Behavior Strategies in Diet Control The Challenge and the Cure

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Behavior Strategies in Diet Control The
Challenge and the Cure
Dr Abeer Al Saweer
Consultant Family Physician, Diabetologist Kingdom
of Bahrain
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Learning Objectives

• To appreciate the importance of lifestyle
  modification in the control of the diabetes
  epidemic.
• To overview the different modalities of behavior
  therapy.
• To understand the role of behavior therapy in
  diet control and thus in diabetes control.

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Introduction

• Diabetes Mellitus is one of the most
  psychologically and behaviorally demanding of the
  chronic medical illnesses.
• Cox and Gonder-Frederick,1992

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Introduction

• Research about diabetes has changed from
  imparting knowledge about the cause and treatment
  to diabetes self-management.
• (Clement 1995)

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What are Behavioral Strategies?

• Strategies, based on behavioral change theories
  which provide patients/clients with tools for
  overcoming barriers to compliance with dietary or
  exercise therapy.

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Do Behavior Strategies work?

• Evidence Statement (A)
• No one behavior therapy appeared superior to any
  other in its effect on weight loss rather,
  multimodal strategies appeared to work best and
  those interventions with the greatest intensity
  appeared to be associated with the greatest
  weight loss.

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Do Behavior Strategies work?

• Strongly Evident (B)
• Programs that combine diet, exercise, and
  behavior modification have been shown to be most
  effective over the short term.
• The NIH Guidelines reported that behavior
  strategies in diet and physical activity produced
  wt losses of approximately 10 in 4-12 months.
• 0

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Common Theories Relevant to Understanding Human
Behavior

• Educational and Behavioral.
• Health Belief Model.
• Theory of Planned Behavior.
• The Wheel of Change.
• Conflict Theory.
• Cognitive Dissonance Theory.
• Operant Learning.

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History of Behavioral Therapy

• First applied in the late 1960's and early
  1970's.
• Initial programs were 10-weeks in length.
  Produced weight losses 4.5 kg.

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History of Behavioral Therapy
Parameters 1970s 1980s 1990s
Length of treatment (wks) 10 14 27
Wt Loss (kg) 4.0 7.6 9.7
Length of F/U (wks) 22 53 64
Loss at F/U (kg) 4.0 4.8 5.6
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Theoretical origin of Behavior approach

• Eating and exercise behaviors are related to body
  weight.
• Behavior can be changed by environmental cues
  before or after the behavior.

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Components of Behavior strategies

• Assess Behavior.
• Change contributors.
• Change consequences/Reinforcers.

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Common Components of Behavioral therapy in diet
Control

• Set realistic goals.
• Self-monitoring.
• Cognitive restructuring and Problem Solving.
• Stimulus control.
• Social support.
• Relapse prevention.

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Self-monitoring

• Involves the systematic observation and recording
  of target behaviors.
• Daily food and physical activity (PA) records for
  the first two weeks.
• After which to complete food records at least two
  days per week and one weekend, continue to
  record the frequency and duration of exercise.

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Stimulus control

• A process which involves identifying and
  modifying environmental cues that are associated
  with overeating and inactivity (Changing
  antecedents and consequences or reinforcers).

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Stimulus control

• Stress management techniques.
• Environmental changes to control cue eating and
  PA habits.

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Cognitive Restructuring

• Involves identifying and modifying maladaptive
  thoughts and advising more positive
  self-statements to assist in behavior change.

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Social Support

• Studies show that persons with higher levels of
  social support tend to be more successful at
  achieving and maintaining weight loss.

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What current strategies look like?
Conducted in groups of 15 individuals.
Two co-therapists.
Weekly treatment meetings for 6 months and
biweekly or monthly meetings for the remainder of
the year to two years.
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What current strategies look like?

• Continued contact is an important component of
  the maintenance program.
• Recently there have been efforts to deliver
  behavioral treatment programs via television or
  the Internet.

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What do strategies contain?

• Standardized.
• Group sessions include a private weigh-in, review
  of self-monitoring records, and presentation of
  the week lesson.
• Assignments are given and reviewed next week.

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Dietary prescriptions in behavioral programs

• Energy Intake.
• Macronutrient intake.
• Food provision and structured meal plans.

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Support for Healthy Eating

• Ongoing support for long term behavior change.
• One approach is to continue treatment contact
  over longer period.
• Another approach is to involve
• the spouse.
• Another one is to involve friends.
• Incentives.

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Tailoring Treatment to Individual subgroups

• Ethnicity.
• Binge eating Disorders.
• Media-based interventions for wt loss.

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Preventing Weight Gain

• Wt gain prevention in young adults.
• Wt gain prevention at time of pregnancy.
• Wt gain prevention at menopause.

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Performance Objectives

• Behavioral approaches are used to help patients
  make long-term changes in their eating.
• Behavioral approaches stress monitoring of
  dietary intake and modifying the cues and
  reinforcers in the environment.
• Better results have been achieved with longer
  periods of treatment contact and more structured
  approaches.