1. 2.1 BEHAVIOUR MODIFICATION CAN IMPROVE NUTRITIONAL OUTCOMES Behaviour Modification to Improve Nutritional Outcomes

2. Behaviour Modification Changing lifelong behaviours is difficult to achieve. This applies to food choices, the quantities eaten or exercise habits. People need incentives to change

3. Incentives to Change Food Habits Physical Health  When diagnosed with a medical condition, many people change their diet and exercise routines.  By doing this they may reverse their conditions and increase their quality of life. Pregnancy and Lactation  Women often change their dietary habits when they find out they are pregnant  Preferable to make changes before conception so the foetus receives increased nutrients

4. Incentives to Change Food Habits Personal appearance  The desire to have a different body shape/figure Athletic prowess  To improve athletic performance, athletes are encouraged to maintain a very healthy diet Famine  Whole communities may have to change their food habits and patterns  Donated food may be from a different culture and unfamiliar

5. Incentives to Change Food Habits Inadequate nutrition  At different stages in the lifecycle people have additional nutritional requirements. For example, in adolescents.  At times of prolonged illness changes in diet may be required to provide the nutrients necessary for the body to heal New Technology in food preparation  Generates change in food habits; food becomes quicker to consume and easier to prepare  Increased availability of pre-packaged and instant foods as well as takeaway

6. Barriers to Changing Food Habits Food habits are learned over a long period of time and are regularly repeated and so they are very hard to change. Common barriers include:  Food likes and dislikes  Food associations  Availability of money  Peer group or family pressure  Boredom  Nutritional knowledge  Ability to cook  Limited time for shopping and food preparation  Interest in food  Short or long term physical conditions

7. Health Behaviour Models (HBM) There are a variety of health behaviour models in current use throughout developed countries to assist people to modify their diet and exercise habits. These recognise that to change behaviour people go through a series of stages. One HBM is the Stages of Change.

9. Stages of Change Pre-contemplation Stage  During this stage, people do not even consider changing.  Obese people may have tried unsuccessfully so many times to lose weight that they have simply given up. (Zimmerman, G. Olsen, C. Bosworth, M. 2000) Contemplation Stage  During this stage, people are ambivalent about changing.  Giving up an enjoyed behaviour causes them to feel a sense of loss despite the perceived gain.  During this stage, people assess barriers (e.g., time, expense, hassle, fear, "I know I need to, but...") as well as the benefits of change. (Zimmerman, G. Olsen, C. Bosworth, M. 2000)

10. Stages of Change Preparation Stage  During this stage, people prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, sampling low-fat foods. (Zimmerman, G. Olsen, C. Bosworth, M. 2000) Action Stage  The changes are made during this stage but evidence shows if the prior stages have been glossed over, action itself is often not enough.  Any action taken should be praised because it demonstrates the desire for lifestyle change. (Zimmerman, G. Olsen, C. Bosworth, M. 2000)

11. Stages of Change Maintenance and Relapse Prevention  Maintenance and relapse prevention involve incorporating the new behaviour "over the long haul."  Discouragement over occasional "slips" may halt the change process and result in the person giving up.  Most people find themselves "recycling" through the stages of change several times before the change becomes truly established. (Zimmerman, G. Olsen, C. Bosworth, M. 2000)

12. Summary (Zimmerman, G. Olsen, C. Bosworth, M. 2000)