Page 191 - Nutrition Counseling and Education Skills: A Guide for Professionals

successful performance and modeling of positive self-statements are recommended, such as “I can handle it.25
Training in mindfulness meditation and guided mindfulness practices may enhance making conscious food

choices and developing awareness of eating cues.33 If confronted with an urge to binge, clients are taught to
imagine their urge as an ocean wave that grows, builds to a crest, and gradually subsides. Not acting on the
urge strengthens SE. Wansick believes that the answer to mindless eating is not to eat mindfully, but to set up
our environments to control external cues so that we mindlessly eat less.34

As an antidote to stress, relaxation training; positive self-talk; meditation; exercise instead of eating;
visualization of relaxing, pleasant scenes or of carrying out coping behaviors when tempted; and stress
management procedures may be needed.29 In visualization, clients are asked to close their eyes and think of a
stressful or tempting situation. The counselor can ask questions that create a visual picture of the situation and
the accompanying emotions. If imagining a party, for example, the counselor may ask: “What do the
surroundings look like?” “What are you doing?” “What are other people doing?” “Where are the foods and
beverages?” “What will you choose?” “Who can you turn to for support?” “What will you say?” “How do you
feel?”

Relapse rates for clients with obesity are high. Patients can make written plans for lapses and relapses,
identifying early warning signs of a slip, and strategies to stay on track. Adopting a problem-solving
orientation to stressful situations or modeling problem solving by thinking out loud with clients is helpful.
The counselor and client can review the events and emotions in past lapses and relapses since patterns may
repeat themselves. When lapses are discussed, it is preferable to discuss how the individual might have
succeeded in preference to focusing on the failures.35

Models and Theories of Change

In Chapter 5, Procheska noted that people recycle through the Stages of Change as people do not maintain
gains the first time. He changed his Transtheoretical model from a linear to a spiral pattern.30 In the model,
recycling to a previous stage is expected as people go through the six stages of precontemplation,
contemplation, preparation, action, maintenance, and termination. RP strategies are important, especially in
the action and maintenance stages. Patients with eating issues and challenges can be expected to progress
through all stages with frequent backsliding.

People in the action stage will encounter high-risk situations, stresses, and temptations that tax coping
efforts. They may slip or lapse in one situation and resist in another. The majority are not successful at the
first attempt at change. Relapse commences with recycling to an earlier stage and can be viewed as a learning
opportunity. Just as Rome was not built in a day, neither is successful dietary change accomplished in a short
period of time.

Clients need to learn self-monitoring and self-management skills to cope with the normal urge to lapse into
old habits. They should be more successful when they keep in contact with a counselor, at least by phone, for
a year or more. The model of life-long treatment is used by several groups, such as Alcoholics Anonymous,
Overeaters Anonymous, and the lifetime membership offered in Weight Watchers.

One would hope that our models and theories of health behavior change would explain and predict change.
Social cognitive theories, the Health Behavior Model, the Transtheoretical Model, and other theories have

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