Page 155 - Nutrition Counseling and Education Skills: A Guide for Professionals

2. Put the fork down between mouthfuls.
3. Chew thoroughly before swallowing.
4. Take a break during the meal. Stop eating completely for a short period.
B. Leave some food on the plate.
C. Make eating of inappropriate foods as difficult as possible.
D. Control snacks.
1. Save allowable foods from meals for snacks.
2. Establish behaviors incompatible with eating.
3. Prepare snacks the way one prepares meals—on a plate.
4. Keep on hand a quantity of low-calorie foods such as raw vegetables; have them ready to eat

and easy to get.
E. Instruct the person that when eating, he or she should not be performing any other act. The cues

associated with eating should be restricted to that act, so the person should not eat while reading,
sewing, watching television, and so on.
F. Have the person continue self-monitoring.
V. Change Exercise Behavior
A. Routine activity
1. Increase routine activity.
2. Increase use of stairs.
3. Keep records of distance walked daily.
B. Exercise
1. Begin a supervised exercise program under a specialist’s direction.
2. Keep records of daily exercise.
3. Increase exercise gradually.
VI. Set Up a Reward-and-Reinforcement System
A. Have family and friends provide this help in the form of praise and material rewards.
B. Clearly define behaviors to be reinforced.
C. Use self-monitoring records as a basis for rewards.
D. Plan specific rewards for specific behaviors. Use written contracts.
E. Gradually make rewards more difficult to earn.
F. Use creative reinforcers, such as dropping quarters in a bank, putting money away for each goal
reached and earmarked for something desirable. Take money back as a punishment if the goal is
not reached.

Box 7-1 ■ Techniques for Behavior Modification

Source: From Farmer RF, Chapman AL, American Psychological Association. Behavioral Interventions in Cognitive Behavior Therapy: Practical
Guidance for Putting Theory into Action. 2nd ed. Washington, DC: American Psychological Association; 2016; Wadden T, Butryn M, Hong P, et al.
Behavioral treatment of obesity in patients encountered in primary care settings. JAMA. 2013;1217:1779–1791; and Lin JS, O’Connor E, Whitlock EP,
et al. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S.
Preventive Services Task Force. Ann Intern Med. 2010;153:736–750.

In some instances, responses occur in chains in which each response produces the stimulus for the next

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