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.

Assessing Readiness to Change

The Five Stages of Change were recognized and outlined in the 1980's by Prochaska and DeClemente to help people stop smoking. In the years since that time, these changes have proven to be useful in helping clients change a variety of behaviors--from drug abuse to alcoholism--and can be helpful in assessing your own clients' readiness to change eating behaviors in order to lose weight.

Here is a brief definition of the stages:
1. PRECONTEMPLATION: The client does not recognize their behavior as a problem

2. CONTEMPLATION: The client is considering the possibility of changing behavior and at the same time rejecting the idea of change

3. PREPARATION: The client is leaning toward change, seriously considering no longer engaging in present behavior

4. ACTION: The client is taking steps to no longer engage in the behavior

5. MAINTENANCE: The client is identifying and using strategies to prevent relapse and addressing other areas of life

6. This stage has been added more recently and signifies the person now has the new habits ingrained in their daily life. In the first five stages we often see relapses and the client can move back and forth easily from one stage to the other. In this last stage there is rarely a backward move.

How can these be used in your practice?
First identifying where the client is currently gives you a great starting place for the conversation. If the client is ready to start limiting their intake of high-fat foods, they may benefit from information on label-reading, or ideas on how to cook using less fat. However, if the client is in stage one or two, they will not be receptive to ideas about eating a lower fat diet. What first needs to be addressed may be the fact that they are overweight and it is harmful to their health. Perhaps they need to know that they will still be able to eat some of the foods they like before they say, "Okay, I'll give it a try".

Finding out where your client is in the readiness to change spectrum will help you realize what they need right now, and this will make you a very attractive professional to them, increasing the chances they come back for another visit.

Another way the stages of change can be helpful is to be able to show the client where they are right now and why. It may be helpful for some people to see that they are in a stage of ambivalence and that, indeed, there are reasons they do enjoy engaging in their current behavior. Just reflecting to them that you hear them say 'eating is an enjoyable activity' and confirming that this is true of most humans will help them see that you are not judging them or making them wrong. This keeps them from becoming defensive, allows them to relax and hear what you have to say, and encourages them because you understand where they are coming from.

And thirdly, the best use of the stages of change is to help your client move ahead to the next one! Later this week I'll show you how I use the stages of change when I start working with clients for weight loss. It's not just one change they are going to make, so I'll show you how I break it down to make it much less intimidating.