Clinician-to-Clinician Update Clinician-to-Clinician Update

Behavior-Change Strategies Key to Achieving Healthful Diet and Activity Lifestyle

May 2016

Draxten-Michelle

Contributed by Michelle Draxten, MPH

A well-balanced diet and regular physical activity promotes overall health, reduces the risk of chronic disease and aids in reaching and maintaining a healthy body weight. Many of our patients understand this but struggle to meet these health goals. To achieve a healthy diet and exercise routine, focus should turn to modifying habits into new behaviors so that they can become part of one’s lifestyle. Healthcare providers can help in this process. Although the thought of change may feel daunting for some of our patients, it’s never too late to start, and health goals may be easier to reach than many clients originally thought.

In our weight management clinic, each counseling session is unique and individualized to the patient. However, two topics consistently come up: (1) the components of a healthy lifestyle and (2) thoughtful strategies on how to incorporate healthful behaviors so that they become part of one’s lifestyle.

Components of a Healthy Lifestyle

All foods can fit into a healthy nutrition plan, but how often certain foods are eaten (frequency) and the amount of specific foods eaten (portion sizes) should be considered. Additionally, variety is important. A healthy, well-balanced diet includes a variety of fruits and vegetables, whole grains, lean protein, low-fat/fat-free dairy, healthy fats and adequate amounts of water.1 Sodium, added sugars, and saturated fats should be limited.

Physical activity is the other half of the healthy lifestyle equation. Regular physical activity makes individuals feel better physically, mentally, and emotionally. With increased physical activity, individuals will want to eat healthful and nourishing foods. Patients should aim for 2.5 hours of moderate-intensity aerobic activity (i.e., brisk walking) every week and at least 2 days every week of muscle-strengthening activities.2 Examples of muscle-strengthening activities include weight lifting, yoga, push-ups, sit-ups, planks, squats, and lunges.

While these guidelines seem straightforward, they are not often understood or followed. Current dietary patterns for the majority of the population do not meet recommended servings of fruit, vegetables and dairy, and exceed recommended amounts of sodium, added sugars, and saturated fats.3

Educating individuals on healthful foods and physical activity guidelines is important. More important, working with individuals to identify strategies to shift health behaviors in a way that is conducive to their lifestyle may be the most promising approach in helping patients achieve sustainable, healthful behaviors.


Making Healthful Behaviors a Lifestyle

Several strategies exist around behavior change. Sustainable behavior change is slow and gradual and looks different for everyone. Self-efficacy, the belief in one’s ability to execute and achieve an outcome, is a key component.4 However, the strategies below focus on changing habits and environments to achieve healthy behaviors. Setting goals also make behavior change feasible. Consider having individuals set SMART goals: those that are Specific, Measurable, Achievable, Relevant, and Time-bound. This strategy can be applied to many behavior change tactics.

Nutrition

Plan ahead. Planning ahead helps with making healthful choices and could mean planning tomorrow’s lunch or planning meals for the upcoming week. Planning ahead helps many eat healthier overall, save time and money, have a variety of meals, stress less, and eliminate having to rely on eating out and eating highly processed foods. A few planning strategies to share with patients include: prepare a food that can be used in two different recipes (e.g., grilled chicken for fajitas one night and adding to a mixed green salad another night); designate a grocery shopping day, make a grocery list and stick to the list; prep and chop fruits and vegetables immediately after returning from the grocery store; and get family members involved with menu planning, grocery shopping, and food prepping.

Make healthful foods available and accessible. Research has shown that individuals are more likely to eat foods that are available and accessible.5 Having ready-to-eat healthy foods can increase the likelihood they are eaten. Preparing vegetables after getting home from grocery shopping or designating a food prep day saves time later and ensures there will be a serving (or more) of vegetables at the next meal. Storing chopped vegetables in a salad spinner in the fridge not only makes them accessible but keeps them fresh and crisp. Rearranging cupboards, counter space, and refrigerators to make healthy foods more visible can make the consumption of healthful foods easier. The same principle holds true for less-healthful foods: removing chips and cookies from visible counter space and shelves can help patients resist any urges.

Encourage patients to try new foods. Our tastes change over time, and a food we did not like years ago might become a new favorite. Some foods take on different flavors depending on the preparation method. Cauliflower eaten raw, for example, will taste very different from cauliflower that is steamed or roasted. Encourage patients to try a new fruit or vegetable every season. Produce that is in-season will have better flavor and cost less.

Be mindful of portion sizes, hunger and satiety cues. As a society, our portion sizes have steadily become larger, and individuals often have difficulty identifying appropriate serving sizes. Research has shown that serving on larger dishes results in greater portions and increased caloric intake.6,7 Eating meals on smaller plates, such as salad plates, can reduce overall portion sizes and calories. Eating past the point of satiety and in the absence of hunger has also become more common. To allow time to assess satiety, recommend that patients slow down when eating by using their non-dominant hand to feed themselves. Or to create a visual guide to control portions, have them use measuring cups to measure appropriate serving sizes. It is also important to educate patients in recognizing hunger cues and eating with intention of nourishment and enjoyment. Diverting attention to a non-food activity (e.g., taking a walk) can be a strategy to recommend if patients experience urges to eat in the absence of hunger.

Have a source of accountability. Individuals tend to be more successful if they have a support system and/or a source of accountability. Consider having patients work with someone who has similar goals and is working on achieving them. Or suggest that they work with a registered dietitian who has experience in goal-setting and behavior change. Tracking behaviors (e.g., logging food intake) is also a beneficial accountability strategy, and there are several, free apps that individuals can utilize. Popular and user-friendly apps include MyFitnessPal, LoseIt and SparkPeople. These apps are also great for tracking physical activity levels.

Physical Activity

Make time for physical activity. Have patients designate certain days of the week and/or times of day to exercise and pack a gym bag that stays in the vehicle so they can exercise after work without having to go home first. Recommend patients set a reminder on their phones to get up and move every hour. Spreading out activity through the day (three 10-minute exercises) can be just as beneficial as exercising one time per day (one 30-minute exercise).

Recommend creative or non-traditional ways to increase activity. Some individuals may be more inclined to be active if they have enjoyable activities that do not necessarily feel like exercise. Walking poles engage a large group of upper-body muscles and can add intensity to a walking workout. Sit-stand workstations have been shown to reduce fatigue, sedentary time at work and appetite, as well as increase energy and sense of well-being.8 Gardening, playing with kids, dancing, having “walking” meetings, biking to work and taking the stairs are just a few creative activities for recommendation.

Rally a support system. Have patients work with someone who will hold them accountable or track their physical activity levels. A step counter is an easy, inexpensive way to set minimum daily step goals. Recommend patients register for an upcoming walk/run event to give them something to work towards.

Pathways to behavior and lifestyle changes are unique and different for everyone. Setting goals, starting with small behavior changes and focusing on the best combinations of strategies for each patient will lead to success.

Article appears in MetroDoctors. 2016;18(3):11-13. MetroDoctors is the journal of the Twin Cities Medical Society.

Michelle Draxten, MPH, is the registered dietitian at the Lifestyle Medicine Program for Weight Management clinic, as well as a research associate at the University of Minnesota, Department of Family Medicine and Community Health, coordinating a study to identify how familial factors act as risk or protective factors for predicting childhood obesity.

References

  1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http:// health.gov/dietaryguidelines/2015/guidelines/.
  2. Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity: How much physical activity do adults need? Accessed January 18, 2016. http://www. cdc.gov/physicalactivity/basics/adults.
  3. What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intakes and limits.
  4. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psych Rev, 84(2), 191-215.
  5. Nicklas TA, Jahns L, Bogle ML, et al. Barriers and facilitators for consumer adherence to the dietary guidelines for Americans: the HEALTH study. J Acad Nutr Diet. 2013;113(10):1317-1331.
  6. Wansink B, van Ittersum K, Painter JE. Ice cream illusions bowls, spoons, and self-served portion sizes. Am J Prev Med. 2006;31(3):240-243.
  7. Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76(6):1207- 1213.
  8. Dutta N, Koepp GA, Stovitz SD, Levine JA, Pereira MA. Using sit-stand workstations to decrease sedentary time in office workers: a randomized crossover trial. J Environ Res Public Health. 2014; 11(7):6653-6665.
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