Moving Towards Healthier Eating:
Making Changes Last a Lifetime

by Mary Choate, M.S., R.D.

The pursuit of perfection often impedes improvement -- George Will

We spend a lot of time thinking about what to eat, reading labels, avoiding certain foods, making sure to eat others. With all this thought, it would seem that healthy eating would be a snap, but often it remains elusive. We try a new eating or exercise program, then all too often become bored or lose motivation and go back to our less healthy habits.

Making good food choices can make us feel better in many ways: decreasing blood pressure, strengthening our immune system, lowering our risk for diseases like cancer and heart disease, normalizing blood sugar, moving us toward our healthy weight, decreasing joint pain, and reducing heartburn, gas, and constipation.

Much attention has been paid to what are called the "stages of change," a way of looking at the process of change as a number of preparatory steps leading to maintenance of the new health habit. Developed by James Prochaska, PhD, professor of psychology and Director of the Health Promotion Partnership at the University of Rhode Island, the six stages of change are precontemplation, contemplation, preparation, action, maintenance and termination. A person may revert to previous stages, but eventually, permanent change is accomplished when a new habit becomes a part of the person making the change. Changes, or steps toward making a change, are most effective when they fit into where you are in your readiness for the change.

Precontemplation: Thinking about thinking about a change…or maybe not
In precontemplation, a person is not considering a change and may not even be aware that change could be of benefit. At this stage, straightforward information about the benefits of change is best. Warning about the hazards of poor health habits generally backfires at this stage. Even gentle coaxing is not likely to be effective. Everyone is exposed to this health information every day, through ads and news reports on television, radio, newspapers, and magazines. This is not the stage for concerned family members and friends to strongly encourage the person to change. Offering information in a positive, low-key way is best. Offer non-judgmental comments like, "Did you hear about how eating fruits and vegetables can help to prevent cancer?" or "Researchers just reported that only three ten-minute walking sessions a day can improve your health!"

Contemplation: A change is in the wind
In contemplation, the person is thinking about making a change within the next six months. Here is where family and friend support is appropriate. Listening to a person's plans for change without criticism, encouraging the person's ability to make the change, focusing on the benefits of the change and upon the hazards of staying with unhealthful behaviors are most helpful at this time.

Preparation: What do I have to do?
In the preparation stage, the person is planning to change to a more healthful habit in the near future and has taken steps towards that change. Here, small, concrete steps are planned. Short-term goals are set. This is a good time to announce the planned change and to take steps like writing out the steps you will take to keep focused and motivated. The focus is on the benefits of the future change, not on the loss of previous poor habits.

Action: It's show time!
During the action stage, the person is actively making changes in behavior. Here, each small change is celebrated and rewarded. Small, consecutive goals move you ahead in concrete, realistic steps. Reaching the goals keeps your overall effort invigorated. Behavioral changes such as breaking a habit of heavy TV viewing by walking instead, or preparing healthful snacks in the evening to bring to work the next day are strategies that may be used in this stage. The support of family and friends continues to be important.

Maintenance: Keep on keepin' on
In the maintenance stage, the person maintains the changed behavior until it becomes permanent. This stage can last six months to a lifetime. The same strategies are used as in the Action stage. Relapses are common here, related to overconfidence, daily temptation, and self-blame for backsliding. An attitude of learning from a relapse and trying again is crucial. Prochaska notes that most people lapse at some point. But, he goes on to point out that people who take action and fail are twice as likely to succeed over the next six months as people who don't take any action at all.

Termination: Bad habit? What bad habit?
In the termination stage, the problem no longer presents a temptation. This is when we have total confidence in our new, healthy behavior, and we exit the change cycle.

For people in the preparation and action stages of change, these ideas from the National Heart, Lung, and Blood Institute may help.

Set the Right Goals
Many of us set unrealistic weight goals, and fail when our changes don't result in quick enough or dramatic enough weight changes. A more effective way to set goals for dietary change is to base them on overall health improvement. For example, it may not be your natural body type to have a tiny 102-pound ballerina body, but a weight loss of only five to ten percent of your starting weight can have a significant effect on your health. This amount of weight loss can result in lower blood pressure, improved diabetes control, joint strain relief, and decreased need for certain medications.

The best goals are specific, attainable, and do not require perfection to obtain them. An example would be a goal of eating one additional colorful fruit or vegetable five days a week. This is specific, as opposed to a goal of just "eat more fruits and vegetables." It is attainable, as a walk through the Co-op produce department will prove. It's forgiving; you have the option of eating one additional colorful fruit or vegetable seven days of the week, but a goal of five days gives you some leeway.

Write It Down
Self-monitoring -- writing down how you are progressing each day -- has been shown to be helpful in moving people towards their goals. This can be as simple as writing on your calendar the colorful vegetable you eat each day, keeping records of your daily walk, or keeping track of all the food you eat. A daily record of your weight is not recommended, mostly because of what the scale weight doesn't tell you. Water weight, menstrual weight changes, and changes in body composition may all be seen as weight gain on the scale, giving a false impression of undesired weight gain.

Doing things differently is, without a doubt, difficult at first. Getting started and sticking with your plans to reach your goals can be tricky. Understanding the change process and most importantly, forgiving yourself for lapses and moving on again can move you towards the health goals you desire.

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