behavior strategies in diet control the challenge and the cure dr abeer al saweer consultant family...
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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
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.
Introduction
Diabetes Mellitus is “one of the most psychologically and behaviorally demanding of the chronic medical illnesses”.
Cox and Gonder-Frederick,1992
Introduction
Research about diabetes has
changed from imparting
knowledge about the cause and
treatment to diabetes self-
management.”
(Clement 1995)
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.
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.
Do Behavior Strategies work?
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.
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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.
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.
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
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.
Components of Behavior strategies
Assess Behavior.
Change contributors.
Change consequences/Reinforcers.
Common Components of Behavioral therapy in diet Control
Set realistic goals.
Self-monitoring.
Cognitive restructuring and Problem Solving.
Stimulus control.
Social support.
Relapse prevention.
Self-monitoringInvolves 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.
Stimulus control
A process which involves identifying
and modifying environmental cues
that are associated with overeating
and inactivity (Changing antecedents
and consequences or reinforcers).
Stimulus control
Stress management techniques.
Environmental changes to
control cue eating and PA
habits.
Cognitive Restructuring
Involves identifying and
modifying maladaptive
thoughts and advising more
positive self-statements to
assist in behavior change.
Social Support
Studies show that persons
with higher levels of social
support tend to be more
successful at achieving and
maintaining weight loss.
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.
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.
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.
Dietary prescriptions in behavioral
programs Energy Intake.
Macronutrient intake.
Food provision and structured meal plans.
Support for Healthy EatingOngoing 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.
Tailoring Treatment to Individual subgroups
Ethnicity.
Binge eating Disorders.
Media-based interventions for wt loss.
Preventing Weight Gain
Wt gain prevention in young adults.
Wt gain prevention at time of pregnancy.
Wt gain prevention at menopause.
Performance ObjectivesBehavioral 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.
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