Instructions for WAVE
Assessment | Recommendations

Recommendations

Weight 1. Discuss the patient’s BMI level with him/her. If patient is at a healthy BMI, give him/her positive feedback, and discuss physical activity and dietary changes below that may help them to maintain their weight. If BMI indicates patient is overweight, discuss specific concerns with the patient, e.g., “I am concerned that your weight may be affecting your overall health/diabetes, blood cholesterol, blood pressure, etc.” Determine patient’s readiness to lose weight by asking, ”Are you interested in making changes to lose weight now?”  If patient indicates readiness to lose weight, give general guidelines with educational handout(s) and web site resources (see below). Encourage patient to set realistic goals for weight loss (5-10% of current weight to begin).  Even a 10% weight loss can have huge health benefits. Affirm the importance of gradual weight loss (1/2 to 1 lb./week—eating 250-500 calories/day less than current intake) and making small changes. If patient is willing, discuss methods for weight loss (decrease calorie intake and increase physical activity).  Common sources of caloric excess include large portions, sugary beverages, added fats, high fat/sugar desserts and snacks, fried foods, etc.  See suggestions below for activity increase and dietary change. Ask patient to choose an area on which he or she would like to focus. Note that exercise and dietary changes may improve the health of overweight individuals even if they do not lose a lot of weight. Provide referrals to weight-loss programs and/or a dietitian if patient would like ongoing assistance.

Activity Discuss the patient’s activity/inactivity level with him/her. If patient is active and does not watch more than 2 hours television or videos a day, give patient positive feedback and encourage them to continue. If patient does not get enough physical activity and/or watches more than 2 hours television or videos a day, encourage a gradual increase in activity, if patient is ready to increase activity. If the patient is totally sedentary, begin with 5-minute sessions and increase by 5 minutes weekly until patient is at 30 minutes, five days a week. Decrease TV/video watching and/or include exercising during TV watching. Give guidelines about how to increase physical activity with educational handout(s) and/or web site resources (see below).

Variety and Excess in Eating Discuss patient’s eating habits with them. Are they getting adequate variety according to the Food Pyramid? Could they be eating too much fat, calories, salt, sugar, etc.? Give positive feedback for patient’s eating habits that meet guidelines. What does the patient think the pros and cons of his/her own eating habits are?  Is the patient willing to make dietary changes? Give suggestions/handouts on specific changes that patient can make to increase variety (i.e. fruits and vegetables, dairy products, etc.) and/or decrease fat, calories, saturated fat, sugar, salt, etc. (see attached lists). Set realistic and specific goals.  If patient is ready to make behavior changes, jointly set goals for a plan of action.  Encourage gradual changes. Arrange for follow-up.  Even brief visits to your office for a “weigh-in” can be a powerful reinforcement tool.  Refer to a weight management program, dietitian or physical activity specialist if appropriate. Provide resources.  Give helpful web site addresses and handout(s).

Patients value what their providers say.  When you introduce and stress the importance of nutrition and physical activity, patients are more likely to initiate behavior changes.

The WAVE protocol can be reproduced on a laminated 5 X 7 card that can be carried conveniently in lab coat pockets, if desired.

The WAVE nutrition pocket guide was developed by Claudia Barner PhD, RD, Judith Wylie-Rosett EdD, RD, Kim Gans PhD, MPH, LDN and members of the Patient and Practice Resources Committee, NIH Nutrition Academic Award with funds from NIH NAA grant HL03924.