2. U.S. Public Health Service “Fit for Duty, Fit for Life” Weight Management Program: Session 5

3. Review of last session Importance of carefully monitoring portion sizes. Reading food labels with attention to portion size. Hints for eating out.

4. Review of assignments 1. Continue keeping food and activity records.  Focus on recording portions.  Measure foods and drinks whenever possible. Were your portion sizes reasonable? 2. Practice reading food labels and determining calories in your usual portion. Any surprises? 3. Practice making special requests when eating out. What special requests did you make?

5. Topics for today Behavioral change – What is it? – What techniques may work for you? Keeping on track – To continue losing weight – To keep from re-gaining weight lost These sessions are not meant to substitute for individual recommendations from your personal health care provider(s).

6. The ABCs of Behavioral Change Definition: Principles and techniques used to modify eating and activity behaviors A- Antecedents - occur before a behavior B- Behaviors – occur during eating (or exercising) C- Consequences – occur after the behavior

7. Antecedents Occur before a behavior – Situations, places – Events, activities – Feelings, emotions – Thoughts … home alone … favorite TV show on … depressed, lonely … “I deserve a treat”

8. Behavior The conduct itself and Any related events, situations, thoughts, and feelings occurring during the behavior

9. Behaviors: Examples Eating Behavior: Eating brownies Related: Taste of food, speed of eating, rate of chewing, level of enjoyment Physical activity Behavior: Taking a walk Related: Intensity, duration, pain or exhilaration Inactivity Behavior: Watching television Related: Duration, feelings

10. Consequences Occur after a behavior – Thoughts – Feelings – Events – Situations …guilty …failure …eat more brownies (behavior) …keep watching TV instead of taking a walk (behavior)

11. The behavioral chain of events Antecedents → Behaviors → Consequences → Behaviors

12. Using behavioral change techniques To gain control of antecedents Control your environment (situation and events). – Be aware of your “triggers” or “cues.” – Avoid situations that tempt you to overeat. – Keep tempting foods out of the house. – Keep your exercise clothing handy; plan for rainy days. Control your thoughts and feelings. – Think positive. – Believe in yourself.

13. Using behavioral change techniques To gain control of behaviors Track your behaviors. – Keep diet and activity records. – Pay attention to who, what, where, when, and why. Set effective goals that are: – Specific and measurable – Realistic – Forgiving (less than perfect)

14. Using behavioral change techniques Behaviors (continued) Eat mindfully – Eat slowly and savor each mouthful. – Be aware of all senses: taste, smell, texture… – Avoid other activities while eating (TV, etc) Exercise purposefully – Be aware and enjoy your surroundings. – Focus on benefits and pleasures.

15. Using behavioral change techniques Thinking through the consequences Reward and praise yourself. “I made a good choice, and I feel good about it!” Learn from your experiences. “I made a poor choice; how can I do better next time?”

16. Classic elements of behavioral change Self-monitoring Keeping food and activity records Stimulus control Controlling triggers and cues Problem-solving How can I handle this situation better? Cognitive restructuring Changing your thinking

17. Applying classic elements of behavioral change Problem: over-snacking in the evening Self-monitoring Keep a log of food intake and activities in the evenings. Look for patterns. Stimulus control When watching TV and drinking beer, you crave salty snacks.

18. Applying classic elements of behavioral change: over-snacking Problem-solving What are my options? Don’t watch TV, don’t drink beer, limit pretzels to a 1-ounce portion, don’t buy pretzels, buy fruit instead Cognitive restructuring What am I willing to change? What can I live without? Can I find another evening activity? Can I drink a beverage that I don't associate with salty foods?

19. Applying behavioral change techniques Think of a recent situation when you ate too much….  Pastries and donuts at work  A retirement celebration  A cocktail party  All-you-can-eat buffet

20. Applying behavioral change techniques Can you identify antecedents, the behavior itself, and the consequences? How could you have broken a link in the behavioral chain to prevent overeating? What did you learn from this episode that can help you handle a situation like this in the future?

21. Let’s look at your progress 1. Are you pleased with your progress so far? 2. Are you successfully losing weight? Are you satisfied with your rate of weight loss? 3. Are you making lifestyle changes that will help you keep off the weight you are losing? If “no” to any of these 3 questions -- Why not?

22. To stay on track… Keep the right foods available. Keep the problem foods out-of-sight. Avoid places and situations that may be problematic. Be actively involved with shopping, planning, and cooking meals. Watch portions. Measure foods. Don’t use food as a reward, or withhold it as punishment.

23. To stay on track… Continue to keep food and activity records, focusing on behaviors you are working on Think positive: “I can do this!” (self-efficacy) Plan ahead. – How will you handle an upcoming holiday or vacation? Plan to occasionally treat yourself to a moderate portion of favorite food. Keep physical activity a priority.

24. Be aware of your “screen time” Screen time = inactive time Television Videos/DVDs Computer Computer games Handheld electronic devices How many hours each day are you spending doing these activities? How can you reduce this “inactive” time?

25. Reality check At this time, what is your primary focus? Losing weight ? or Maintaining your current weight ?

26. Focusing on keeping it off? “National Weight Control Registry” Tracks individuals who have lost ≥ 30 pounds and kept it off for at least 1 year http://www.nwcr.ws/ These successful weight-maintainers report… Eating a low fat diet Watching calories Eating breakfast Weighing often, maybe even daily Exercising 60 to 90 minutes daily

27. When you get off track Don’t let lapses lead to relapse… or collapse! Expect “slips”…but get back on course. Don’t set unrealistic expectations for yourself. Never use the terms “cheating” or “failure” Expect to not be perfect. Learn from your experiences.

28. Summary of today’s session Behavioral change – The ABCs (Antecedents, Behavior, Consequences) – Using techniques to stay in control Keeping on track – To continue losing weight – To keep from re-gaining weight

29. Assignments for the coming week 1. Continue to keep food and activity records -- - Add a column for thoughts and feelings. - Monitor your screen time. 2. Look at antecedents and consequences related to your eating and activity behaviors. 3. Set 1 or 2 behavioral goals to address these issues.