U.S. Public Health Service

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U.S. Public Health ServiceFit for Duty, Fit for
Life Weight Management Program Session 5
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Review of last session

• Importance of carefully
• monitoring portion sizes.
• Reading food labels with attention to portion
  size.
• Hints for eating out.

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Review of assignments

• Continue keeping food and activity records.
• Focus on recording portions.
• Measure foods and drinks whenever possible.
• Were your portion sizes reasonable?
• Practice reading food labels and determining
  calories in your usual portion.
• Any surprises?
• Practice making special requests when eating out.
  
• What special requests did you make?

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Topics for today

• Behavioral change
• What is it?
• What techniques may work for you?
• Keeping on track
• To continue losing weight
• To keep from re-gaining weight lost

These sessions are not meant to substitute for
individual recommendations from your personal
health care provider(s).
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The ABCs of Behavioral Change

• Definition Principles and techniques used to
  modify eating and activity behaviors
• A- Antecedents - occur before a behavior
• B- Behaviors occur during eating (or
  exercising)
• C- Consequences occur after the behavior

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Antecedents

• Occur before a behavior
• Situations, places
• Events, activities
• Feelings, emotions
• Thoughts

• home alone
• favorite TV show on
• depressed, lonely
• I deserve a treat

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Behavior

• The conduct itself
• and
• Any related events, situations, thoughts, and
  feelings occurring during the behavior

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Behaviors Examples

• Eating
• Behavior Eating brownies
• Related Taste of food, speed of eating, rate of
  chewing, level of enjoyment
• Physical activity
• Behavior Taking a walk
• Related Intensity, duration, pain or
  exhilaration
• Inactivity
• Behavior Watching television
• Related Duration, feelings

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Consequences

• Occur after a behavior
• Thoughts
• Feelings
• Events
• Situations

guilty failure eat more brownies
(behavior) keep watching TV instead of taking a
walk (behavior)
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The behavioral chain of events

• Antecedents ?
• Behaviors ?
• Consequences ?
• Behaviors

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Using behavioral change techniques

• To gain control of antecedents
• Control your environment (situation and events).
• Be aware of your triggers or cues.
• Avoid situations that tempt you to overeat.
• Keep tempting foods out of the house.
• Keep your exercise clothing handy plan for rainy
  days.
• Control your thoughts and feelings.
• Think positive.
• Believe in yourself.

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Using behavioral change techniques

• To gain control of behaviors
• Track your behaviors.
• Keep diet and activity records.
• Pay attention to who, what, where, when, and why.
• Set effective goals that are
• Specific and measurable
• Realistic
• Forgiving (less than perfect)

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Using behavioral change techniques

• Behaviors (continued)
• Eat mindfully
• Eat slowly and savor each mouthful.
• Be aware of all senses taste, smell, texture
• Avoid other activities while eating (TV, etc)
• Exercise purposefully
• Be aware and enjoy your surroundings.
• Focus on benefits and pleasures.

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Using behavioral change techniques

• Thinking through the consequences
• Reward and praise yourself.
• I made a good choice, and I feel good about it!
• Learn from your experiences.
• I made a poor choice how can I do better next
  time?

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Classic elements of behavioral change

• Self-monitoring
• Keeping food and activity records
• Stimulus control
• Controlling triggers and cues
• Problem-solving
• How can I handle this situation better?
• Cognitive restructuring
• Changing your thinking

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Applying classic elements of behavioral change

• Problem over-snacking in the evening
• Self-monitoring
• Keep a log of food intake and activities in the
  evenings.
• Look for patterns.
• Stimulus control
• When watching TV and drinking beer, you crave
  salty snacks.

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Applying classic elements of behavioral change
over-snacking

• Problem-solving
• What are my options?
• Dont watch TV, dont drink beer, limit
  pretzels to a 1-ounce portion, dont buy
  pretzels, buy fruit instead
• Cognitive restructuring
• What am I willing to change?
• What can I live without?
• Can I find another evening activity?
• Can I drink a beverage that I don't associate
  with salty foods?

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Applying behavioral change techniques

• Think of a recent situation when you ate too
  much.
• Pastries and donuts at work
• A retirement celebration
• A cocktail party
• All-you-can-eat buffet

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Applying behavioral change techniques

• Can you identify antecedents, the behavior
  itself, and the consequences?
• How could you have broken a link in the
  behavioral chain to prevent overeating?
• What did you learn from this episode that can
  help you handle a situation like this in the
  future?

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Lets look at your progress

• 1. Are you pleased with your progress so far?
• 2. Are you successfully losing weight? Are you
  satisfied with your rate of weight loss?
• 3. Are you making lifestyle changes that will
  help you keep off the weight you are losing?
• If no to any of these 3 questions --
  Why not?

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To stay on track

• Keep the right foods available.
• Keep the problem foods out-of-sight.
• Avoid places and situations that may be
  problematic.
• Be actively involved with shopping, planning, and
  cooking meals.
• Watch portions. Measure foods.
• Dont use food as a reward, or withhold it as
  punishment.

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To stay on track

• Continue to keep food and activity records,
  focusing on behaviors you are working on
• Think positive I can do this! (self-efficacy)
• Plan ahead.
• How will you handle an upcoming holiday or
  vacation?
• Plan to occasionally treat yourself to a moderate
  portion of favorite food.
• Keep physical activity a priority.

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Be aware of your screen time

• Screen time inactive time
• Television
• Videos/DVDs
• Computer
• Computer games
• Handheld electronic devices

• How many hours each day are you spending doing
  these activities?
• How can you reduce this inactive time?

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Reality check

• At this time, what is your primary focus?
• Losing weight ?
• or
• Maintaining your current weight ?

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Focusing on keeping it off?

• National Weight Control Registry
• Tracks individuals who have lost 30 pounds and
  kept it off for at least 1 year
• http//www.nwcr.ws/
• These successful weight-maintainers report
• Eating a low fat diet
• Watching calories
• Eating breakfast
• Weighing often, maybe even daily
• Exercising 60 to 90 minutes daily

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When you get off track

• Dont let lapses lead to relapse or
  collapse!
• Expect slipsbut get back on course.
• Dont set unrealistic expectations for yourself.
• Never use the terms cheating or failure
• Expect to not be perfect.
• Learn from your experiences.

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Summary of todays session

• Behavioral change
• The ABCs
• (Antecedents, Behavior, Consequences)
• Using techniques to stay in control
• Keeping on track
• To continue losing weight
• To keep from re-gaining weight

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Assignments for the coming week

• Continue to keep food and activity records --
• - Add a column for thoughts and feelings.
• - Monitor your screen time.
• Look at antecedents and consequences related to
  your eating and activity behaviors.
• Set 1 or 2 behavioral goals to address these
  issues.