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Nutrition psychology: stages of change

As a fitness professional it is important you consider the relationship between nutrition and psychology. Various aspects of client behaviour will impact on the compliance and ultimate success of dietary guidance.

Stages of change

A client’s personal dietary intake can be a topic of guilt and embarrassment for some, this is particularly prevalent in those that feel they may be over eating or suffer with emotional eating or binge eating. Therefore, communicating with clients about their habitual nutrition is something that has to been done with empathy, respect and patience.

It is important to understand the theory of behaviour change when assessing whether a client is ready to make healthier dietary choices (DiClemente 1992) (Blackman 2011).

Depending on which stage of change the client is at will depend on the course of action taken to support them to get to the next stage of change and improve the quality of the diet long term.

To demonstrate this, a new client who is overweight and had visited his GP four weeks prior to starting exercise training will be used as an example. His GP advised him to reduce the sugar in his diet or he will be at risk of insulin resistance and diabetes.

If this client at the “pre-contemplation phase” he may not have even considered implementing this advice. To support the client, it would be important to increase their self-efficacy, their belief in their own ability to complete tasks. This could be done by swapping to a natural based sweetener and creating more nutritious, less energy dense versions of their favourite sweet foods. This makes reducing sugar intake seem more realistic. A pros and cons list of removing sweet foods from the daily diet would also benefit this client.

A client at the contemplation phase will have formed an intention to remove sugar from the daily diet but not performed any attempts to do so yet. They will be aware that something needs to change but may not know how to do it. Education regarding what foods sugar is in would be a good starting point with clients at this phase, as well as coming up with alternatives to their current food choices such as swapping table sugar to stevia, chocolate spread to a natural nut butter and cola to soda water with lime.

If the client is in the preparation phase of change they have a positive intention and have already made some attempt to remove sugar from their diet. They may already have swapped sugar for sweetener in their tea or opting to avoid dessert when going out for dinner. It is important at this stage for you to encourage the client and discuss more ways which can make reducing sugar from the diet habitual. This could involve providing information on simple homemade sauce and soup recipes instead of buying pre-made ones which are often laden with sugar.

When a client is in the action phase of change they will be consistently making sensible choices and have adequate knowledge of sugar swaps. At this stage however there is still potential for a client to relapse and old habits may start to occur again. This may happen as a result of a different environment such as a holiday or an emotional experience such as an ill family member or birthday celebrations. To encourage the client to continue their behaviour change it is vital to discuss particular circumstances that may prevent them from maintaining their healthy lifestyle, and coming up with ways to overcome them before they happen. For example, if their birthday is coming up, a piece of cake is part of a balanced lifestyle but they could request their friends not to buy them chocolates.

Reaching the maintenance stage of behaviour change is the goal, at this stage the client would have removed the majority of sugar from their diet for at least six months and opts for healthy options habitually. If the client reaches this stage, a relapse to regular sugar consumption is greatly reduced.

It is important to remember to reinforce the client when they are making progress, even if it is only a small amount. For some people simple changes such as having two instead of four biscuits a day is a big achievement. So by reinforcing that will support them reaching their goals and encourage long term behaviour change.

It is likely that during behaviour change the client will ask you your own personal dietary techniques to reduce sugar, or whichever behaviour change they are trying to make. As a role model to the client it is vital that you can present personal examples of how you successfully manage to have limited sugar in the diet. This will not only increase trust between the client and yourself, but also by the client observing desired outcomes in the observed behaviour, they are more likely to model, imitate and adopt that behaviour; this is the social learning theory. For example, if their trainer does not eat sugar and is not overweight they are more likely to be inclined to replicate this behaviour.

If you are interested in further developing your coaching skills, please get in touch for upcoming CDP events.

Rachel x