"A client says to me, 'My New Year's resolution is to lose 20 pounds. What diet do you recommend?' Of course, I went into my spiel about how diets don't work, except temporarily, that to lose weight you have to think lifelong behavior change and lots of exercise. She listened politely, but when I was done talking, she still wanted to show me a diet she had clipped out of a magazine. She asked if I thought it would work. It looked pretty well-balanced, lots of vegetables, not too restrictive. I told her it looked fine, that you could lose weight on just about any diet. I guess some people like dieting, planning diets and thinking about losing weight. However, I wanted to give her some information on the importance of lifestyle modification for long-term success, but she was so into this diet, I didn't know what else to say. I did tell her to keep coming to class, and that exercising regularly was important for keeping the weight off. I guess lifestyle modification is a lot harder to commit to than going on a diet for a month or two."
Lifestyle modification means changing behaviors that are problematic.
Perhaps you have had a similar experience in your work as a fitness professional. We are a dieting culture, and we want quick-fix solutions to difficult problems. It can be a challenge to convince clients that lifestyle change is the only successful path to a healthy weight.
What is lifestyle modification?
Lifestyle modification means changing behaviors that are problematic, and replacing them with new, more helpful behaviors. Someone who wants to lose weight would eliminate habits that lead to the consumption of excess calories, develop more healthful eating behaviors and add more physical activity to their days. While this sounds simple, we know that changing lifestyle habits can be a complicated and difficult challenge.
Clients need to know that even small changes can make a difference. Some habits might be fairly mindless responses to the environment: donuts appear at the staff meeting, and your clients snack along with everyone else, even if they are not hungry. Simply becoming more aware of their habits can often lead to healthy changes.
Self-monitoring and problem solving
Many people already have some ideas about what behaviors contribute to their weight problems. But self-monitoring can help clarify the factors that trigger and/or reward these behaviors. In the case of weight control, clients should record food intake and physical activity, noting the situations and feelings that precede or accompany these behaviors. Once people have a better picture of their behavior, they can take steps to change some of their habits.
Problem solving simply involves brainstorming possible strategies to address an issue, weighing the pros and cons of each solution, and then implementing the best one. If donuts at the staff meeting trigger unwanted eating, your client might decide to take a cup of tea to the meeting and sit as far away as possible from the donuts. Over time, this new behavior becomes a permanent part of your client's lifestyle that takes little thought or self-control. Problem solving strategies generally consist of changing environmental factors (e.g., not going into the donut store) or a client's response to the environment, as in the staff meeting example above.
Referrals: When simple changes are not enough
When clients share their difficulties with lifestyle modification, it's important to recognize that simple lifestyle changes are not always sufficient to address certain problems. For example, clients with health problems should be referred back to their providers for more specific health-related advice. Similarly, while fitness professionals can endorse standard nutrition guidelines, such as the Food Guide Pyramid, they should refrain from giving dietary advice tailored to specific health problems.
Sometimes clients say things that may indicate serious problems such as eating disorders or depression. If you have any concerns that you are not able to handle, refer clients to someone with more expertise in that particular area, or to their healthcare provider.
Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith College, Northampton, Mass.
Berkel, L.A., W.S. Carlos Poston, R.S. Reeves and J.P. Foreyt. Behavioral interventions for obesity. Journal of the American Dietetic Association 105 (5, Suppl. 1): 35-43, 2005.
Cotton, R.T. (Ed.) Lifestyle & Weight Management: Consultant Manual. American Council on Exercise: San Diego, Calif., 2005.
Fabricatore, A.N., and T.A. Wadden. Lifestyle modification in the treatment of obesity. In D.J. Goldstein (Ed.), The Management of Eating Disorders and Obesity. Humana Press: Totowa, N.J., 2005.
Wing, R.R., and S. Phelan. Long-term weight loss maintenance. American Journal of Clinical Nutrition 82 (1): 222S-225S, 2005.