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Columns: Health Yourself

Why is behavior change so hard?

By Victor Katch

Cause and effect

No SmokingA recent 12-year longitudinal study on health behavior changes by the Health Analysis Division at Statistics Canada reveals some disturbing trends. This study examined habits regarding smoking, physical activity, alcohol consumption, and diet (fruit and vegetable consumption) among 5,404 Canadians. The subjects were 50 years or older and were studied after they received an initial diagnosis of chronic illness (heart disease, cancer, stroke, respiratory disease, and diabetes). The results showed that even after being diagnosed with a disease condition, and after being counseled by a health care professional on lifestyle modifications to change their condition, most people did not make major lifestyle adjustments to alter their condition.

Smoking was the most commonly reported successful behavior change for those smokers diagnosed with heart disease, diabetes, cancer, or stroke. Surprisingly, those diagnosed with respiratory disease were the exception—not only were they more likely to smoke before diagnosis (25 percent), there was no significant decrease in the percentage who continued to smoke after diagnosis.

The pre-to-post diagnosis for behavior changes in alcohol consumption, physical activity, and fruit and vegetable consumption were depressingly disappointing. Despite professional counseling regarding behavior modification, people did not make significant changes even after a positive diagnosis of disease.

Confronting change

It seems to me there are multiple, interrelated reasons behavior change is so difficult. First, we all live in a world of delusion. We rarely believe what we do will be the cause of our death—until it happens, of course. Mickey Mantle, the great New York Yankee Hall of Famer who ultimately died from liver disease from years of drinking, reportedly said on his death bed, “If I knew I was going to live this long I would have taken better care of myself.”

Most of us don’t want to confront the fact that what we do really matters, until it’s too late.

As we get older, what we do and how we live often define us. Thus, if we have to make a change in how we live, it often means changing what we consider to be our uniqueness. Changing a lifestyle habit often means having to change social circles and activities. Changing behaviors often means trying something new and different, and this has proven difficult for most people.

How we change

Legs of a young man runningLifestyle behavior changes occur in one of two ways: something you do (conscious behavior change) or something done to you (injury, forced change in surroundings, etc.).

Conscious behavior change is a process. It involves specific steps that require time to master. There are new skills to learn like cooking and eating different foods, engaging in new and different physical activities, or even changing sleeping habits. Often, once these skills are learned it takes additional time to integrate them into permanent behavior patterns.

Steps to changing behavior

One popular model of behavior change proposes five stages everyone experiences when adopting new lifestyle behaviors.

  1. Precontemplation—In this stage you have no “real” intent on changing behaviors. However, you know something is amiss, but you’re not sure what it is or what specifically to do. Often you experience anxiety, discomfort, or problems that bother you. At this stage, change is hypothetical.
  2. Contemplation—In this stage you “get it.” Something is wrong and you want to know what it is, but you’re not ready to do anything about it. You engage in self-talk, but you are indecisive at this point.
  3. Preparation—In this stage you want to do something. You’ve had it; you’re not happy. You gather information by talking to others, seeking information online, or getting a professional diagnosis. You might be scared and sometimes you rehearse what you need to do (think “New Year’s Resolution”). At this point you may or not share your decision.
  4. Action—Here you go! You dive in and really do something. You become committed and begin to work hard. You join a group, seek professional help, or engage a trusted friend or significant other to help you. This stage may take a long time as you learn and practice new behavior skills. In this stage you are likely to experience the ups and downs of success and failure.
  5. Maintenance—During this stage you’re locked in. Research suggests that as little as six weeks of success can reinforce behaviors that have real potential of becoming permanent.

Skills of successful changers

Joyful jumperPeople who study behavior change recognize several skills that successful changers possess.

Successful changers maintain a singular focus on success. They don’t engage in self-doubt. They avoid individuals and activities that might sabotage their efforts.

Successful changers show a quality of persistence. Making changes often means taking two steps forward, one step back. At least the trajectory is in the right direction. Persistence pays off.

Successful changers know and practice change all the time. Changing means practicing all the time, not just on the weekends. Changing behaviors means being committed for the long haul because we know new behaviors can change lives forever.

The Katch 30-Day Health Yourself Nutrition Pledge

Take my 30-day pledge as a way to practice healthy nutrition behavior changes. Keep records in the form of a blog, diary, notes, etc. Detailing your efforts each day will help you practice correctly. Keeping note also encourages persistence.

At the end of the day, reflect on your feelings for a few moments. Think about the obstacles you faced and the insights you gained. Identify ways to ensure lasting success. It’s also a good idea to keep records of your sleeping pattern, your body weight, your mood, your digestion, your perception of self, and/or any other aspect of self that will motivate you toward successful change.

Can you do it?

Try at least one to three of the following good-eating pledges. Of course you can pledge to do as many as you wish. Spend 30 days putting these pledge(s) into practice.

1. I pledge to drink zero soda pop (soft drinks or processed juices).

2. I pledge to eat zero meat (red meat, poultry, fish).

3. I pledge to cut out all red meat and poultry from my diet (fish is OK) for at least three out of seven days of each week.

4. I pledge to eat zero dairy products.

5. I pledge to cut out all dairy products from my diet for at least three out of seven days of each week.

6. I pledge to eat a quality breakfast every day.

7. I pledge to eat nothing out of a bag, can, bottle, or package that has more than seven listed ingredients.

Apple girth

8. I pledge to eat zero refined sweeteners such as sugar, any form of corn syrup, cane juice, or the artificial stuff like Splenda, etc.

9. I pledge to eat zero deep-fried foods.

10. I pledge to eat zero refined grains such as white flour or white rice. (Items containing wheat must say whole wheat, not just wheat.)

11. I pledge to drink zero caffeinated beverages.

12. I pledge to drink no more than one caffeinated beverage per day.

13. I pledge to drink zero alcoholic beverages.

14. I pledge to drink no more than one glass of wine per day.

15. I pledge to avoid eating at any fast-food restaurant.

16. I pledge to avoid eating any packaged sugary snacks. Instead, I pledge to eat fresh fruits, vegetables, whole nuts, or popcorn (without butter).

17. I pledge to try a minimum of three new foods (vegetables, fruits, spices, recipes) per week for a total of 12 new foods.

18. I pledge to eat vegan at least three or more days per week.

19. I pledge to prepare at least one new main course per week.

Post your comments and suggestions below regarding progress with some of the nutrition pledges. Perhaps you can inspire other “Health Yourself” readers to follow your example and start the change.

• Newson, JT et al. 2012. “Health Behaviour Changes after Diagnosis of Chronic Illness among Canadians Aged 50 or Older.” Component of Statistics Canada Catalogue no. 82-003-X. Health Reports
• Prochaska, JO; et al. 1994 “Changing For Good: the Revolutionary Program that Explains the Six Stages of Change and Teaches You How to Free Yourself From Bad Habits.” New York: W. Morrow.

Victor Katch

Victor Katch

VICTOR KATCH has been active in the exercise, nutrition, and weight control arena for more than 40 years at the University of Michigan. He earned his undergraduate degrees in international relations (political science) and physical education (kinesiology) from California State University at Northridge. He also did undergraduate work in international relations at the prestigious University of Uppsala in Sweden. Katch's graduate degrees are from the University of California, Berkeley. He is a professor in movement science in the School of Kinesiology. He has three children and five grandchildren, and is an avid exerciser who enjoys year-round walking and jogging with his wife, Heather, and playing golf whenever possible, weather permitting.