Behavior Change – if it was easy it wouldn’t be change

If it looks too good to be true, it probably is…

In many diet and exercise sales ploys, there are before and after shots. This one person is showing f sexy six-pack or loss of half their body weight. They look great.All you can see is their before and after. Yes, they probably did what the site is selling you. What you don’t know is what other things were in their favor at that particular time. It is likely that there were a lot of other good things happening to them that made their success more likely.The other thing we don’t see is their progress between the before and after. Progress could have been full of plateaus, lapses and times where they got stuck. For whatever reason they found the support offered by the organization good for them. The people selling the product kept them going through their tough times

To be successful making change you need several things:

  • Identify goals that are targeted to your needs.
  • Information on how to make the appropriate changes to achieve those goals.
  • Resources, tips, and tricks to help you develop plans to embed the changes in your daily life.
  • Support for when things don’t go as planned – for example when daily life takes a surprising detour.
  • Time to establish the new routines.
  • Monitoring to measure your outcome.
  • A cheer squad to help you celebrate your success.

This blog series is going to go into some details about the how, why and what around behavior change. My experience as a dietitian has taught me some interesting things about change. If you have a different experience or other ideas please post a comment. We can chat about them – I love learning from others.

6 ways to increase your activity levels to improve heart health

Inactivity is the modern smoking. Although I doubt we will have a smoke free New Zealand by 2025, we have made huge reductions in smoking rates. This has happened through changes to workplaces and public spaces to discourage tobacco use. At the same time, with increased mechanization and computerization we have become less active. We are now seeing the serious health consequences of physical inactivity.

Inactivity a problem from cradle to grave

Occasionally I see people for advice on their children’s health. Recently I saw a family with a child who was very overweight at 18 months.  I referred them on for specialist advice because of other matters but one thing struck me. No one in that family had time for the wee fella to spend tummy time and tottering time. Both parents worked, he was in day-care. He had no regular times where he got encouragement to move his little body.  Everyone was on such a tight schedule.

As a stepmother and a dietitian, I have to tread a fine line around my step kids (skids!) in relation to their eating and activity. The younger one has never heard my rant about her not doing physical activity at school. Why? She  because she “didn’t want to do it.”  I loathed and detested PE.  Even now I get anxious about sport, despite having found a wonderful fitness specialist who has helped me overcome my physical limitations. I even enjoy playing lawn bowls…something I wish had been on the PE curriculum.

At the other end of life, people remark I have amazing parents. They both are  active well into their 80s. They both know that they are either going to use it or lose it and remain active despite aches and pains.

Modern life is pushing us to inactivity. We need to think how to push back.

So what are the activity guidelines.

These changed in 2015 and reflect modern research physical activity.

  • Sit less, move more! Break up long periods of sitting.
  • Do at least 2 ½ hours of moderate or 1 ¼ hours of vigorous physical activity spread throughout the week.
  • For extra health benefits, aim for 5 hours of moderate or 2 ½ hours of vigorous physical activity spread throughout the week.
  • Do muscle strengthening activities on at least 2 days each week.
  • Doing some physical activity is better than doing none.

Terminology Explained

Moderate activity means moving so you have an elevated heart rate. You feel warm but you can speak in sentences. As you get fitter your capacity to exercise moderately will increase.  You will need to increase either the intensity or duration to get the same benefits.

Vigorous activity means activity with a heart rate close to your maximum capacity. You will feel hot and be unable to talk in sentences.

Muscle strengthening means using your body to resist gravity. It includes things like carrying items and lifting things. The most obvious non-strength building activity is cycling.

2 ½ hours represents 30 minutes 5x per week. You can do this in one or two bursts of activity each week. If you do it will have less cardiovascular health benefit.

5 hours represents 60 minutes 5x per week.  This is the guideline for children and young people. This means we need to encourage movement at home as well as at school. Play can be active.

Reducing inactivity means trying to avoid sitting for more than 25 minutes in each half hour. Aim to get up and move  for 5 minutes.

Many people, because of pain, physical disability or lack of fitness will not even try.  For them trying is important = doing some is better than none.

So how do we start being active more often.

My top hints

  1. If you use a computer for work or leisure use a pomodoro timer
  2. Look at active transport to work – 10 minutes twice a day of walking to and from the bus will add up
  3. Have a ½ hour screen free time after dinner for everyone to do something active, even if it is the housework!
  4. Find some activity you can tolerate, if not love to do. I tolerate going to the gym. I love playing lawn bowls. And it doesn’t have to have a cost – walking, dancing to music, playing with the kids are all free.
  5. Try to avoid short trips by car. If a trip is less than 10 minutes by car it is walkable.
  6. If you have pain or a health concern reducing your activity speak to your GP to find out what is best for you. Most joint pain will improve with physical activity.

Physical activity the cardiovascular benefits

Blood pressure: regular physical activity reduces blood pressure and strengthens the heart’s pumping mechanism.

Cholesterol: Activity meeting the guidelines will reduce LDL cholesterol and increase HDL cholesterol

Blood glucose: Physical activity reduces insulin resistance and lowers blood glucose

Stress reduction: Physical activity reduces psychological stress and distress.

Workplaces can have policy to help people maintain physical activity. The most important thing a workplace can do is recognise the importance of reducing inactivity and make it possible for people to get up and move. Even if jobs are active you can reduce the risk of injury by activity rotation and having regular breaks for movement .

What 7 steps help reduce both diabetes and heart disease?

Diabetes and Heart Disease are intimately linked. During Heart Month (February 2019) I will be posting regularly how individuals and employers can tackle these diseases together.

People with Type 2 diabetes (T2DM) have 2-4 times the risk heart attack or a stroke than people who don’t. Making lifestyle change to either preventT2DM, reverse it or manage it better reduces this risk.  Managing risk needs to happen in all parts of people’s lives. As an employer if you want a healthier workforce, invest in advice and education to support your staff.

The American Heart Association has defined a list called Life’s simple 7. These changes manage heart disease risk and diabetes. They are core to the messages taught in group, online and individual education sessions by Helen Gibbs Dietitian Ltd

1.            If you smoke, stop.

How can you help those who still smoke? Many smokers fear weight gain.  Getting information on the relative risk of weight vs. smoking is important. Receiving education on how to minimize this gain helps.  

2.            Eat better.

My education sessions promote dietary improvement. Diet improvement can improve health independent of weight loss. Recent research has demonstrated the importance of a high fibre diet, part of ‘nutrient dense eating.’. In my courses and 1:1 sessions I focus on “nutrient dense eating”. This style of eating improves health and reduces disease risk, regardless of weight change.

3.            Get regular physical activity

I work hard achieve appropriate physical activity levels, so I get it.  I have a lot of empathy for clients and their struggles to be active. This personal experience has informed my learning. I use what I have learned to motivate people to be more active.  Employers may need to think how they can support increased activity in daily living. If people are active there is a benefit to the employer in reduced absenteeism

4.            Lose weight if you are overweight

Unlike some dietitians I am not a proponent of Health At Every Size (HAES) model of care. We have to get rid of the worst parts of dieting culture; but we need to support people to improve their health through body fat reduction. Individual care means addressing the most important aspect of eating for that person. If clients have disordered eating or eating distress, they need support to address this. Many people are too ashamed to discuss their eating distress. Having a compassionate and experienced dietitian accessible to your workforce increases their chance of asking for help.

5.            Keep your blood pressure in the proper range

In group sessions I talk about what to do, and how to do it. This includes the changes needed to reduce blood pressure. The good news is these changes can also improve other aspects of health.  Workplaces with canteens or onsite food supplies may need to match education with better choices. If you are large enough to have these services you are large enough to need a detailed food policy. The impact of alcohol can not be overstated with blood pressure. I provide alcohol harm reduction education as part of lifestyle education.

6.            Keep your blood fats and cholesterol levels in a healthy range.

The media coverage of the possible causes of heart disease has left people confused.  Providing evidence-based advice and practical ‘How to’ education helps your staff make informed choices.

7.            Keep your blood glucose under control.

Elevated blood sugar damages the circulation.  Even if you have a fit and healthy workforce, they damage their health by drinking sugar containing soft drinks and energy drinks. Your business can have policy to support water drinking.  Once people have pre-diabetes or Type 2 diabetes, cutting back sugar is not enough. I work with people so they understand that they need to cut their saturated fat to lower blood glucose levels. Saturated fat acts to increase insulin resistance, making the locks stickier (link to video). Insulin resistance limits the work of circulating insulin.

New Zealand has an aging workforce. We also have increasing rates of diabetes and heart disease. Having unwell staff costs you money. Investing in prevention makes sense. Contact me if you want to know more about the services I offer.

First step: If you have health insurance for your staff see if dietetic services are covered. If they are not ask why.

How do you get 30g fibre in your diet daily?

There has been a lot of media coverage about fibre in the diet. A high fibre diet reduces the risk of heart disease. We know that 90% of people are failing to get enough fibre.  So how do you improve your dietary fibre intake? How do you do it on a low income?

Fibre occurs in plant-based foods. The relevant Eating statements for adult New Zealanders are:

Enjoy a variety of nutritious foods every day including:

  •              plenty of vegetables and fruit
  •              grain foods, mostly whole grain and those naturally high in fibre
  •            some legumes, nuts, seeds, fish and other seafood, eggs, poultry (e.g., chicken) and/or red meat with the fat removed.

Choose and/or prepare foods and drinks:

  •    that are mostly ‘whole’ and less processed

I demonstrate how I would address each eating statement below. In the lists I only show the fibre containing foods. There would be other things added to the meals such as milk, cheese, yogurt, meat and cooking oils etc

Plenty of vegetables and fruit

I used the “what’s fresh” website to select seasonal fruit and vegetables based on the day of writing the blog. Eating seasonally can be a challenge if you have strong likes and dislikes.  It is important to encourage ongoing “tries” of vegetables to encourage a wide variety. Frozen vegetables are acceptable

Item Amount (as eaten) Fibre
Green Beans 80g 2.7
Corn on the cob – 1 medium 90g 2.4
Lettuce 50g 1.0
Tomato – medium 50g 1.7
Cucumber – 4 slices with skin 50g 1.5
Strawberries – 4 large 80g 1.2
Orange – 1 medium 90g 3.1
  TOTAL 13.6g

In this instance I imagined that the salad would go with lunch, and the cooked vegetables would go with dinner.

grain foods, mostly whole grain and those naturally high in fibre

The most common complaint I get is the cost of wholegrain bread. For the purpose of this exercise I am going to use a $1 loaf of bread. This will illustrate cheap bread can still help you meet your fibre intake. I am suggesting you use a sandwich slice and choose the wheatmeal bread

Item Amount (as eaten) Fibre
3 slices wheatmeal bread ($1 range) 94g 4.2g
Oats 45g 5.8g
Pasta (white own brand) 200g (100g dried) 4.0g
  TOTAL 14g

some legumes*, nuts, seeds, fish and other seafood, eggs, poultry (e.g., chicken) and/or red meat with the fat removed.

Item Amount (as eaten) Fibre
Peanut butter 20g 1.2g
Almonds 15g 1.3
Lentils 15g 1.6g
  TOTAL 4.5g
  • 20g peanut butter – see below
  • 30g of almonds consumed every second day
  • If you had two vegetarian meals each week e you would meet this goal. Each meal contains at least 50g (120g cooked) of lentils or other beans. If you are not able to sneak vegetarian past your family use lentils mixed in with your mince.

Choose and/or prepare foods and drinks: that are mostly ‘whole’ and less processed

 One of the biggest ways to improve fibre intake is have snacks that are mostly whole and less processed.

Snacks arranged here are not the usual processed cakes, biscuits and crackers.

  •               1 slice bread with 20g peanut butter daily (afternoon tea)
  •               1 piece of fruit as snacks (supper time)
  •               30g almonds every second day (morning tea)

This is a fairly basic diet.  Not everyone is going to stick to this all the time. Following the 80% rule (make good choices 80% if the time) then you can get a good fibre intake

If you would like to know more about fibre in the diet and have a diet makeover to increase your fibre intake, then make an appointment to see me.