Positively influence clients' nutrition choices

Transcription

1 Positively influence clients' nutrition choices What influences clients decisions to change nutrition? There are many factors that can influence people s willingness to change - the environment (physical, social, financial), thoughts, feelings, attitude, knowledge, dietary preferences, values, beliefs, skills, and timing all can play a role. Collaboratively forming a plan with clients to enhance positive influences and decrease negative influences can boost motivation to start changing nutriton or help them to stay on track with healthy eating. The physical environment Access and the availability of food in and around our homes and workplaces can influence our decisions to eat healthily. According to Brian Wansink s Mindless Eating, if food is visible and convenient to obtain, the more of it we will eat. Helping client s to recognise and remove unhealthy triggers and replace with healthy alternatives can help with choosing healthy options. The financial environment The cost of healthy eating can influence choice of foods International studies report that healthy food is more expensive than unhealthy food, and local studies have shown that people in low- income categories are less likely to buy and eat healthy food 1 In a 2011 survey of Australians, 13% reported they could not afford to eat nutritionally- balanced meals 2 Research from the Harvard School of Public Health (HSPH) found the healthiest diets cost ~ $1.50 more per day than the least healthy diets 3 If a client is concerned with cost of healthy food discussing ideas from these resources could help them to make healthy choices:

2 o o the- public/smart- eating- for- you/nutrition- a- z/healthy- eating- on- a- budget/ o The social environment Social influences on food intake refer to the impact that people have on the eating behaviour of others. Even when eating alone, food choice is influenced by social factors because attitudes and habits develop through the interaction with others 4. Research published in the Journal of the Academy of Nutrition and Dietetics 5 examined data from 15 studies that observed food intake and food choice. The study's researchers found that if participants were given information indicating that others were making low- kilojoule or high- kilojoule food choices, it significantly increased the likelihood that participants made similar choices. Similarly, people choose food types based on what they perceive is a social norm - to identify with a given group and gain social approval Social situations also tend to revolve around food, such as meeting for meals at cafes and restaurants. The venue in which food is eaten can affect food choice, particularly in terms of what foods are on offer. Creating strategies with your clients can assist them to manage social influences to stay on track with healthy eating or maintain new nutrition behaviours: o Brainstorm regular or upcoming social situations and create a management plan for each separate occasion o Evaluate social network to assist with choosing when and how to spend time with others o Preregulate consumption - methods include reviewing online restaurant menus in advance and/or setting rules such as: don t eat the bread roll or dessert, and stick to a healthy main meal only. o Keep pace with the slowest eater at the table - Research has shown that people who eat quickly and eat until full are three times as likely to be overweight 6. o Aim to be the last person to start eating when in a group reduces the opportunity for consumption o Choose eating companions wisely - research has shown we mimic the eating behaviours of those we eat with Thoughts The way we think about a situation influences behaviour Thoughts can be unhelpful or helpful with regards to making decisions about our eating behaviours: o Helpful thoughts motivate change in eating habits or maintenance of healthy eating o Unhelpful thoughts cause people to remain stagnant Often unhelpful thoughts happen quickly in response to trigger events - such as a stressful day

3 Clients may have developed unhelpful thinking patterns in response to trigger events in their lives. Particularly if they have been trying to diet or lose weight over a long period of time. By helping clients to be aware of unhelpful thinking they can better recognise patterns associated with choosing unhealthy foods, and develop alternative thoughts or interpretations for these situations. Feelings Moods and feelings can lead to overeating or choosing unhealthy foods People commonly associate certain emotions with food, ie. comfort food when sad or stressed or overeating with happy celebrations Help clients to identify emotions linked with foods and eating patterns Brainstorm with clients alternative ways to get rid of negative feelings or prevent over indulging at celebrations Dietary preferences Taste is consistently reported as a major influence on food behaviour. Taste preferences and food aversions develop through experiences and are influenced by our attitudes, beliefs and expectations 4 Our taste buds are also rooted in our evolutionary past - evolution equipped humans with strong taste preferences for fat, sugar and salt 7 Helping people to find ways to enjoy healthy foods can persuade them to choose healthier options Knowledge New knowledge about the risks of current behaviours and/or benefits of new behaviours can increase motivation to change, particularly if if the risks or benefits seem personally relevant. New information can increase the importance of making a change due to numerous reasons including: o Desire to avoid risk or danger o Malalignment with values or vision o Fear of consequences of current behaviour o Benefits of new behaviour Values Principles, standards or qualities that people hold in high regard. Values guide the way we live our life and the decisions we make. A value may be described as qualities that we consider to be of worth. Understanding a person s values can be useful in finding out: o What is most important to your client o Motivations your client has for change o The paths towards change that would be most compatible with your client s values If client s become aware of nutrition behaviours that fall short or contradict longer- term life values it can exert a powerful effect on motivation to change their behaviour. Example questions you can ask your clients:

4 Tell me what you care most about in life. What matters most to you? What would you say are the rules you live by? What do you try to live up to? Describe the goals that guide your life, the values you try to live by. Beliefs An internal feeling that something is true, even though that belief may be unproven or irrational. Beliefs reflect who we are and how we live our lives. For example, alcohol won t affect the health of someone like me. Theories and models of beliefs and behaviour change have been proposed to explain and describe people s decision making. Below are two examples of these models. The cognitive dissonance model Based on the notion that people seek internal consistency between their beliefs, attitudes and behaviour. Inconsistency results in uncomfortable feelings that leads people to reduce the dissonance and achieve consonance by: o Changing attitudes, behaviour or beliefs. For example, changing eating behaviours to be a better role model for children o Acquiring new information that outweighs the dissonant beliefs. For example, there is not enough evidence to prove small amounts of drinking in pregnancy will cause harm to the baby o Reducing the importance of the beliefs. For example, enjoying today is more important than worrying about things that may not even happen in the future. By asking your client about their beliefs they may realise their eating or drinking behaviours are not aligned. This usually results in uncomfortable feelings and a need to reduce the dissonance. This may lead to a decision to change their nutrition behaviours to achieve consonance. The health belief model This is based on the concept that an individual perception s motivate their behaviour. By asking questions to determine the client s perceptions about the impact of their current behaviour and advantages/disadvantages of adopting a new behaviour may help assist with change. Build empathy and understanding of client s current beliefs, clarify gaps in knowledge, assist them to evaluate the impacts of change and build confidence by planning for perceived barriers. Skills - Organisation and planning A cross- sectional European study of 1000 adults found one of the most frequently perceived barriers to healthy eating was lack of time. 8 Thinking ahead and planning meals is key to gaining more time to eat healthily. It also helps to maximise foods that are high in nutrients but lower in kilojoules.

5 Organisation and planning skills make healthy eating easier and help to manage other factors that may lead to unhealthy choices, such as physical or social environments To help clients with planning and organisation the Eat For Health website offers information on planning a weekly shopping list and example meal plans using the dietary guidelines: well/tips- eating- well/meal- planning. Importance and confidence to make a nutrition change The afore- mentioned factors can influence clients perception of the importance of making nutrition changes and affect confidence in their ability to make a successful change. Confidence Readiness Importance Reference: Rollnick, Mason & Butler (1999) Importance = Why should I change? How would things be better if I did change? Confidence = How will I do it? Can I do it? By asking people how confident they feel about changing or how important changing their nutrition is helps to determine how ready they are. Is your client ready to make nutrition changes? People will vary in their readiness to make changes to their nutrition. For example clients may be: o ready to focus on nutrition o thinking about making some changes to nutrition o not contemplating making changes to nutrition o already making changes to nutrition People can also vary in their readiness to change different nutrition behaviours. Ie. a client may already be eating plenty of fruit and vegetables each day, be thinking about cutting down on discretionary foods, and not yet contemplating reducing their alcohol intake. A popular model used to describe people s readiness to make changes is DiClemente & Prochaska s Stage s of Change model.

6 This model can be used to understand the stages people may cycle through when deciding to change their nutrition behaviours. For example someone may not have even thought about their nutrition (precontemplation) but then hear that their food intake could influence energy levels and since they have been feeling tired start to consider change (contemplation). They decide to ask a dietitian about how foods affect energy, read recommended resources and start to make a plan on how they could improve their food intake (preparation). They start to make changes (action) and after six months those changes have become part of their regular food intake (maintenance). Stage of Change Precontemplation Contemplation Preparation Action Description The individual has no intention to take action and is generally unaware or under- aware of the problem. They tend to not think seriously about changing and are not interested in any kind of help. People in this stage tend to defend their behaviour and do not feel it is a problem. They may be defensive when people attempt to make them change. The individual is aware a problem exists and serious thought is given to changing the behaviour in the next six months. However there is no commitment to take action. People weigh the pros and cons of quitting or modifying their behaviour. Although they think about the negative aspects of their habit and the positives associated with giving it up or reducing it, they may doubt that the long- term benefits will outweigh the short- term costs. The individual intends to take action within the next 30 days and may have taken some behavioural steps in this direction. People tend to do a lot of research about how to stop / how to start and have thought about specific ways to achieve their goal. The individual has recently changed their behaviour (defined

7 Maintenance Termination as within the last six months) and is taking direct action in order to achieve their goal. They may have modified their problem behaviour or acquired new healthy behaviours. This stage involves the most overt behaviour changes and requires considerable commitment of time and energy. The individual has been sustaining their behaviour change for at least six months and intends to maintain the behaviour change going forward. They work hard to consolidate the gains attained during action and prevent relapse to earlier stages. The individual has no temptation to relapse or desire to return to their unhealthy eating habits. They have full confidence in maintaining the change. How to approach nutrition with clients Once you determine your client s readiness to discuss nutrition, having the right approach that is tailored to their stage of change will increase the likelihood of your client adopting positive nutrition behaviours. Nutrition coaching approach Traditionally advice- giving and the dispensing of knowledge was the only strategy used for encouraging nutrition change. There are two problems with this: o Evidence shows it is rarely information alone that will motivate people to change o To ensure safe practice, expert nutrition advice should only be dispensed by those who have relevant nutrition qualifications. Nutrition coaching is an answer to both dilemmas it involves skills and strategies to motivate clients to change nutrition and helps you to stay within your scope of practice. There are an increasing number of research studies and reviews that provide evidence for a coaching approach to faciliate nutrition and health change What is nutrition coaching? Nutrition coaching is an approach of partnering with your clients to enhance their own strategies to support nutrition change and improve outcomes. Nutrition coaching involves: o Partnership - an equal relationship where personal trainer and client solve problems together o An attitude of acceptance and empathy o Putting the client first and giving priority to their concerns o Encouraging clients to produce their arguments for change, and own ways of achieving it o Asking open questions and allowing the client to talk more than you

8 o Affirming the client s behaviours to support, encourage, recognise and acknowledge their worth o Reflective listening to help clarify the meaning behind client s words and to create momentum in the conversation, driving it forward. o Summarising to clarify understanding of what has been said, transition forward, or to help clients reflect on what they have expressed o Planning and goal setting once a client has committed to change a nutrition behaviour Traditional Ineffective Approach Ø Personal trainer is the expert in the consultation Ø Rigid standard solutions Ø Personal trainer advises the patient what to do Ø Personal trainer talks more than the client Ø Information and goal overload Ø Personal trainer chooses goals they think are important for the client Nutrition Coaching Approach Ø Client speaking more than personal trainer Ø Individually tailored solutions Ø Client is respected as an expert in their own life Ø Client chooses goals, strategies and tasks Ø Personal trainer offers options and information Ø Barriers to change are addressed Tailor your approach to their stage of change To be an effective in helping client s to change nutrition you also need to tailor your approach to match your client s readiness to change. If you have a client that hasn t even considered nutrition, trying to set goals with them may make then think you are insensitive, don t understand them, and are pushing your agenda in front of their own. Pre- contemplation This is usually a discussion about a client s nutrition concerns or lack thereof. The aim is to determine if they have considered change or are willing to consider change. It may be appropriate to offer to provide them with the Australian Guide to Healthy Eating or the link to the Eat For Health Website. Invite them to discuss nutrition later down the track if they would like. Contemplation The client is contemplating change and is weighing up the pros and costs of changing their nutrition behaviour/s. The aim is to encourage exploration of possible behaviour change whilst clarifying that the decision to change is ultimately theirs. By investigating with your client the influences that affect

9 willingness to change nutrition they may start to feel more in control and aware of what is stopping them from moving forward. Preparation The client is preparing to change their nutrition and has been considering how they will make specific steps towards implementing change. The aim is to help them set a goal/s and tasks with a plan to track and review, address possible influences that may create barriers to change, and ensure they have a trial and error mentality. Action The client is practising their new nutrition behaviour and attempting to establish it as a habit. Aim to provide positive feedback on their accomplishments, ensure they have adequate support and plans in place, and check in with their influences, barrier management, strengths and vision. Maintenance The client has been maintaining their new behaviour for at least six months. Aim to provide positive feedback on their accomplishments, discuss what is working for them to stay on track, reinforce internal rewards, identify triggers and strategies for relapse if it occurs and plan for follow up support. Relapse The client has stopped or is inconsistent with their new behaviour/s. Review their reasons and triggers for relapse. Discuss the influences on their nutrition behaviours - barriers and facilitators involved. Provide ongoing support, check in with their vision and strengths, remind the client of trial and error mentality. Revise their plan or devise a new plan. Keys to positively influencing clients nutrition choices 1. A nutrition coaching approach with your clients 2. Determine each client s stage of change 3. Tailor your approach to their stage of change 4. Collaboratively investigate influences on their nutrition behaviours 5. Ask your clients to choose a nutrition change that is most important to them and one they feel most confident about starting 6. Assist your clients to set up a goal, action plan with method of tracking and a review date 7. Check in with how they are feeling about their nutrition goal (especially their confidence and importance). Review goal and plan if necessary.

10 References 1. Kettings, C., & Sinclair, A. J. (2009). A healthy diet consistent with Australian health recommendations is too expensive for welfare- dependent families. Australian and New Zealand Journal of Public Health, 33(6), Lockie, S. & Peitsch, J. (2012). Public opinion on food security. Canberra: Australian National University. 3. Rao, M., Afshin, A., Singh, G., & Mozaffarian, D. (2013). Public health - Research: Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta- analysis. BMJ Open 3(12): e004277, doi: /bmjopen European Food Information Council. (2005). The determinants of food choice. Retrieved December 2014 from, food- choice/ 5. Robinson, E., Thomas, J., Aveyard, P., & Higgs, S. (2014). What Everyone Else Is Eating: A Systematic Review and Meta- Analysis of the Effect of Informational Eating Norms on Eating Behavior. Journal of the Academy of Nutrition and Dietetics, 114(3), Koutatsu, M. et al. (2008) The joint impact on being overweight of self reported behaviours of eating quickly and eating until full: cross sectional survey. BMJ, 337:a Hamid,T.K.A. (2009). Thinking in circles about obesity. New York: Springer Science + Business Media. 8. Kearney, J. M, McElhone, S. (1999). Perceived barriers in trying to eat healthier results of a pan- EU consumer attitudinal survey. The British Journal of Nutrition, 81 Supp2: S133- S137.