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.
Prochaska, J. O. and Diclemente, C.C. “Transtheoretical
Therapy: Toward a More Integrative Model of Change.” Psychotherapy:
Theory, Research and Practice. 1982; 19(3):276-287.
Golan M. “The PATCH Program,” Parental Agency
Targeting Children's Health. 2008.
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