Applying the Stages of Change to Weight Loss Clientele

Last week I wrote about the 5 stages of change. Today I will explain one way I use them with my clients. I have a handout I use during the first meeting as part of the initial assessment process. I discuss what the stages of change are and how they are a normal part of the process of change. We acknowledge that change may be difficult and that there are behaviors some people are very against even considering. For instance, in looking at behaviors that affect weight, a person may say they are "ready to start exercising, have been thinking about how to will make better restaurant choices, but will never, ever keep a food diary so don't even bring it up again!"

I have adapted my handout from one used in the Department of Defense HEALTH (Healthy Eating and Active Living in Tricare Households) weight loss program book. The changes are divided into a short list of behaviors that can be made to help weight loss occur. Instead of "I am ready to lose weight" there are specific behaviors listed down the left side of the chart. Here are some examples:

1) Keep a food diary, either on paper or online
2) Keep an exercise journal
3) Choose lower calorie foods more often
4) Choose reasonable portion sizes
5) Incorporate physical activity into daily life

Across the top of the chart there are statements correlating to the stages of change:
1) I'm not interested in doing this
2) I have thought about doing this
3) I have tried to do this on and off and intend to again very soon
4) I am doing this successfully, but for less than 6 months
5) I have been doing this successfully for at least 6 months

I have my client examine the chart, and fill in the appropriate box for each behavior with the correlating stage of change they are in with today's date.
For instance, the client in the above example may fill in today's date in the boxes to correlate, "I have been incorporating physical activity into my daily life but for less than 6 months; I have thought about making healthier choices in restaurants on and off; and I am not interested in keeping a food diary". Using the date instead of a checkmark allows us to come back in a month or two and see what has changed with their stages. It's another way to measure the success of their mindset and of our coaching sessions.

Often I have found a client to change their stage and not realize it. When we meet for the 6th time, for instance, they are telling me how they read the nutritional content of fast food choices before they go out to eat so they can choose the low calorie options, and they pack their lunch every day for work, when before they were always driving through the pick up window for a jumbo burger and extra large fries.
I will ask them, "Do you realize how much your behavior has changed? Do you remember driving through and picking up fast food almost every day before last month?" and they may shrug it off. It's a tremendous help to their progress for them to see what a huge change they have made and for me to acknowledge how far they have come with this change. That is how I find using a date in the appropriate box helps: So they can return to the chart occasionally and have a visual of moving ahead. I have them place today's date now in the next box if they have advanced to the next stage of change.

This can also help them see how it's possible to repeat the forward movement with another habit; so I ask them, "which of these behaviors would you like to address next?"

In coaching, the weight loss expert does not decide what the next change in behavior will be: we ask the client to choose one to work on next. We may address one the client is not interested in to find out why, and to help them see what might lead them to become interested.

One woman said, she was not interested in keeping a food diary, period. I asked her what her objection was to doing this. She explained it would make her uncomfortable to have to confront how much she actually ate. When I explained this was the very purpose of keeping a food diary--to realistically see what her intake was on a daily basis--she agreed to try it. She ended up finding it extremely helpful in making further changes to reduce high calorie foods and went on to lose weight successfully.

Let us know what you do with the stages of change to assess, reassess, and motivate your clients.