. Author manuscript; available in PMC: 2009 Aug 3.

Published in final edited form as: J Natl Med Assoc. 2009 Jun;101(6):552–564. doi: 10.1016/s0027-9684(15)30940-8

Table 2.

Implementation Plan for Spirituality Counseling.

Ask the subject to identify the issues in their own life that contribute to overweight and obesity (step #5).	The counselor will help assess the problem by listening attentively, being non-judgmental, allowing the expression of feelings, and being warmly supportive, as is recommended for spiritual counseling in general. ⁷⁵ Asking participants to summarize thoughts from their reflections journal can also help participants become aware of problem areas.
Ask for specific definition of the way in which the subject feels powerless over the situation or condition (step #3).	Careful analysis of the contributing problems can identify areas that may be truly out of a person’s hands, and those areas may need to be surrendered (steps #7). Efforts can then be concentrated on the areas that can be modified.
Ask in what way a higher Power or connections with others can help (step #2).	The counselor asks questions to help subjects uncover spiritual influences that can be useful in coping with events or experiences that interfere with maintaining weight loss behaviors. These spiritual connections can provide empowerment over problems that are difficult or impossible to address alone (step #1). Some study participants will already have strong spiritual connections while others will require specific readings and meditations to first strengthen those connections (step #2). Other readings and meditations will help subjects understand how these connections support a healthy lifestyle (step #3).
Identify character traits that contribute to the problem such as seeking approval, seeking control, obsessive/compulsive behavior, rescuing, taking inappropriate responsibility, hiding feelings, fear of abandonment or authority (step#4).	For example, often time demands stand in the way of exercising daily and preparing healthier foods. The spiritual counselor works to help the participant value herself, using assigned readings and meditations. These will reaffirm the value of each person in the eyes of her Higher Power. The participant can then allow her Higher Power to help re-prioritize her time demands, with the knowledge that if she does not take care of herself she may not be able to fulfill the role her Higher Power has for her, such as the care of others.
Confess the behavior (step #1).	Admitting the problem is needed before one can work to address the problem (step #4). This can be revealed by open-ended questioning from the counselor and by use of the reflections journal to become aware of underlying causes of difficult situations.
Get ready to work in partnership with your Higher Power to remove this behavior (step #6).	Participants will require varying amounts of counseling before they will be ready to allow a Higher Power to guide them toward a healthier lifestyle. For example, readings can help strengthen the connections needed and can demonstrate how partnership with a Higher Power can help minimize the stress of life’s demands. Using a Higher Power for guidance can help minimize distress from difficult situations.
Through prayer or meditation ask for knowledge of your Higher Power’s will for you (steps #8, #3).	Daily prayer or meditation will be an important component of the program to help participants bring their Higher Power into their new, healthier lifestyle. Accountability is a key element of weight loss, and weight gain is generally observed when counseling contacts stop. ⁷⁶ If accountability can be transferred to a Higher Power through daily prayer or meditation, weight loss maintenance may improve.