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Oct 14

Behavior Change Strategies for Successful Long-Term Weight …

Introduction

Obesity is a major risk factor forcardiovascular disease and health problems (Mertens & Van Gaal,2000; Pi-Sunyer, 1998). People in the U.S. are spending $50 billion ayear on weight loss products and services (Weiss, Galuska, Khan, &Serdula, 2006). Despite these expenses, most of their lost weightwill be regained (Wing & Phelan, 2005). Public health guidelinesrecommend a combination of reduced food intake and increased physicalactivity, as effective approaches to achieve long-term weight loss inadults (Shay, Shobert, Seibert, & Thomas, 2009). How canExtension professionals give support for long-term weight loss? Howcan we educate individuals to achieve healthy lifestyle changes andmaintain them even after our program ends?

To lose weight and maintain healthy weight,individuals must not only be motivated and make a commitment to loseweight and maintain being healthy (eat balanced meals and physicallyactive), but also understand what to expect during three differentstages in behavioral changes (initial, improvement, maintenancecondition stages). Simply giving participants information on ahealthy diet and an exercise prescription, and offering a walkingprogram is not enough (Morgan, 2006). Extension professionals need toknow how to use behavior change strategies (Gordon, 2002) and helpparticipants to develop their own plans. This will facilitateincorporation of health recommendations into their daily lives andmake them adhere to them in the long run.

We can use self-efficacy, which is thecore element of social cognitive theory (Bandura, 2004), andself-management strategies (Karoly & Kanfer, 1982) tomaintain their control on behavior changes. These strategies can beapplied to Extension programs and maximize the effectiveness ofchanging individuals' behaviors and long-term weight loss.

Self-efficacy can be defined as anindividual's personal judgment of his or her ability to succeed inreaching a specific goal or outcomes. Self-efficacy is one of themost important determinants of whether behavioral change takes place(initial condition), because, unless people believe that they canproduce desired effects by their actions, they have little incentiveto act for behavioral change. Self-efficacy also affects whetherpeople mobilize the motivation and perseverance needed to succeed(improvement condition), and finally, their ability to recover fromfailures and relapses, and how well they continue their behaviorchanges once their goals have been achieved (maintenance condition).

Extension professionals can help to enhanceself-efficacy by a) setting goals and expected outcomes that areimportant for focusing on activities in group lessons and promptingincreased efforts and b) establishing strategies for overcomingbarriers to prevent participants from interrupting healthy lifestylepractices by providing social support from teams in group exerciseclasses or offer sessions before or after regular programsparticipants are already attending.

Use the S.M.A.R.T. (Specific, Measurable,Achievable, Realistic, Timely) principle to come up their own goalsfor each behavioral change stage; initial condition stage (4-6weeks), improvement condition stage (12-20 weeks), and formaintenance conditioning stage (6 months and beyond). Higher outcomeexpectations are stronger motivators; however, unrealistic,unattainable outcome expectations may discourage participants tocontinue (Dalle Grave et al., 2005).

Example: "I will walk an extra 1mile (2,000 steps) 3-4 times per week for the next 4 weeks." Thegoal is specific, measureable, and achievable using a currentresource (have a pedometer), realistic, and timely (deadline for yourgoal - 4 weeks).

All participants will face barriers tomaintain their committed behavioral changes sooner or later in yourprogram. Personal, social, and environmental barriers vary fromperson to person; however, Extension professionals could list commonbarriers and discuss solutions for effectively overcoming thesebarriers in a group. Participants who have more positive attitudescan share their outlook with other participants who may have the samegoals and barriers.

Example: "I don't have time toexercise." Time constraint is the most frequent barrier toregular physical activity.

Solution: Have participants 1) makedaily activity chartsexample: 15-minute walk during lunch break,2) choose activities they enjoy, 3) create a buddy system, 4) settime frame for when the goal should be reached by, 5) get a rewardwhen the goal is reached, and 6) prepare for a new barrierexample:in case of rain, play bowling.

Key features of self-management strategiesinclude goal setting, peer support networks, self-monitoring(ongoing follow-up), and self-reinforcement.

After participants have set their goals andexpected outcomes, Extension professionals can introduce aself-monitoring system in which participants can evaluate their ownprogress weekly or monthly. Their progress, whether they are meetingor failing to meet the established goals, serves as a motivator forcontinuing adherence to their behavioral change.

Reinforcement (rewards) work as goodmotivators for changing behaviors. There are intrinsic motivators(stimulation that drives an individual to adopt or change abehaviorexamples: enjoyment or satisfaction) and extrinsicmotivators or external incentives (money, new outfit). Both areuseful for positive reinforcement in behavioral changes, especiallyin the early stage of change. For a long-term weight control, anindividual's intrinsic motivations for regular physical activity playa more important role than focusing on changes in body weight anddiet-related changes (Teixeira et al., 2006).

Long-term weight loss is a difficult task.Most individuals who start with good intentions and commit to changetheir behavior fail to continue. Extension professionals can usebehavior change strategies to enhance participants' motivation andadherence to regular physical activity and healthy diet, rather thanonly focusing on weight changes. We also need to be creative anddevelop a fun activity. A good example is the milk taste challenge:Ask participants to taste samples of milk (whole, 2%, 1%, and fatfree), and ask them if they can taste the difference. Participantslearn about the health benefits of fat free-milk and may switch fromwhole milk to reduced fat milk.

It is important that Extension professionalsempower individuals and provide them with the most effective behaviorchange strategies.

Bandura, A. (2004). Health promotion bysocial cognitive means. Health Education & Behavior, 31(2), 143-164.

Gordon, J. C. (2002). Beyond knowledge:Guidelines for effective health promotion messages. Journal ofExtension [On-line], 40(6) Article 6FEA7. Available at:http://www.joe.org/joe/2002december/a7.php

Dalle Grave, R. D., Calugi, S., Molinari, E.,Petroni, L. M., Bondi, M., Compare, A., Marchesini, G., & theQUOVADIS Study Group. (2005). Weight loss expectations in obesepatients and treatment attrition: An observational multicenter study.Obesity Research, 13 (11), 1961-1969.

Karoly, P. & Kanfer, F. H., (1982).Self-management and behavior change: From theory to practice. NewYork, NY: Pergamon Press.

Mertens, I. L., & Van Gaal, L. F. (2000).Overweight, obesity and blood pressure: The effects of modest weightreduction. Obesity Research, 8 (3), 207-278.

Morgan, K. S. (2006). A community approach totarget inactivity. Journal of Extension [On-line], 44(3)Article 3IAW2. Available at: http://www.joe.org/joe/2006june/iw2.php

Pi-Sunyer, F. X. (1998). NHLBI Obesityeducation initiative expert panel on the identification, evaluation,and treatment of overweight and obesity in adultsThe evidencereport. Obesisty Research, 6 (Suppl. 2), 51S-209S.

Shay, L. E., Shobert, J. L., Seibert, D., &Thomas, L. E. (2009). Adult weight management: Translating researchand guidelines into practice. Journal of the American Academy ofNurse Practitioners, 21 (4), 197-206.

Teixeira, P. J., Going, S. B., Houtkooper, L.B., Cussler, E. C., Metcalfe, L. L., Blew, R. M., Sardinha, L. B., &Lohman, T. G. (2006). Exercise motivation, eating, and body imagevariables as predictors of weight control. Medicine & ScienceSports & Exercise, 38(1), 179-188.

Weiss, E. C., Galuska, D. A., Khan, L. K., &Serdula, M. K. (2006). Weight-control practices among U.S. adults,2001-2002. American Journal of Preventive Medicine, 31 (1),18-24.

Wing, R. R., & Phelan, S. (2005).Long-term weight loss maintenance. Am. J Clin Nutr, 82 (Suppl.1), 222S-225S.

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