Blending the Ingredients for Behavior Change

When you are making chocolate chip cookies, you need the right ingredients. Chocolate chips, butter, sugar, vanilla etc. If you do not include one of the ingredients or put hot sauce in instead, your chocolate chip cookies won’t come out as planned. I guarantee you won't enjoy those cookies.

I liken this recipe idea to the Transtheoretical Model of Change. We all know what we are supposed to do, but we don’t always do it. Sometimes, we start baking, we forget to add ingredients, and we don’t always get the final product we want.

There is an equation in motivational interviewing that describes the ingredients needed for change: Knowledge x Motivation x Confidence = Change Resistance

Ultimately, it is not about just knowing what the right choices are, but examining behaviors we engage in and the motivation we have. There are many ingredients that can foster change such as knowledge, vision, plan, resources, taking ownership, developing new coping skills and confidence. Other behaviors such as resistance, fear, denial, low motivation and comfort can keep people from changing.

Everyone is at a different stage of behavior change. Creating permanent change requires a shift in mindset and a willingness to try a new method.

The 5 Stages of Change

• Pre-contemplation phase: This stage is where the person has no intention to change and is reluctant to admit they have a problem. They may rationalize why the behavior is okay to continue.
• Contemplation phase: In this stage the person is willing to consider change and acknowledge that they have a problem. However they are still on the fence about starting treatment.
• Preparation phase: The decision is made to stop the behavior. Commitment and determination to change requires a realistic plan and support. People will usually take action in the next month. A motivating belief usually propels people to enter into the next phase.
• Action phase: Individuals at this stage will enter treatment or seek counseling. They seek an external support network to keep them accountable and cheer them on.
• Maintenance phase: This phase takes 3-6 months. The threat of old patterns becomes null or insignificant and confidence increases.

Why is behavior change so important? Lifestyle related disease states are ever increasing. Metabolic syndrome affects 40% of people older than 60¹ and combines at least 3 of the following issues: high blood sugar, high triglycerides, high blood pressure, abdominal obesity or low HDL ("good") cholesterol. This puts patients at higher risk for cardiovascular events.

What are risks of developing metabolic syndrome?

• Waist circumference over 35" for women and 40" for men
• Triglycerides over 150 mg/dL
• HDL level less than 50 for women, less than 40 for men
• Fasting blood sugar of 100mg/dL or higher

Losing just 3-5% of body weight can lower a person’s risk for metabolic syndrome. Many of my clients have comorbidities such as asthma, hyperlipidemia, hypertension, diabetes, IBS and more, due to their weight. One of my primary goals is to help them create positive behavior change to reduce their risk of chronic disease, morbidity and mortality.

Patients need support when they are embarking on a new journey with their health. If we can meet them where they are in the stages of change, we will create better rapport and results. Change is not always easy. According to CDC statistics, 70.7% of Americans older than 20 are overweight. Without a sustainable plan, support, and the skills to deal with setbacks that come with every day life, it can be difficult to succeed. The majority of individuals who embark on a change or goal pursuit revert back to old behaviors within the first few months. Moods happen, motivation declines, life happens, and when setbacks occur, getting back up proves to be difficult.

Pharmacists are uniquely positioned to help patients adapt healthy behaviors. There is an increasing need for pharmacists and health coaches to partner with other healthcare professionals, such as doctors, nurse practitioners, and physician assistants, for this purpose. If someone is identified as 'pre-diabetic,' many times there will be a minimal conversation that involves little direction on an action plan. A healthcare professional may say, 'Just lose weight. Eat less and move more.' The ambitious patient may take action and Google a diet plan or hire a nutrition coach. However, other patients do not know what action to take and thus experience disease progression and worsening blood markers.

We must discover why we overeat to then create permanent change. Otherwise, we can get in a cycle of constantly yo-yo dieting, or regaining and losing.

What increases the likelihood of permanent change?

• Accountability
• Discovering inner motivation to pull you to your goals rather than push you
• Supporting self confidence and autonomy
• Understanding and applying the knowledge and skillset
• Support from family, friends or a coach
• Creating new, positive habits
• Increased self awareness to understand why we do what we do

Coaching allows collaboration between client and coach to help foster growth and transformation. As a coach, I help my clients increase self awareness, create new habits, which leads to improved self confidence and a skillset of success to enable them to be healthy for a lifetime.

Reference

1. Metabolic Syndrome. Mayo Clinic. www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916. Accessed February 23, 218.