What is your first food-related memory?" I asked Jacky.
Jacky replied that when she was a little girl, she was quite certain that she would never grow and her legs would never reach the floor when she was sitting in a chair.
At least that's what her dad had told this picky eater. Today Jacky is overweight and constantly dieting. She fails to see the connection between her present condition and what she was told as a child.
How do we change our behavior? Can we alter it for good?
James Prochaska and Carlo Diclemente (1982) developed a model for change. This model categorizes how each person goes through change into 5 consecutive stages.
•Stage 1: PRECONTEMPLATION STAGE. A person may be partly or completely unaware that a problem even exists. Therefore, at this point the idea of change is not seriously considered.
•Stage 2: CONTEMPLATIVE STAGE. The individual becomes aware that a problem exists. Therefore, he or she contemplates the need for change, weighing the risks and benefits, but taking no active steps.
•Stage 3: DETERMINATION STAGE. The person's commitment is strengthened. The individual gets ready to make a change and plans a mode of action, but takes no action.
•Stage 4: ACTION STAGE. The individual chooses a strategy for change and begins to pursue it, modifying his or her habits and environment.
•Stage 5: MAINTENANCE STAGE. The person makes efforts to sustain the change achieved in the action stage. He or she learns how to detect and guard against dangerous situations that may cause a relapse and a return to problematic behaviors.
Back to Jacky...
The Pre-contemplation, Contemplation and Determination Stages
What motivates a person more? Running away from or going towards? Dodging a bullet or pursuing a dream? How about a little of both?
As a toddler, Jackie was usually satisfied after eating small amounts of food, unless it was candy, chocolate and such. Her dad, aiming for good, warned her of the dire consequences of not maintaining a nutritious diet; for example, she would never grow taller than a five-year-old. Jacky believed her dad, the principal authority in her life.
Inducing fear or criticism as an external motivator gets more quick results than promising the fulfillment of dream (which, in reality, may or may not come true). However, this is a damned-if-you-do damned-if-you-don't situation all around.
A fearful child either complies to avoid harm or, if he doesn't, is burdened with guilt and self-recrimination. Therefore, whatever action the child ends up taking is not connected to the most pivotal elements of behavior, or in this case, weight management success: his inner feelings of hunger and satiety and his likes and dislikes. Skipping Change Stages 1 to 3 produces no real internal motivation and therefore compromises Stages 4 and 5. Subsequently, a spinning wheel of dieting failures results in increased weight gain.
According Prochaska and Diclemente (1982), if a change is to be induced, it is the parent's, educator's and/or therapist's role to help the child move consecutively through all the stages of change. He must support the child by raising his awareness of the need for and benefits of change and by alerting him or her of the implications of continuing his current unhealthy behavior.
How is this achieved? By taking the following steps:
•setting up a daily schedule; providing nutritious, appealing mealtime options; and being a positive role model
•encouraging the child to express his or her feelings, concerns and beliefs
•helping the child develop a plan for change
•teaching the child new skills
•raising the child's self-confidence by acknowledging his or her success and providing opportunities to be independent.
It seems that Jacky's dad had, albeit unintentionally, left her to go through Stages 3 to 5 on her own. He could have relayed to her the importance of balanced nutrition, which results in growth and health, while discussing ways to achieve it, rather than menacing her with artificial fears. Would Jacky be coming to my clinic today if her dad had given her that knowledge?
Burdening Dad with the guilt of his daughter's adult weight management issues may seem extreme. But this is my point: Why not start by educating the caregivers? After all, having and imparting the knowledge of how to maintain healthy eating is part of their job description.
Jacky replied that when she was a little girl, she was quite certain that she would never grow and her legs would never reach the floor when she was sitting in a chair.
At least that's what her dad had told this picky eater. Today Jacky is overweight and constantly dieting. She fails to see the connection between her present condition and what she was told as a child.
How do we change our behavior? Can we alter it for good?
James Prochaska and Carlo Diclemente (1982) developed a model for change. This model categorizes how each person goes through change into 5 consecutive stages.
•Stage 1: PRECONTEMPLATION STAGE. A person may be partly or completely unaware that a problem even exists. Therefore, at this point the idea of change is not seriously considered.
•Stage 2: CONTEMPLATIVE STAGE. The individual becomes aware that a problem exists. Therefore, he or she contemplates the need for change, weighing the risks and benefits, but taking no active steps.
•Stage 3: DETERMINATION STAGE. The person's commitment is strengthened. The individual gets ready to make a change and plans a mode of action, but takes no action.
•Stage 4: ACTION STAGE. The individual chooses a strategy for change and begins to pursue it, modifying his or her habits and environment.
•Stage 5: MAINTENANCE STAGE. The person makes efforts to sustain the change achieved in the action stage. He or she learns how to detect and guard against dangerous situations that may cause a relapse and a return to problematic behaviors.
Back to Jacky...
The Pre-contemplation, Contemplation and Determination Stages
What motivates a person more? Running away from or going towards? Dodging a bullet or pursuing a dream? How about a little of both?
As a toddler, Jackie was usually satisfied after eating small amounts of food, unless it was candy, chocolate and such. Her dad, aiming for good, warned her of the dire consequences of not maintaining a nutritious diet; for example, she would never grow taller than a five-year-old. Jacky believed her dad, the principal authority in her life.
Inducing fear or criticism as an external motivator gets more quick results than promising the fulfillment of dream (which, in reality, may or may not come true). However, this is a damned-if-you-do damned-if-you-don't situation all around.
A fearful child either complies to avoid harm or, if he doesn't, is burdened with guilt and self-recrimination. Therefore, whatever action the child ends up taking is not connected to the most pivotal elements of behavior, or in this case, weight management success: his inner feelings of hunger and satiety and his likes and dislikes. Skipping Change Stages 1 to 3 produces no real internal motivation and therefore compromises Stages 4 and 5. Subsequently, a spinning wheel of dieting failures results in increased weight gain.
According Prochaska and Diclemente (1982), if a change is to be induced, it is the parent's, educator's and/or therapist's role to help the child move consecutively through all the stages of change. He must support the child by raising his awareness of the need for and benefits of change and by alerting him or her of the implications of continuing his current unhealthy behavior.
How is this achieved? By taking the following steps:
•setting up a daily schedule; providing nutritious, appealing mealtime options; and being a positive role model
•encouraging the child to express his or her feelings, concerns and beliefs
•helping the child develop a plan for change
•teaching the child new skills
•raising the child's self-confidence by acknowledging his or her success and providing opportunities to be independent.
It seems that Jacky's dad had, albeit unintentionally, left her to go through Stages 3 to 5 on her own. He could have relayed to her the importance of balanced nutrition, which results in growth and health, while discussing ways to achieve it, rather than menacing her with artificial fears. Would Jacky be coming to my clinic today if her dad had given her that knowledge?
Burdening Dad with the guilt of his daughter's adult weight management issues may seem extreme. But this is my point: Why not start by educating the caregivers? After all, having and imparting the knowledge of how to maintain healthy eating is part of their job description.
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