What is The Stages of Change model?

The Stages of Change is a model based on Intention to Change. When applied to health what this means is that you are thinking about, or actively doing something, which you know is good for your health.  The steps through which you pass, to get to that healthier way of behaving are considered cyclical. We all have capacity to move through the stages of change.

How do I change?

Most people do not change behaviours quickly and decisively. Before you even feel the desire to change you live in PRE-CONTEMPLATION. This is a stage where you may not realise your behaviours are unhealthy, or you may know but have no desire to change. For some reason, or many reasons,  you then  start thinking about changing – we call this CONTEMPLATION. This stage can last months, even years. You might think it’s not worth changing as the actions seem too much, too difficult, involve too much time. Or, you might only spend weeks thinking about things, then you decide to commit.

PREPARATION is next.  You might buy equipment, or stop an unhelpful subscription. You  might set aside time, or ask someone to buddy with you. Professional help might be sought, family and friends involved. Again, you can spend weeks or months in this stage, as you get yourself ready to take that first real step. Most usually, once you have decided to work on something, you spend less than 4 months in this stage.

Now it’s the time for ACTION. You are making changes to how you more usually behave. One of the objectives of the action stage is to look to new habits to work upon, and to embed them in your life. You learn confidence and believe you can continue with the changes you have begun to action. Despite temptation to return to previous habits, the action stage serves to remind you that if you can change across one day, you can change across  another day.  You usually spend around 6 months in this stage, though often it takes less time to feel like a habit is embedded. Everyone is different.

The MAINTENANCE stage of the cycle looks to where you no longer really look to the older behaviours. Instead, the positives associated with changing feel so good, it is worth keeping going with those changes. Previous ambivalence resolves. Making behavioural  changes into habits can still be challenging, but they no longer involve conflict. You are different now.

Do I pass straight through from one stage to the next?

Usually not! The illustration describes LAPSE and RELAPSE.  If you have ever tried to change anything in your life you may be familiar with lapsing. This is where you have slipped from what you had been trying to do on a single occasion. A slip can be a one off, or could lead to a series of slips or lapses. When we spend more time lapsing versus carrying out the new behaviour, we are considered to have relapsed. We have returned to our old habits. The illustration shows how we can slip in and out of all of the stages. Even a habit you have carried out for 6 months can be dropped.  But the longer you stay in the action and maintenance stages, the more likely you are to change your health status for the good.

What do clinicians  do? What do I do?

Clinicians will use different tools to move you from one stage of the cycle to the next, or to keep you in a stage as best fits with your life right now. Our goals are always to support you and your physical and mental health. We aim to keep you steady with  changes you have already adopted, or move you to a position where you feel able to implement change.

I use strategies such as the ones below.

1. Raise consciousness

I might talk to you about a healthier way of being, versus staying the way you are now

2. Dramatic Relief

I might help you to explore the feelings you have when you think about keeping the unhealthy behaviour or behaviours. These can be feelings like anxiety, or guilt, or shame. I help you to explore feelings you have when you think about behaving differently, perhaps feelings of optimism and hope

3. Evaluating the Self

I use tools such as imagining how things would be if you did change, what being and feeling healthier might look like, what you would gain through the process

4. Evaluating your environment

I help you think about how your  unhealthy behaviours might impact others, and what they want for you

5. Liberation of the environment

I  assist you in exploring your environment so that you see opportunities for change, and that society supports what you are trying to do for yourself

6. Liberation of Self

I guide you to believe in the possibility of change and then commit to doing so

7. Helping Relationships

I work with you to identify people who can support you in your endeavour; individuals who will help you to achieve your desired outcomes, not get in your way

8. Counter Conditioning

I work with replacing particular ways of thinking or behaving with other healthier ways of thinking and behaving

9. Reward systems

I ask you to think through rewards for yourself, things that might keep you motivated along the way – these could be experiences, or gifts, or even just time for your self

10. Stimulus Control

Together we figure ways to help you  change your environment, whether at work or at home, so that you have cues towards the carrying out of the healthy behaviour or behaviours. Those cues associated with the unhealthy behaviours are removed.

If you would like me to help you move forward with your healthier way of being, please get in touch. I would be delighted to support you through the stages of change model, to better health.

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There is very good evidence to support the use of self-monitoring as a strategy to help you manage your weight. But weighing everyday may not be necessary.  Ask yourself “what am I trying to find out when weighing?’  Then decide how often to weigh.

Active weight loss – weigh every day

If you want to lose weight, set yourself a target within a healthy time frame. A healthy time frame is one which is scientifically possible. A healthy time frame will not tip you over the edge to unhealthy eating patterns. Weighing each day can be helpful as you will  learn how your body loses weight. Everyone has a different body. None of us will lose weight at the same rate. Nor will we respond to the same programme in the same way. Weighing every day can help you to understand how you respond to a particular programme of weight change.

Will weighing every day affect me psychologically?

The evidence suggests that for adults who are actively seeking treatment to lose weight, weighing daily is helpful and supportive. Weighing daily does not lead to individuals feeling bad about themselves. Instead, the closer  connection with weight and the changes noted on the weighing scales, the more likely we are to be able to reduce our weight and maintain a new, leaner mass.

What makes my weight fluctuate?

Hormones

When you weigh every day you see that your weight can change if your hormones are changing e.g. during menstruation.  This can be to do with hormones affecting bowel emptying. Perhaps you become constipated or experience very loose stools and lose fluid.

The food and drink you consume

You may notice how eating late in the day,  or eating spicy or salty meals can affect your weight. Even when you eat the same number of calories but there is different macronutrient content, you may notice changes in your weight. Eating carbohydrates late often looks like weight gain in the morning. Don’t worry. Your weight will settle again during the day.

Alcohol

If you drink alcohol the evening before weighing you might be dehydrated in the morning. You might look like you have lost weight. Again, your weight will settle  as long as you drink plenty of fluid.  Weight fluctuations are often driven by changes in bodily fluid.

Exercise

Exercise can also affect fluctuations in your weight. This is not usually due to burning up 1000s of calories, and more to do with fluid and carbohydrate storage in the body.  Weighing daily  helps you to understand these nuances in weight change. Weighing daily can help you to learn to be calm with your weight, as you figure out what might be affecting weight changes.

Weight loss maintenance – weigh frequently

Once you achieve your goal weight, after a weight loss programme, it’s a good idea to continue to weigh yourself regularly. The evidence suggests that when we remain vigilant with this, and pay attention to the weighing scales, it helps us to keep between a narrow band of weight fluctuations.

You don’t have to weigh everyday.   You could weigh 2 – 3 times per week, or perhaps once per week, but on the same day each week. Weighing is a strategy which helps to keep us focused on weight. With weight loss maintenance it can you keep you bought in, and motivated to your new self, your new body weight.

if you wish to continue to weigh daily, this is perfectly acceptable.

When should I not weigh?

If you have ever experienced an eating disorder, or are perhaps in the midst of one, it can be challenging to figure your way through with the weighing scales. The best thing in this scenario is to work off the guidance that your dietitian will have given you if you are in recovery. Your dietitian  will have given the best guidance for you as an individual. Your guidance will be determined by your history and what type of eating disorder you have or are experiencing.

If you would like help with your weight management, or with an eating disorder, please get in touch. I will listen. I will see you.

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Eat to a pattern Whether your pattern is 3 meals per day or 3 meals and a snack, stick to what works for you. This will help you to train your body to identify hunger signals.  If  you feel hungry  in between these eating episodes, you can consider whether you are actually hungry, or if you are craving something else.

Take a breath before opening the fridge or cupboard door. Maybe put a sticker on the front to remind you of the more mindful approach you are trying to adopt. Counting out 60 seconds may help you walk away. Sometimes we all just need a moment.  And if you would like a breathing exercise to try, why not consider this one which looks to mindful breathing as a helpful way to centre you.

Ask yourself what is going on Are you really hungry? Perhaps you are just  bored? Maybe you are  tired? Is work stressing you out?  Identify why you think you might be hungry and figure out if you really need to eat, or if you just want to eat.

If you are not hungry

Walk away. And if you don’t need to eat think about how you could comfort yourself in a different way. I like to do something physical, as it distracts my brain and helps me concentrate on something else. Leaving the house and walking in the park, or just walking around the block can be enough to dissuade me from messing with my eating routine. Find your ‘go to solutions’ by trialling different distraction techniques.

If you are hungry

Eat sitting down. This helps with digestion and metabolism of food, and allows the body to optimise absorption and use of nutrients.

Serve food on plates or in bowls. Don’t eat from the fridge, or from packets or bags. Lay the table and make your food look nice. Use a napkin. Treat yourself as you would a friend you invited for a meal.

Enjoy a measured amount. Using smaller bowls and plates can help us manage our portion sizes as food tends to look bigger the smaller the plate. If you are still hungry when you have finished, you can always go back for more.

Take your time at the table. Sometimes setting a timer for 20 minutes can help, even longer if you have opportunity to relax and rest after the meal. Another idea is to use chopsticks if you are not used to them, or using your non-dominant hand to eat. Eating differently helps to slow us down also.

Take small bites. Put your spoon or fork down in between mouthfuls. Sit back. Chew well. Breathe. Then lean forward and enjoy another mouthful. Repeat. Try not to add to what’s already in your mouth, but wait until you have had a proper swallow before having some more food. This helps with savouring and enjoying the deliciousness of the food we are consuming.

Sit and eat without distractions. So no TV or screens or other devices. Don’t even have them on the table. We can all do with eliminating some technology from our lives. Let your mealtimes be the beginning of some  tech free time.

How does it all feel?

Consider the senses. Spend your first 5 minutes noticing the food. What does it look like? How does it smell? What is the texture like? Can you pick the food up? Does the food crackle or sizzle before or during eating. Food can be so interesting, we just need to remind ourselves.

Pay attention. Consider your body and how you are feeling. Remember you don’t have to eat everything on the plate. You are allowed to leave food behind.

If these top tips for mindful eating feel challenging to achieve by yourself, get in touch. I will be happy to help you implement this mindful way to improving your eating and your health.

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Mindful eating and weight loss

How do we eat mindfully?

Explore the environment before, during and after eating

How to use mindful eating

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Normal Eating is

• Eating regularly e.g. 3 meals per day, or maybe 6 smaller meals, or maybe 3 meals and 2 snacks
• Occasionally under-eating. Maybe you didn’t have time to grab breakfast before work. Perhaps you had a super big lunch. you might have a smaller lunch as you are going out for dinner
• Occasionally over-eating. Because the food at that dinner party was really good, or you love when your Dad makes his famous pizza
• Eating foods that you like… because you like them
• Choosing less of the foods you like sometimes because you know you can eat them another time, perhaps tomorrow, perhaps next week
• Choosing to eat foods that you know are ‘good for you’ because good health is important
• Not always worrying about your weight but maybe being concerned if your doctor has advised you
• Occasionally counting calories or grams of protein but not always, and always having a good reason for doing so
• Not feeling guilty when you eat certain foods
• Being flexible with food and being able to eat differently when faced with things you don’t usually have
• Not always choosing the healthiest offering
• Not pretending to yourself that you are choosing to eat a certain way for ‘the planet, or because you have an allergy when you do not
• Sometimes eating certain foods because you are sad or upset, but not always turning to food on these occasions
• Being able to eat like others when in a group
• Being able to say ‘yes’ to pudding or ‘no’ to pudding according to how you feel, and not because of an unhelpful voice in your head
• Not feeling shame when you eat – no matter what it was, or how much you ate.

Normal eating is complex as above, as we try  to find balance in the midst of so many opportunities to eat all the time. And our desire to be perfect can sometimes override our realisation that  no-one is perfect all of the time, no matter what you might think. Don’t let your ideas of perfect eating or the perfect body get in the way of normal eating.

And if you would like help on that journey,  please get in touch.

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How many calories? How much fat?

Everyone has an idea of normal eating, though they may not know it.  Often the way a person has been brought up to eat, will constitute their normal eating pattern. But of course, we are all brought up to eat quite differently. We eat for so many different reasons. We eat for health and to give our bodies energy to do things. We eat for fun and to celebrate joyful events. We eat when we are sad and need comfort. We eat when we are bored. And of course… we eat when we are hungry. Almost forgot : )

But what is normal eating?

Normal eating is what’s considered acceptable in terms of eating patterns, not just to ourselves, but also to society. For a dietitian, there are many different aspects of eating to cover when supporting an individual through an eating disorder.  What is ‘normal’ is likely to have become increasingly skewed overtime as the eating disorder has progressed.

Eating certain foods at different times of the day, not eating when hungry, eating only foods that are on a safe list, eating only certain amounts of different foods. Some individuals restrict foods so much, the eating disorder drives a binge, perhaps a purge, or other weight control behaviour.  Changes to eating behaviours can become insidious as little by little the individual changes how they cope with food.  Trying to change a skewed idea of eating is the challenge of the dietitian working in eating disorders. This is what normal eating should look like.

We want to:

• Eat regularly e.g. 3 times per day plus a snack or two
• Consume foods we know are good for us like fruits and vegetables
• Enjoy foods we like e.g. chocolate or cheese
• Choose from all the food groups
• Feel confident to choose to be vegan or vegetarian but not because it’s offering us opportunity to restrict our foods
• Feel confident we can eat in front of other people and participate in social events based around food

We also want it to be okay to occasionally

• Treat ourselves to super processed foods like food from a fast food joint
• Overeat and need to rest afterwards – think Diwali, or Christmas or Hannukah
• Undereat because we are going out to dinner later and want to save space to have more than one course

We don’t want to

• Spend our lives counting calories though this can sometimes be helpful
• Weigh ourselves more than once a day – and for some this could be once per week
• Become obsessed with health
• Avoid treat foods such as crisps or chocolate because  we are told they are bad for us
• Play  games – pretending we have an allergy when we are trying to restrict our intake

We need to understand that

• Our bodies are fuelled by the food we eat
• We need lots of different kinds of foods to carry out the functions of normal living
• If we deprive our bodies of food we will experience surges of appetite hormones
• Our brains are involved in all of our decisions around food
• Our gut and the microbiome affect our mental health so we need to nourish our gut

Eating normally is about so many different things. There is a lot to work through when trying to get better from a state where how you eat is really not normal.  Eating according to proteins or carbohydrate or fat content can be fine – but really that’s for dietitians to guide you through. Fasting, then over-eating, then fasting again really doesn’t work. Dietitians work to find your happy place where it’s food that you are eating, not nutrients. Eating normally is about ticking the bullets above, and eating in a healthful way. No food is off limits.  Food is fun and can have a wonderful place in your life… if you can let it.

Further information about eating disorders can be found here.  If you feel you need help with managing an eating disorder please get in touch.

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