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Behavior Change: The Missing Ingredient in Disease Prevention Programs

In 2009, The World Health Organization announced that 63% of all annual deaths are due to noncommunicable diseases1. We often refer to noncommunicable diseases (NCD’s) as “chronic” diseases. They are non-infectious conditions that progress slowly, last a long time and include disorders of the heart and lungs, cancers and diabetes. In 2009, the WHO also declared most NCD’s are preventable via four lifestyle changes – improved diet, increased activity, reduced use of alcohol and reduced use of tobacco1.

Poor diet and inactivity were also listed as the major contributors to obesity –  a condition which itself increases the risk of almost every NCD and grossly affects health care costs. In 2014 the U.S. alone spent a predicted $305.1 billion on medical costs3 resulting from obesity and suggested more than half of U.S. adults are overweight or obese2.

With all the evidence clearly demonstrating high cost of disease, reduced quality and quantity of life and a clear link between lifestyle choices and disease occurrence, it is no wonder health related programs have hit the roof.

Over the past several decades we have been bombarded with schizophrenic commercial diet plans addressing eating, gyms and fitness studios targeting activity, ‘wellness’ programs focusing on one size fits all diet and exercise and even disease prevention programs taking it one step further addressing all four areas listed by the WHO.

However, despite our efforts and an awful lot of money being spent by employers and individuals; obesity, type 2 diabetes, most cancers, stroke and heart disease –continue to surge.

What are we doing wrong?

Behavior Change: The Missing Ingredient

We all know that change can be difficult. Take weight loss. Most people have an understanding that to lose weight, behavior modification in the areas of diet and activity are essential. However, how many people and programs address this properly?

Weight loss efforts normally look like this: a diet which severely restricts calories, hanging on as long as you can, seeing some results, a return to regular eating habits (because the caloric restriction was unrealistic), and eventually a return of weight.

If any health goal is to be successful, what needs to be implemented is a solid understanding that while weight loss–in this case–is the ultimate goal or desired outcome, the true goal(s) involves the behavior change associated with the cause of the weight such as dietary habits, activity levels and behavioral issues. When these underlying behaviors are addressed, successful sustainable weight loss will occur.

Some programs do recognize the importance of behavior change, however most still fall short in its implementation.

Assessing Readiness To Change

In the late 70’s, psychologist James Prochaska began exploring the elements required to successfully change a behavior. In addition to recognizing the importance of exploring barriers to change and having the resources, knowledge and support to change, Prochaska conceived the Transtheoretical Model (TTM).

The TTM describes 5 stages individuals progress through to successfully modify a behavior. Within each stage, different tools and strategies exist to assist the progression, making it critical to identify which stage an individual is in – because the approach will be different. TTM recognizes change as a process, not an event, and accepts that most individuals do not move through the steps in a linear fashion. Relapse is common and therefore understanding what might trigger a relapse is an important part of this process.

Again, using weight loss as an example, a good disease prevention program first and foremost would identify the behavior changes required to reach the desired outcome. In this case, let’s say, increasing activity levels. The TTM then recognizes that not every individual is in the “action” phase – the phase where exercise is actually taking place and measurable changes exist. Instead it recognizes that some individuals may be in more of a preparation stage – one which involves exploring exercise programs, finding a good coach, buying a pair of running shoes or finding a buddy to walk with in the future. In this case, by identifying which stage an individual is in – their “readiness”- , the appropriate coaching, language, motivation and tools can be used to push the individual along the path.

When the individual is supported along their path, appropriate guidance can be given so that the individual eventually makes activity part of their lifestyle – a true behavior change, not simply a 2 week all or nothing attempt.

In 2009, the WHO estimated 1.9 million deaths were attributable to physical inactivity indicating greater than 60% of adults do not meet daily requirements. During this same year the WHO estimated 2.7 million deaths were attributable to diets low in fruits and vegetables1.

In fact eating a healthy diet, increasing physical activity and avoiding tobacco use can prevent 80% of premature heart disease and stroke, 80% of type 2 diabetes, and 40% of cancers1.

When disease prevention programs focus their efforts on these behaviors, not necessarily the disease or desired outcome, and provide immediate evidence-based tools and strategies to match “Readiness”, only then can goals be reached successfully.

Newtopia is a disease prevention program which recognizes the importance of behavior change and implements tools and strategies to best match clients with their personal readiness. Learn more by subscribing to our blog.

References

  1. http://www.who.int/features/factfiles/noncommunicable_diseases/en/
  2. http://www.cdc.gov/media/pressrel/2009/r090727.htm
  3. http://www.thefiscaltimes.com/2016/02/12/US-Obesity-Rate-Hit-Record-High-2015

 

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