Behavior Strategies in Diet Control

The Challenge and the Cure

Dr Abeer Al Saweer

Consultant Family Physician,Diabetologist

Kingdom of Bahrain

Learning Objectives

To appreciate the importance of lifestyle modification in the control of the diabetes epidemic.

To overview the different modalities of behavior therapy.

To understand the role of behavior therapy in diet control and thus in diabetes control.

Introduction

Diabetes Mellitus is “one of the most psychologically and behaviorally demanding of the chronic medical illnesses”.

Cox and Gonder-Frederick,1992

Introduction

Research about diabetes has

changed from imparting

knowledge about the cause and

treatment to diabetes self-

management.”

(Clement 1995)

What are Behavioral Strategies?

Strategies, based on

behavioral change theories

which provide patients/clients

with tools for overcoming

barriers to compliance with

dietary or exercise therapy.

Evidence Statement: (A)No one behavior therapy appeared superior to any other in its effect on weight loss; rather, multimodal strategies appeared to work best and those interventions with the greatest intensity appeared to be associated with the greatest weight loss.

Do Behavior Strategies work?

Do Behavior Strategies work?

Strongly Evident: (B)Programs that combine diet, exercise, and behavior modification have been shown to be most effective over the short term.

The NIH Guidelines reported that behavior strategies in diet and physical activity produced wt losses of approximately 10% in 4-12 months.

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Common Theories Relevant to Understanding Human

Behavior

Educational and Behavioral.Health Belief Model.Theory of Planned Behavior.The Wheel of Change.Conflict Theory.Cognitive Dissonance Theory.Operant Learning.

History of Behavioral Therapy

First applied in the late 1960's and

early 1970's.

Initial programs were 10-weeks in

length. Produced weight losses 4.5

kg.

History of Behavioral Therapy

Parameters 1970s 1980s 1990s

Length of treatment (wks) 10 14 27

Wt Loss (kg) 4.0 7.6 9.7

Length of F/U (wks) 22 53 64

Loss at F/U (kg) 4.0 4.8 5.6

Theoretical origin of Behavior approach

Eating and exercise behaviors are related to body weight.

Behavior can be changed by

environmental cues before or

after the behavior.

Components of Behavior strategies

Assess Behavior.

Change contributors.

Change consequences/Reinforcers.

Common Components of Behavioral therapy in diet Control

Set realistic goals.

Self-monitoring.

Cognitive restructuring and Problem Solving.

Stimulus control.

Social support.

Relapse prevention.

Self-monitoringInvolves the systematic observation and

recording of target behaviors.

Daily food and physical activity (PA) records for the first two weeks.

After which to complete food records at least two days per week and one weekend, & continue to record the frequency and duration of exercise.

Stimulus control

A process which involves identifying

and modifying environmental cues

that are associated with overeating

and inactivity (Changing antecedents

and consequences or reinforcers).

Stimulus control

Stress management techniques.

Environmental changes to

control cue eating and PA

habits.

Cognitive Restructuring

Involves identifying and

modifying maladaptive

thoughts and advising more

positive self-statements to

assist in behavior change.

Social Support

Studies show that persons

with higher levels of social

support tend to be more

successful at achieving and

maintaining weight loss.

What current strategies look like?

Conducted in groups of 15 individuals.

Two co-therapists.

Weekly treatment meetings for 6 months and biweekly or monthly meetings for the remainder of the year to two years.

What current strategies look like?

Continued contact is an important

component of the maintenance

program.

Recently there have been efforts to

deliver behavioral treatment

programs via television or the

Internet.

What do strategies contain?

Standardized.

Group sessions include a private weigh-in, review of self-monitoring records, and presentation of the week lesson.

Assignments are given and reviewed next week.

Dietary prescriptions in behavioral

programs Energy Intake.

Macronutrient intake.

Food provision and structured meal plans.

Support for Healthy EatingOngoing support for long term behavior

change.

One approach is to continue treatment

contact over longer period.

Another approach is to involve

the spouse.

Another one is to involve friends.

Incentives.

Tailoring Treatment to Individual subgroups

Ethnicity.

Binge eating Disorders.

Media-based interventions for wt loss.

Preventing Weight Gain

Wt gain prevention in young adults.

Wt gain prevention at time of pregnancy.

Wt gain prevention at menopause.

Performance ObjectivesBehavioral approaches are used to

help patients make long-term changes in their eating.

Behavioral approaches stress monitoring of dietary intake and modifying the cues and reinforcers in the environment.

Better results have been achieved with longer periods of treatment contact and more structured approaches.