How to Achieve Long-Term Change for Diet and Health

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Transtheoretical Model of Change

In 1982, Dr. James Prochaska (a psychologist) and Dr. Carlos DiClemente published the Transtheoretical Model of Change - popularly known as the Stages of Change. (1)

Why would I bring this up in a blog post that is supposed to be relatable and understandable to anyone in the general public? Because there is an enormous trend in America to lose weight, and the media-focused nature of our culture grabs people through fad diets and unregulated supplements. These methods of weight loss are short-term and potentially safe, and also ineffective in the long-term, leading to weight gain above what you started at.

This model is used often by RDNs in nutrition & wellness counseling to evaluate where their client is at, and go from there. There is no point in talking about how to eat a healthy diet if someone isn't interested!

The 5 stages are: pre-contemplation, contemplation, preparation, action, and maintenance. Mental and emotional change occurs from pre-contemplation through preparation, and visible behavioral change occurs from preparation through maintenance. Relapse occurs when old behaviors infiltrate the new habits maintained in the last phase, maintenance.

(source)

The Stages of change model (above) is a continuous process. It occurs over time, and repeats for numerous goals. Relapses occur, but can be learned from! There is no end point in this cycle - there is always a way to "get back on the horse".

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Am I ready to change?

I mentioned before the difference between short-term effects of fad diets and long-term benefits of behavior change facilitated by the Transtheoretical Model of Change. Now that we're done with all the background stuff, you probably want to know how this applies to YOU, right?

It's important for you to identify where you are in the stages of change because where you start affects what path you take to where you are going.

Let's summarize each stage and give examples. The figure to the right identifies all 5 stages as well as a key phrase you may hear (in your head, from a friend?) that can help guide you to the right step.

Pre-Contemplation
You have no intention on making any changes. This can be for different reasons:

• You aren't aware of health issues or impacts.
          "There's nothing wrong with drinking a lot on the weekends."
          "I didn't know I had diabetes/heart disease/etc."
• The negative aspects of changing trump the benefits.
          "If I make changes to my diet, the healthier foods will be so expensive and take up too much time to         prepare. I don't want to do that."
          "I always go out and eat with my friends, and if I pack my lunch I won't be able to do that. It's not             worth it."
  
• You have not made successful changes in the past and you don't think you can do it now.
          "I tried Weight Watchers, and it worked at first, but then I just gained all the weight back."
  
  
  
  

Contemplation
You know there's a problem, but aren't committed to making any changes.

• Unsure what changes to make, or where to even start
          "My doctor told me I have diabetes, but I don't know what to do to manage it."
          "I know I'm overweight, but with all the articles I read online and in magazines, I don't know                     what strategy to try."
  
• Don't feel committed to the effort of changing
          "I know I should eat healthier, and it would be good for my family, too, but it's just too much time             for me to have to prepare dinner after a long day at work."
  
  
  
  

Preparation
You know there's a problem, and you are ready to take action in the next month. But, you may feel a little hesitant, almost like you're testing the waters.

• You're unsure of your ability to carry out these changes.
          "I read through the booklet you gave me about healthy eating options, and printed off some                     healthier recipes from online, but I'm still not sure about starting it on the 1st."
          "But what happens if I...(can't, don't, forget)..."
  
• You're making exciting, big goals!
          "I'm going to lose 5 pounds this week!"
          "I'm going to cook every night for my family instead of ordering take-out food!"
  >These goals are often unrealistic, and in a sense, setting yourself up to fall short. See the next section on setting SMART goals.
  
  
  
  

Action
You have implemented change and are working on making healthy behaviors a new habit. SMART goals are key to make sure you are achieving your goal, and to keep you motivated. Strategies are developed for you to meet your goals and provide you with step-by-step assistance. Goals build on eachother, and SMART goals let you look back over the week and learn from your mistakes and/or build yourself up on your success!
        "I went to the gym three times this week, just like I said I would."
        "I packed my lunch almost every day this week. I had a really hectic morning on Monday and forgot..."
        "I'm really enjoying the Zumba class me and my neighbor go to. I've noticed I'm more excited to go                     when its with her - and when she cancels I usually skip."

Maintenance
You have made your action-steps a new habit - something you don't even think about anymore! (Or very often). Perhaps you've even started a new goal. In this stage it's important to stay somewhat focused on that behavior, because you are vulnerable to relapse. If your car is in the shop for a month and you can't get to the gym...what will you do? If you are getting tired of the healthy recipes that lasted you the past 6 months...what will you do? Relapse is when you fall back into your old behaviors (you get busy, so you stop for fast food on the way home from work more...) Relapse happens, and its OK if you learn from it and keep pushing on!

Key steps are to in this phase are to:

• Be aware of relapse
• Re-evaluate your plan and check-in regularly
• Keep things new and exciting! Try new recipes and activities.
  
  
  
  

Think of a behavior you want to change - or have changed. What stage are you in now? How did you start thinking about it? If there's nothing like that going on in your life right now, what could you change?

Read on to find out what to do with that "stage of change"!

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How can I make long-term changes?

I mentioned "SMART" goals before as key to transitioning from preparation into action, and then into maintenance. SMART goals help guide you to your overall goal in a way that almost guarantees your success!

S - specific
Be specific. A goal to "lose weight" is not specific. SMART goals help outline a way to get there.

M - measurable
The goal should indicate outcomes that you can look back on in a week, two weeks, a month and say "yes, I did that".

A - action-oriented
You should write down what you can DO to achieve this goal.

R - realistic
Losing 5 pounds a week is not realistic (or safe!) Neither is saying you will go from never cooking dinner to cooking dinner everyday the first week.

T - time-sensitive
Similar to measurable, your goal should specify a time period. An additional advantage to this is you can change your goal from week-to-week, building up to the ultimate behavior change.

You're thinking..."Enough telling me what I shouldn't write as a goal and tell me what I should write!"Read on.

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TIP: Think of a way to hold yourself accountable - write it down where you can see it, tell a friend or family member about it and ask them to check in with you, or maybe they'll even join you!

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Goal
"I want to start working out."

SMART Goal
"I will join a gym this week and attend an orientation session to learn how to use the equipment. Then I will pack a change of clothes and work out after work on Tuesday and Thursday next week."

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Goal
"I want to lose weight."

SMART Goal
"When I go out to eat this week for lunch, I will choose the regular size french fries instead of the super-size, and will try the grilled chicken sandwich."

Goal
"I want to feel better about myself."

SMART Goal
"Tonight I will make a list of 5 things I like about myself. I will write them down in my planner (or on my phone) for the next two weeks and read them in the morning, at lunch, and before bed."


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Goal
"I want to lose weight."

SMART Goal
"I will look up two recipes to try this week. I will go to the grocery store tomorrow and get the ingredients, and make sure I leave work early enough to get home to cook."

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How did this information impact you? Check-in and leave a comment.

- Bailey

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References:
(1) Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19:3, 276-288.