Question 3
From your personal or professional experience, what types of behavioral intervention do you think are most effective in achievement of lifestyle changes?
posted by Amy Sammis @ 9:50 AM
16 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
16 Comments:
The behaviorist at my first rotation had patients keep a journal reflecting what they ate, when they ate it and their feelings before, during or after the meal or snack. The patients were responsible for journaling and could choose not to, but the behaviorist strongly encouraged them to. This intervention was so useful because it was easy to recognize patterns when reflecting on journal entries. Times of day, certain meals, whether the patient was eating alone or with company all made a difference. This journal can carry over to sessions with the dietitian and may help the dietitian understand weight management issues, attitude towards certain foods, etc. I think this is a very useful tool and I saw how this helped patients recognize why certain behaviors may be occurring and how they could work to improve them.
From my experience in counseling people and personal training I like to start off with having people define goals using the SMART goals method. Then I also think that doing a root cause analysis is helpful. For example, everyone tells you they want to lose weight. Doing root cause analysis questions you get them to actual say that they want to lose fat and the real reason why they want to lose fat. Most people will say to feel better but if you dig deeper and get them to say increase self esteem when doing a certain activity or so they can sleep. These two activities combined have gave me the best results in counseling behavior change. this along with keeping them accountable and having them tell someone close to them to keep them accountable too.
I like the idea that Alana has observed at her rotation as well. However, I feel like people have to be highly motivated already in order to make the commitment to keep a journal like that. I think this could be a very useful tool for motivated individuals but would be curious on if it would work to motivate/be useful in unmotivated clients.
I agree that it may not be the most useful tool for those who are not as motivated, but I was surprised at how many patients were willing to journal and found it beneficial. I agree, Nate, that holding individuals accountable for their progress and willingness to change is really important. Providing the tools and resources to change is our job, but they have to want change for themselves.
I believe that a food journal can be highly successful because it forces people to look at the foods they are eating. This can help them realize patterns as well as simply see how many calories they're taking in per day. The problem with food journals, though, is they most be filled out every time someone eats and that can be a hassle. People may also get disappointed in their choices and choose to bury their head in the sand by not continuing to fill our their journals. I also think that many times, eating patterns and choices are very emotional based and teaching skills such as stress management can be helpful so that people feel they have another outlet besides food.
I agree with Nate in the fact that setting goals with patients is a great first step because if people have nothing to strive for, it's much easier to fall off the wagon. I also believe that getting down to the root cause of their behavior is key because we don't just want to treat the symptoms, but rather get to the real problem.
Although there are MANY methods of behavior intervention, I think it is totally dependent on what works for the person. One thing that might work for one person may not work for another. So individualizing is very important. However, personally, I believe that small sub-goals leading up to a big goal is most effective. I am a true believer that small achievements make the big one that much sweeter. Encouragement and support is so important also. Making sure that the family celebrates each little goal with the patient and will support them every single day is crucial. If the patient has no backing at home they will likely fail. To constantly be working towards a goal for years or your whole life can be exhausting, making those goals reasonable and altering if found to be unachievable or too easy may be necessary. After a person is maintaining a desired lifestyle for a while, I think it is great to encourage them to still celebrate their lifestyles.
From professional experience, I believe one of the best behavioral interventions that are most effective in achievement of lifestyle changes is motivational interviewing. While teaching the alcohol education class through Health Promotion and Wellness this past year I found that motivational interviewing can be effective in moving an individual from one point of the stages of change to another. From personal experience, I have seen that food journals can be beneficial if paired with a counseling portion to help the client pinpoint changes, conquer challenges and gain motivation and self-esteem to start and begin to change. It is one thing to write down when you eat, what you eat, how much, with who, how, etc. To pair that with not only how you feel but to also go over the quantities and feelings felt with a counselor or therapist seems to help the client grasp the whole meaning and start to challenge their ways. I think a big part of change is becoming comfortable with it, feeling prepared and motivated helps as well.
The general theme here is food logging, which I totally agree with. Whether is a detailed log such as Alana described including emotions or simply tracking dietary intake on an app, studies have repeatedly concluded that individuals who log their intake are more likely to reach their goals than those who do not.
Also having someone, whether it be an RD, lifestyle coach, psychologist, etc. help you follow up on those goals is imperative. I've sat in on some lifestyle coaching sessions where the entire session is essentially discussing last session's goal and if the client wants to stick with the same goal or create a new one. Having someone hold you accountable makes a huge different in your behavior change.
After completing my community rotation I have seen how effective nutrition education and the promotion of self-monitoring can be. Specifically journaling about daily intake and exercise, but also going beyond the numbers and expressing one’s feelings in relation to eating and other events that specifically relate to that day. This promoted self-reflection and growth by identifying routines, meal times, evenness of calorie intake, or what went well that day or what did not go well. I found this method to be effective for identifying and changing negative behaviors. In addition to journaling, goal setting seemed to be rather effective as well, and this also promotes a sense of accomplishment and self-efficacy.
As everyone said, food logs are very powerful behavioral intervention tools. They help with being aware of what is consumed during the day as well as the opportunity for the person to go back through his or her day and see where they could have improved in their diet.
I don't have much experience with this type of behavioral intervention, but I think that personal goal setting can be very effective. Guiding a patient or client through setting their own goals seems to be effective. As professionals we can make sure the goals are measurable, specific, realistic, etc. I like Nate's suggestion of using the SMART method. Of course, combining this with other methods like journaling would be ideal! :)
I agree that using the SMART method to define goals would be effective. It's so important to not only make goals, but to set quality goals that are specific, measurable, achievable, realistic, and are given within a specific time frame.
Taylor, I agree that having in addition to setting goals and food logging it is very beneficial to have someone to follow up with as time progresses. I have observed and also taken part in following up with patient’s goals throughout my community rotation and saw, first hand, how effective it can be. Whether or not the patient has achieved their goals, it is really helpful to review what struggles or positive aspects were accomplished while meeting the goal or even what changes could be made. This type of review provides a sense of accomplishment but also offers a sense of accountability as you had mentioned.
Erin, I agree with what you said regarding the journaling helping clients identify negative behaviors. I observed a couple of sessions with a client at CCC who had done just that. It was great to hear her talk about being able to realize when she was about to repeat a habit of reaching for food. Unless we can help clients identify their triggers or cues they will be less likely to be able to break the cycle.
Molly, I also agree with how you indicate the value of counselor to review the log with the client. Even though it is written down, sometimes it takes an impartial pair of eyes to help make connections between feelings and behavior.
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