation and specifics from the Healthy Eating and Active LifeStyles Wellness Questionnaire. If you want to customize the plan further, please do so. This is meant as a guide and should be tailored to meet your center's needs. Some new students will come to you with healthy behaviors already in place and will simply need to be pointed in the right direction to continue these behaviors. Others will have greater needs.
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Assessing a​​nd Responding to Motivation Levels (Questions 1 and 4)
Category
 Example Potential Strategy to Work with This Rationale
Student does not currently eat healthy food and exercise and is not ready for change:
Choice D		 On the Healthy Eating and Active LifeStyles questionnaire, Jacquie circles choices a-f on question 5. She writes in the margin that she doesn't like exercise AT ALL!!! In talking with her, you ascertain that she understands that there are health risks associated with being overweight, but she does not want to change her eating and definitely does not want to exercise.
  • Follow obesity chronic care management plan (CCMP), if applicable. Follow up with her per CCMP.
  • Treat co-morbid conditions, if applicable.
  • Make her aware that there are people available on center to help her if she starts to think about adopting healthy behaviors. Inform her of your open door policy.
  • Ask her questions. Prompt her to talk about current habits and reasons why she does not want to adopting healthier habits (questions 2 and 5). Avoid telling her what she "should" do.
  • Follow up in one month.
  • If she expresses interest in making a change on a subsequent visit, follow instructions in next category.
 Student could benefit from healthy lifestyle changes but has indicated that she is not ready. At this point, your role is to help her begin to contemplate changes. Since she is currently not considering making changes on her own, it is too soon to plan or begin changes. Behavior change will not be accomplished at this meeting. Your role is to plant the seed and follow up at a later date.

These are probably the hardest students to work with, as often they are the ones who need our help the most. However, pushing this topic at your initial meeting will probably backfire.

Student has been thinking of making a change, unsure of where to begin:
Choice C		 On intake, Anthony indicates that he wants to begin to exercise and eat healthy, but does not know how to go about it. He indicates that he feels silly when he exercises because he really does not know how. He loves food and eats a lot.
  • Follow obesity chronic care management plan (CCMP), if applicable.
  • Treat co-morbid conditions, if applicable.
  • Encourage him to talk about his past experiences with weight loss, including successes and failures, and his goals for the future.
  • Refer him to the recreation department.
  • Help him draft a plan to implement changes and meet regularly with student to track proress and revise plan.
  • Follow up as needed.
 Student has indicated that he has thought about losing weight, but needs help figuring out how to do it. He is in the contemplation phase. We want to help him move into the planning phase. This means helping him devise a strategy that he can stick to (not supplying him with a predetermined strategy). After he is comfortable with his plan, he can put it into action.
Student knows that they want to develop healthy habits on center:
Choice B		 Shana is sick and tired of being overweight. She had just started walking a little bit with a neighbor before coming to Job Corps. She was planning on taking a dance class at the community center but then she got her arrival date. She wants to follow through with her plan.
  • Make her aware of recreation opportunities, healthy offerings in the cafeteria, groups on center, and anything else that will support her in her efforts.
  • Help her draft a plan to implement changes and meet regularly with student to track progress and revise plan.
  • Follow up as needed.
 Student is ready to follow through with the plan she already made. She will need help tailoring her plan to the opportunities available on center, but she is ready to get started.
Student already has healthy habits and wants to continue them in their new environment:
Choice A		 After reviewing his questionnaire and speaking with him, you learn that Raul has always been active. He has played soccer since he was little. His mom has always cooked healthy, traditional El Salvadorian food. He wants to know how to sign up for soccer.
  • Make him aware of recreation opportunities, healthy offerings in the cafeteria, groups on center, and anything else that will support him in his efforts.
  • Ensure he has the opportunity to express his preferences to all those involved including the Recreation and Food Service Managers.
 Student has already adopted healthy behaviors; our job is to help him maintain those behaviors. We can accomplish this by having activities and healthy, culturally appropriate foods available.


Respon​​ding to Inconsistencies
Category Example Potential Strategy to Work with This Rationale
Student is motivated to exercise but not eat healthy, or vice versa.
(Question 1, answer D; Question 4, answer B)		 On Tyrone's questionnaire, he indicates that he does not want to change the way he eats, but would like to get started with an exercise program.
  • Focus on his exercise program. Get him talking about what he likes to do. Discuss recreation opportunities with him and refer him to the recreation department.
  • Make him aware that there are people available on center to help him if she starts to think about his diet. Inform him of your open door policy.
 Behavior change is most effective when one behavior is targeted at a time, especially when the person is ambivalent with one behavior. Often with diet and exercise, one behavior change will follow the other.
Student is motivated for behavior change (Question 1, answer B), but contradicts this motivation (Questions 2 and 3). Samantha responds that she wants to eat healthy. She also indicates that she doesn't like the way healthy food tastes and she is tempted by unhealthy foods.
  • Try to help her develop a discrepancy. Ask her:
    • What she thinks she might need to do to change the diet. Help her come up with some potential solutions.
    • Where she thinks that she will be in five years if she continues eating unhealthy foods.
  • Let her determine the next step. Help with a healthy-eating plan or schedule a follow up.
 In order to move forward, student needs to discover on her own that her current behaviors are not moving her closer to her goals. Your goal is to lead her down a path where she discovers that unhealthy food will not help her reach her goals. By the end of this conversation, hopefully she will decide to try incorporating a few healthy foods into her diet.


Mental Health Referral
Category Example Potential Strategy to Work with This Rationale
Student indicates that she uses food or exercise to cope with negative feelings.
(Question 2, answer E; Question 6; various answers)
 Mark indicates that he often eats when bored, sad, upset, etc. He says that he thinks the best reasons to exercise are to:
  • Feel less stressed out
  • Feel better about the way I look
  • Sleep better at night
  • When talking with Mark, be alert for potential problems handling stress and self esteem issues.
  • Refer him to the CMHC, if warranted.
  • CMHC may use components of "Foods and Moods" curriculum when working with him.
 Student has indicated emotional issues on his questionnaire. Both food and exercise can be used to self medicate stress, depression, and low self esteem. His behaviors probably will not change until he handles the issues that are causing them.
Student indicates all healthy behaviors, has a very low BMI, and answers various benefits to exercise. Monica indicates that she eats healthy and exercises a lot. She chose the following as good reasons to exercise:
  • Feel less stressed out
  • Lose weight
  • Feel better about the way I look

Her BMI is 16.2. She is underweight.
  • Assess Monica for an eating disorder.
  • Refer to CMHC.
 This questionnaire has raised red flags that the student might be struggling with an eating or body image disorder.

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