Practical and Efficient Tips to Encourage Lifestyle and Behavioral Changes in the Exam Room

We have all been here before, maybe even on a daily basis, multiple times per day: You are sitting across from your sweet middle-aged patient with a medication and problem list that feels overwhelming to you. And you are the provider, the one with medical knowledge. Just take a second and imagine how they must feel. You can probably picture the innocence in your patient’s face as they ask you, “How did all these things happen to me? What can I do to prevent them from worsening?”  Or maybe you are meeting with the patient who has been bouncing in and out of the hospital, finding it difficult to stay compliant with their medications.  Or maybe it’s a young mother, determined to become healthier for the sake of her children and, one day, her grandchildren. It could even be a patient unaware of the simple changes in their diet or lifestyle that could lower their A1c.

We are all faced with these patient scenarios. Sometimes it can feel helpless, or even frustrating. How do we truly help without coming across as nagging?  The task of encouraging patients to elicit behavior change is one of the most daunting and underutilized skills we have, yet, when done successfully it is empowering and incredibly helpful for our patient’s health. 

Let’s walk through a non-comprehensive list of practical, simple tips and tools to consider when discussing behavior change with patients.

Listen

Sit down, close the laptop, and turn your listening ears on. Ask your patient (without directly asking your patient) “Why are you the way you are?” Listen to your patient’s stresses, worries, fears, traditions, culture, habits, and routine. Listen to see their social, financial, educational and spiritual state. Listen and look to find understanding, to find the why. There is a lot you can discover without having to play 20 questions. Understanding where your patient lives, how they live, and why they live, breathe, and make their daily choices is powerful knowledge. This foundation helps to build relationships and rapport and provides you the opportunity, as their provider, to meet them where they are. 

Assess Willingness for Change

Let’s flash back to your college psychology course and review the stages of change. 

Precontemplation: unaware or in denial of the need for change . 
Contemplation: acknowledges there is a need for change but is not willing or not confident to make change .
Preparation: getting ready for change, making a game plan, setting goals.  
Action: making changes and steps towards achieving goals. 
Maintenance: continuing to maintain the behavior change.

Set the Example

You have probably heard the saying, “Practice what you preach.” Set an example in how you strive to live healthy and make positive behavior changes and how you extend grace to yourself. Be realistic with your patients that you too don’t always meet your goals, but that you continue to work towards them. Transparency helps your patient have grace for themselves. 

Patient Directed Goals

After listening, assess if your patient is ready and willing to make a change. If your patient is not ready, that is okay! Reassess next visit. If they are, ask your patient, “What are one or two goals you have for yourself after our conversation?” It is okay if they have none. If they have 20, try to encourage them to boil it down to three or less. Try to coach them to make their goals “SMART” goals, but make sure they are the ones that come up with their behavioral changes. Flashback to psychology class again: SMART goals are Specific, Measurable, Achievable, Relevant, and Time Bound. For example, it may not be achievable for a patient who drinks 12 soda cans a day to completely stop drinking all sodas in one day. It may be more realistic and achievable for their goal to be to reduce soda intake by 50% in the next two weeks by decreasing by 1 can every 1-2 days. Once they reach that goal, then tackle it down to zero sodas a day!

Document and Follow Up

Write down your patient-directed goals in their chart and have a close follow-up via appointment or portal message to check in and see how they are doing and how you can best support them. A good sports team often has a coach, cheerleader, and fans in the stand. As their provider, you get to be them all!  Watch, cheer, and walk alongside them as they meet their goals and add more to them. Be a loyal fan and support them every season. Remind them that they can do it and it’s okay to come back to the drawing board to adjust their goals and game plan. Small achievable SMART goals lead to victories, which instill confidence and continue to encourage positive behavioral change!

Most of these tips can be applied in various settings, whether it's nutrition, exercise, medication compliance, physical therapy compliance, or smoking cessation. Let’s touch on some practical tips for three big areas of lifestyle intervention we encounter daily with our patients: nutrition, exercise, and treatment compliance.

Tips for Nutrition

Start with a 24-hour food recall. It is a lot less complicated than it sounds. Asking your patient, “What did you eat/drink yesterday or what did you eat/drink in the past 24 hours?” often elicits a more comprehensive and honest answer compared to “What do you like to or typically eat?” Let your patients know, you’ve probably heard it all and that you aren’t here to shame their choices but rather help encourage them in creating a sustainable healthy lifestyle. You may even find out that your uncontrolled type 2 diabetic who is frustrated at their A1c and weight is drinking a 2L bottle of soda per day and making leaps and strides with that knowledge (true story).
Sugary Sweet Beverages. This one is huge! Ask what your patient drinks! It is often a hidden and overlooked source of added sugars and unwanted caloric intake. Sodas, fruit juices, lemonades, sugary coffee drinks, electrolyte drinks, sweet tea, energy drinks, alcoholic beverages… the list could go on!  A study published in Nature in 2020 estimated that 1 in 10 cases of Type 2 Diabetes and 1 in 30 of cardiovascular disease could be attributed back to sugary sweet beverage intake as a major cause. Knowing your patients and the population you serve is key here. Some ethnicities have specific common drinks or teas that are a part of their culture and may contain added sugar. Some cultures have different names for drinks, and knowing this can help guide your conversation. Some individuals believe only “dark sodas” have sugar and “clear/light sodas” do not. 
Team Approach. Encourage your patients and their families to make healthy lifestyle goals together. If your patient’s goal is to decrease the amount of added sugar by decreasing candy and soda intake to help their type 2 diabetes, then it’s not super helpful if their family member is stocking the fridge and pantry with visible candy, sodas, and yummy, sweet treats. Just like if your patient who is a heavy alcohol drinker is trying to pursue sobriety, then having alcoholic beverages in sight in the home is also not helpful.
Moderation, not restriction.  Lifestyle changes should be sustainable and empowering. Not controlling and restrictive. This allows for more grace, enjoyment, and follow through with individual goals.
Food Order. Some studies have suggested that eating non-starchy vegetables first, followed by protein/fat source, and then carbohydrates last, leads to better post-prandial glucose and insulin concentrations. Pretty easy swap for a potential positive effect!
Affordable Whole Foods. (This is not a shout out to the store.) When able, skip the package, factory, and drive-thru line and buy and eat whole and fresh foods that naturally grow and roam! Here are some tips for your patients to consider:

Farmers Markets often accept SNAP benefits and will double them.
Some Medicare patients can qualify for a host of different nutrient-dense food programs, with some options for home delivery!
Discount grocery stores.
Frozen fruits/veggies.
For those with a yard, growing their own little garden.
Try to shop on the perimeter of the store. Most of your produce, meats, and dairy products are found on the perimeter. More processed foods are in the middle aisles of the store. 
Have a list and stick to it .
Cooking at home is often cheaper and healthier than eating out.
Shop for the deals and the fresh, in season produce (often cheaper!)
Never go to the grocery store hungry . . . we all know how that works out :)

Tips for Exercise

Any movement is better than no movement. Plain and simple! The American Heart Association recommends a minimum 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise for adults per week with 2 days of resistance/weight training per week. While this should be our goal for our patients and ourselves (yes, I am looking at you, resident working 70 hours per week), realistically we know that most of our patients (and a good majority of residents) are not achieving this on a weekly basis. Therefore, making movement simple, fun, easily integrated, and not overwhelming or intimidating is the goal! 
Make movement fun. Maybe your patient enjoys running or going to the gym and lifting--if so, that is fantastic! If not, there are other ways to be active: kicking a soccer ball, playing basketball, pickleball, pilates, dancing, walking, hiking, biking, swimming, water aerobics, gardening, etc. The key to finding something sustainable is to find something that is not a chore but is enjoyable and a way to relax! 
Make movement practical & social. Here are some tips to consider:

Better with friends, family, and pets! 
Park at the back of the parking lot to get more steps in!
Get outside! 
Take the stairs.
Get a walking pad or under-desk bike.
Take a lap around the outside of the grocery store, department, or hardware store before you start shopping. 
Walking/moving for even 10 minutes after meals has a significant impact on helping lower blood glucose spikes. Most people could fit this in after their lunch break at work!
Mini Movements: exercise on commercials, while kids are napping, while dinner is cooking in the oven. Set alarms on your phone or watch to encourage you to move for a few minutes every hour!

4. Make movement affordable. 

Don’t have small hand weights? Use water bottles or canned goods 
Don’t have a big space inside your home to work out? Get outside when you can! Get creative, don’t let your space limit you. Use your chairs, steps, walls, or sofas as workout props. 
Don’t have finances for gym membership or safe outdoor community? Try some free YouTube workout videos or free apps. There are tons of options ranging from 10 minutes to 1 hour of all different fitness styles and levels. 
Reach out to the local YMCA or gym. Some have senior, low-income, and family discount options!

Tips for Medication/Treatment Compliance

Listen and find the root cause. Maybe your patient has questions or hesitations about their treatment plans that were left unanswered, or they might not understand the disease state and the possible side effects of non-management. Maybe they have greater life stressors and worries than their health right now. Understanding where your patient is can help you identify health knowledge gaps and determine how to meet them with compassion and support.
Assess transportation needs. Is the lack of a vehicle causing your patient to not pick up their medications? Look to move their medications to a mail-order pharmacy or one within walking distance to their house or on their bus route. Reach out to your social worker or case manager if your clinic or patient has one for local and state transportation resources. 
Pill Organizers. Simple, cheap, and helpful. It just needs to be filled and emptied, which can be the hard part :) 
Too Many Medications. Does it feel like your patient has a zillion medications with varying times and regimens (BID, TID, QD, QID, etc.) and there isn't enough room in the pill organizer? We would all get confused! Find a local pharmacy that does pill packing. Pills are placed in a packet with the date and time of day. New packets are administered when the medication regimen shifts, so make sure to let your patient know to keep them up to date. 
Forget forgetfulness. If safe and possible, place medications next to the bed or beside the coffee pot. Encourage your patients to set alarms on their phone at certain times of the day and, if needed, set a reminder alarm 20 minutes later so they really do not forget. When and if able, move medication times to a more convenient part of your patient’s daily routine (i.e., taking medications at lunch vs breakfast for someone who works an overnight or early morning shift).

All in all, this list of tips is in no way comprehensive but hopefully gives you reminders, tools, and encouragement to spend the extra 5-10 minutes listening, talking, engaging, and encouraging your patient to make healthy and sustainable lifestyle changes.  Now, practice what you preach, get off your phone, grab some carrot sticks, and get outside!

References

https://medicine.llu.edu/academics/resources/stages-change-model

Anderer S. Sweetened Beverages Linked to Millions of Global Diabetes and Heart Disease Cases. JAMA. 2025;333(9):747. doi:10.1001/jama.2024.28816

Hashimoto, K., Dora, K., Murakami, Y. et al. Positive impact of a 10-min walk immediately after glucose intake on postprandial glucose levels. Sci Rep 15, 22662 (2025). https://doi.org/10.1038/s41598-025-07312-y

https://www.heart.org/en/healthy-living/go-red-get-fit/what-exercise-is-right-for-me

Imai S, Kajiyama S, Kitta K, Miyawaki T, Matsumoto S, Ozasa N, Kajiyama S, Hashimoto Y, Fukui M. Eating Vegetables First Regardless of Eating Speed Has a Significant Reducing Effect on Postprandial Blood Glucose and Insulin in Young Healthy Women: Randomized Controlled Cross-Over Study. Nutrients. 2023 Feb 26;15(5):1174. doi: 10.3390/nu15051174. PMID: 36904173; PMCID: PMC10005673.