U.S. Public Health ServiceU.S. Public Health Service““Fit for Duty, Fit for Life”Fit for Duty, Fit for Life”

Weight Management Program: Weight Management Program: Session 5 Session 5

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Review of last sessionReview of last session

Importance of carefully

monitoring portion sizes.

Reading food labels with attention to portion size.

• Hints for eating out.

Review of assignmentsReview of assignments

1. Continue keeping food and activity records. Focus on recording portions. Measure foods and drinks whenever possible. Were your portion sizes reasonable?

2. Practice reading food labels and determining calories in your usual portion.

Any surprises?

3. Practice making special requests when eating out.

What special requests did you make?

Topics for todayTopics 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).

The ABCs of Behavioral ChangeThe 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

AntecedentsAntecedents

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

… home alone… favorite TV show on

… depressed, lonely

… “I deserve a treat”

BehaviorBehavior

The conduct itself and Any related events, situations,

thoughts, and feelings occurring during the behavior

Behaviors: ExamplesBehaviors: ExamplesEating 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

ConsequencesConsequences

Occur after a behavior

– Thoughts– Feelings – Events

– Situations

…guilty

…failure

…eat more brownies (behavior)

…keep watching TV instead of taking a walk (behavior)

The behavioral The behavioral chain of eventschain of events

Antecedents →

Behaviors →

Consequences →

Behaviors

Using behavioral change Using behavioral change techniquestechniques

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.

Using behavioral change Using behavioral change techniquestechniques

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)

Using behavioral change Using behavioral change techniquestechniques

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.

Using behavioral change Using behavioral change techniquestechniques

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?”

Classic elements of behavioral Classic elements of behavioral changechange

Self-monitoringKeeping food and activity records

Stimulus controlControlling triggers and cues

Problem-solvingHow can I handle this situation better?

Cognitive restructuringChanging your thinking

Applying classic elements of Applying classic elements of behavioral changebehavioral 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.

Applying classic elements of Applying classic elements of behavioral change: over-snackingbehavioral change: over-snacking

Problem-solving What are my options? Don’t watch TV, don’t drink beer, limit pretzels

to a 1-ounce portion, don’t 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?

Applying behavioral Applying behavioral change techniqueschange 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

Applying behavioral Applying behavioral change techniqueschange 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?

Let’s look at your progressLet’s 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?

To stay on track…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. Don’t use food as a reward, or withhold it as

punishment.

To stay on track…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.

Be aware of your Be aware of your “screen time” “screen time”

Screen time = inactive timeTelevisionVideos/DVDsComputerComputer gamesHandheld electronic devices

How many hours each day are you spending doing these activities?

How can you reduce this “inactive” time?

Reality checkReality check

At this time, what is your primary focus?

Losing weight ?

or

Maintaining your current weight ?

Focusing on keeping it off?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

When you get off trackWhen you get off track

Don’t let lapses lead to relapse… or collapse!

Expect “slips”…but get back on course. Don’t set unrealistic expectations for yourself. Never use the terms “cheating” or “failure” Expect to not be perfect. Learn from your experiences.

Summary of today’s sessionSummary of today’s 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

Assignments for the coming Assignments for the coming weekweek

1. Continue to keep food and activity records --

- Add a column for thoughts and feelings. - Monitor your screen time.

2. Look at antecedents and consequences related to your eating and activity behaviors.

3. Set 1 or 2 behavioral goals to address these issues.