How Do We Make Healthy Lifestyle Changes?

Every January 1st, millions around the globe make the commitment, yet so few actually follow through with the resolution: I will live healthier.  We all know what we need to do to live healthier: eat more fruits and vegetables, less sugar and fried foods, more exercise, and so on.  But then why the heck are so few of us able to do it?  And maintain it?

The answer to this question involves understanding the process of change and all of the decisions surrounding it, most notably, prioritization.  When we choose to make a change, we are usually choosing to start something new…and make a change to an existing habit.  But existing habits are safe…comfortable…important (I need to focus on next week’s deadline)…low effort (why go for a jog when there’s an inviting couch and TV in my house)…tasty (the morning pastry)…etc.  While adopting a new, healthy lifestyle behavior/habit can be important to us, is it more important than the activities/habits we are currently doing?  That is the rub.

Whether you want to eat better, become more active, quit smoking, learn a language or transition to a new career, the States of Health Behavior Change Model developed by James Prochaska et al. is, in my opinion, one of the best ways to classify where you are in the process of change.  A summary of the model is as follows, adapted from Health Behavior and Health Education: Theory, Research and Practice, 4th Ed.:

  • Pre-contemplation – No intention to take action within the next 6 months
  • Contemplation – Considering taking action within the next 6 months…usually weighing Pros vs. Cons of a change
  • Preparation – Preparing to take action within the next 30 days and has taken some behavioral steps in this direction
  • Action – Changed overt behavior for less than 6 months
  • Maintenance – Changed overt behavior for more than 6 months
  • Termination – No temptation to relapse and 100% confidence
  • **Relapse – Reversion from preparation, action or maintenance phase to a previous state of change

Reaching the termination phase is rare for most healthy lifestyle behaviors, except for things like quitting smoking, drugs, drinking, etc.  Relapse, while not a part of the original model, is a real and frequent issue faced by anyone making a change and has since made its way into the model for many practitioners.  Life gets in the way sometimes: vacations, a new baby, a big work deadline all happen…and more frequently than we anticipate!  During these stressful times we may go back to old behaviors that are not the healthiest for us.  However the key to recovery is recognizing the relapse, re-determining where you are in the States of Change and steadily progressing yourself back to action and maintenance…if that is our priority.

So how does this model really work…in real life?  Here is an example:  Bob is a 51 year old consultant who lives a very busy, “on-the-go” lifestyle traveling often for a demanding job.  He works long hours and goes to client dinners multiple times a week which usually include alcohol and tasty, fattening foods.  Because Bob is traveling often, he rarely cooks and tends to eat at fast food establishments often to save time.  Bob recently went to his doctor for a physical and lab work…the results showed he had elevated cholesterol, triglyercides and insulin resistance (pre-diabetes).  The doctor prescribed Bob medication for the conditions, but told Bob he could do a lot to help prevent future disease and possibly reduce his need for medication if he started eating healthier and became more physically active.  This is Bob in each state of change:

  • Pre-contemplation – Bob sees no reason to change his current habits because he believes that the medication will control his health issues
  • Contemplation – Bob is considering working out in the morning before work and eating a bit healthier at client dinners, but he likes sleeping as late as he can in the morning, enjoys those steaks at dinner and ultimately is concerned that devoting time to these changes may negatively impact his job performance
  • Preparation – Bob has decided that his health is more important and has created a plan to start working out at the hotel gym two days a week in the morning, limit himself to one drinks at client dinners and will look to choose salads or grilled foods rather than fried/oily menu items at client dinners twice a week.
  • Action – Bob has successfully started acting on his plans for the past few weeks.
  • Maintenance – Bob has successfully maintained his changes for the last six months, has lost 14 lbs., and is now contemplating increasing his workouts to three times a week!
  • Relapse – A huge work deadline causes Bob to miss his workouts for the past 2 weeks and he has found himself eating more fried foods because they are more appealing to him after dealing with a highly stressful work day.  Bob recognizes this is occurring and is making plans to start back on his workout and eating plan once the deadline passes this week (what phase would that bring Bob back to?)

While Bob made a number of changes, don’t feel like you have to do many things at once.  Don’t try to workout 5 days a week and eat salads every day if your current habits involve no exercise and fast food for most meals.  Start with small, specific, measurable, achievable changes.  If you drink 3 cans of soda a day, commit to having only 2 sodas a day.  That will save you about 140 calories a day, or about 14.6 pounds a year.  If you are not working out at all, strive to exercise once a week for 30-45 minutes.  Once you achieve this change, then focus on the next.  So think about what you want to change…and remember this:

Believe in the power of your ability to follow through on any statement beginning with the words: “Starting now…”

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