Obesity - Behavior Change

Behavior Change

Natasha B. Sharpe

Simmons College

Behavior Change

Introduction

        Obesity is a major problem in the United States, and it leads to a multitude of co-morbidities.  As a health care provider it is difficult to watch your family fall victim to the tragic obesity epidemic, and even worse when that family member is also a health care provider.  My father, who is also a nurse, is considered obese according to his BMI.  He has a history of be^{[a][b][c][d][e][f][g][h][i]}ing very fit since his years in the Marine Corp, but with age and a decrease in physical activity he has developed the same issue that many Americans face today.  Three years ago my father had a Transient Ischemic Attack (TIA). At this point, my father was determined to get healthy.  He quit smoking, started eating better, and began exercising.  He lost 30 ^[j]pounds on his own during this time and admitted he felt better than ever.  Unfortunately, this success was short-lived.  He never picked the smoking habit back up, but he did ^[k]start eating very unhealthy foods and stopped going to the gym regularly, which lead to him gaining, even more, weight than he had before.^[l][m]  His starting weight was 262, and his goal was to lose 20 pounds over ten weeks^[n][o].

Theory Description

Developed in^[p] 1983 by Prochaska and DiClemente, the Trans-Theoretical Model (TTM) was used to help people make healthy lifestyle changes.  It focuses on the decision making of the individual as well as intentional change.  In the past, this theory has successfully been applied to behaviors such as addiction, smoking, obesity, and lack of exer^[q]cise. (Wilson, 2016, para. 1)  This theory involves five stages that reflect the subjects view or readiness to change.  These five stages include Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance.  The Pre-Contemplation stage is typically when the individual has no plans in the immediate future to change their situation. The Contemplation stage is seen when the person begins to recognize that a behavior change is needed and they plan to implement the changes. The Preparation stage is when the person actually takes the necessary steps to make the change. In the action stage, the person has actually changed their behavior and intends to continue this be^[r]havior.  The last stage is the Maintenance stage.  This happens when the person has continued the behavior change for greater than six months.  For people to progress through these stages, they need to have an awareness of the advantages of change and ^[s][t][u]know they outweigh the disadvantages.  This is called decisional balance.  They also need to have self-efficacy or confidence to make and maintain the changes.  There are ten processes that the TTM calls processes of change, and are strategies used to help subjects make and maintain change.  They are consciousness-raising, dramatic relief, self-reevaluation, environmental reevaluation, social liberation, self-liberation, helping relationships, counter-conditioning, reinforcement management, and stimulus control.  People using the TTM often go through the steps cyclically. (Seals, 2007)^[v][w][x][y]

Before I approached my father a^{[z][aa][ab][ac][ad][ae][af]}bout weight loss, he was in the Pre-C^[ag]ontemplation stage.  He had no real plans of pursing a healthy lifestyle again or changing his eating habits.  After my initial phone call, he was on board.  I expressed my desire to use him as my subject because I wanted him to be healthy and be around a long time for his grandchildren.^[ah][ai]  This strategy was the Consciousness-Raising, as I was making him more aware of his unhealthy lifestyle.  I also used the environmental re-evaluation strategy here by pointing out that his negative behaviors could impact his grandchildren one day if they are not corrected.  I think using his family as an incentive was a key motivating factor.  During our initial conversation, he ^[aj]easily transitioned into the contemplation stage.  This was not a very long stage for him, as he was willing and ready to make the changes immediately.  The preparation stage happened during our second phone call two days later.  We had a meeting ^[ak]over FaceTime and made a plan that was both safe and feasible. He remained on this stage throughout the entirety of this assignment.^[al][am]

Plan of Action

        During the second meeting, my father and I had ^[an]agreed that eating a primarily whole foods plant based diet would be the most beneficial for health and weight loss.  On rare occasions, he would have grilled chicken with his meal.  He downloaded the My Fitness Pal application on his phone to help record his meals, caloric intake, and exercise.  The app was very easy to use, and my father became ^[ao][ap]proficient with it in no time.  We reviewed his diet every week together during FaceTime interviews and talked about healthy food choices as well as some recipes he would try.^[aq]

Secondly, we decided he would go to the gym five days per week.  He already had a Planet Fitness membership that he was not using, so this made it easy for him to actually go to the gym.  We talked about the various forms of exercise he could do such as cardio, weight-lifting, classes, etc.^[ar] He decided he would stick with cardio which would be done on the treadmill and elliptical machine.  The time he spent doing cardio was logged into his My Fitness Pal app routinely, and we would talk about that during our weekly conversati^[as]ons as well.  There were only two weeks were he went to the gym four days instead of the five days that were planned.