Behaviour Change Techniques

In this article, we will share additional behavioural change techniques for lifestyle modification.

Identifying Barriers and Problem Solving

You can ask the patient to think about potential barriers to the management plan and identify ways of overcoming them to help ensure that they can carry out the plan. If the person can’t think of any, you may want to prompt them with some examples of common barriers that others have found. It is also important to point out to the patient that relapses are inevitable and to be expected. But planning for scenarios where relapses are more likely to occur will help to reduce their likelihood and impact.

IF THEN Planning

IF-THEN planning is a useful tool. This involves the patient thinking about possible ‘high risk’ scenarios that may de-rail their weight management efforts and then thinking about what they would do in those situations.

For example:

Situation: I am going out for breakfast or lunch with friends when usually I would be having a meal replacement shake as part of the ketogenic very low calorie diet.
Plan: I will choose something on the menu that sticks to the low carbohydrate requirement and instead replace dinner that night with the meal replacement shake.

Identifying Eating Triggers

Another way is to help patients recognize what their triggers are for eating. You can ask patients to think of four of their biggest triggers for eating unhealthy foods, snacking or over-eating. Get them to write them down and to be as specific as they can when thinking about these triggers. Then get them to think about possible strategies they can put into place to avoid giving in to the hunger or urge to overeat or snack. An example includes

You can also teach the person about hunger awareness and being able to recognise the difference between physical and psychological hunger. The Hunger Level Scale is a useful tool for patients so that they can think about reasons that may be triggering them to eat. This can be found at the link below: https://www.health.qld.gov.au/__data/assets/pdf_file/0019/152812/wtmgt_hungerscale.pdf

Use of Prompts

If the patient has trouble remembering, sticky notes, setting alarms, phone calls, or text reminders can be used to prompt the target behaviours. There are a number of resources available in terms of apps as well that can assist. Work with the patient to see if any of these might be helpful.

Rewards and Reinforcement

Both the patient and the clinician should use rewards for efforts made towards achieving goals. This can include praise and encouragement as well as material rewards. For example, the patient may treat themselves to a weekend away when they reach specific goals.

Restructuring the Environment

You can discuss with the patient ways that they might be able to alter their environment that it is more supportive of the target behaviour. For example, they might be asked to lock up or throw away their high-calorie snacks or take their running shoes to work so they can go for a walk at lunchtime.

Time Management Skills

A common barrier people often state is about lack of time. If the patient identifies this as a barrier, then you may want to help them learn ways in which they can better manage their time in order to make time for the behaviour. These include setting goals, having a task list, prioritizing tasks, scheduling when the task will be done, focussing on one task at a time, and minimising distractions. There are some time tracking software programs that can help.

Dealing With Negative Emotional Responses

Patients may have unrealistic expectations and set unachievable goals in relation to their eating or physical activity. This can set them up for failure when they can’t keep up with their unrealistic expectations and goals. Even if their goals are realistic, when patients don’t achieve their expectations and goals, they can have negative thoughts and feelings that can impede progress. One strategy is to help patients reframe their thoughts whenever they experience an outcome that is not what they wanted or expected. This strategy helps them to change their thoughts and feelings about an undesired outcome so they can ultimately change the negative emotional response. Ask the patient to tell you what they are thinking and feeling about the outcome that they have had and listen to the type of ‘self-talk’.

For example:

Negative thoughts and feelings in relation to an unrealistic goal or outcome that is not expected or wanted

Reframing thoughts and feelings in relation to an outcome that is not expected or wanted to have a more positive response

Strategies for Long Term Weight Maintenance

Studies of people who have managed to successfully maintain large weight losses using behavioural strategies^{17, 18} have the following elements in common:

• They continually adhere to a strict dietary pattern; they either restrict calories or eat the same type of foods, knowing already what their calorie content is
• They weigh (monitor) themselves regularly and make adjustments to their eating habits or exercise if they see their weight is creeping up
• They exercise frequently, at least an hour a day 5-7 days per week
• They don’t take breaks or holidays from their eating habits – they maintain the same eating behaviours 7 days a week, and when away from home
• They minimize their TV watching

The studies suggest that behaviours enabling weight to be kept off are very strict and regimented, with a self-monitoring and accountability regimen assisting in keeping the weight off.