Health & Weight Modification Test Bank Chapter 11 3e

Chapter 11

Lifestyle Modification to Promote Health and Weight Management

Learning Outcomes

Upon successful completion of this chapter, students should be able to:

1. Distinguish between the six stages of change described in the transtheoretical model.
2. Apply stages of change theory to lifestyle modification strategies for individuals at each stage who need to change their behaviors for health and/or weight management.
3. Summarize the health belief model, theory of planned behavior, and social cognitive theory and apply these theories to stages of change.
4. Discuss strategies for planning for lapses and relapse.
5. Apply the experiences of successful weight suppressors in the National Weight Control Registry to effective weight management strategies for others.
6. Describe ways in which culture influences weight management beliefs and behaviors and how we can help make lifestyle interventions culturally relevant.

Chapter Outline/Summary

1. How people change:

Weight loss can be challenging. Individuals who try surgery, very-low-calorie diets, and pharmaceutical methods find that they need to make lifestyle modifications to achieve success. Lifestyle modifications involve changing behaviors, and the transtheoretical model of change (stages of change theory) can help us design individualized weight-management approaches that promote success and minimize failure.

1. Stages of change theory:

The transtheoretical model describes change as progressing through six stages: precontemplation, contemplation, preparation, action, maintenance, and termination. Identifying a person’s stage of readiness for change and developing an approach that matches readiness can help people progress to at least the next stage and reduces the likelihood that people will drop out of a program or discontinue the new behavior. Not everyone is immediately ready for action.

1. Behavioral strategies for people thinking about change
2. The precontemplation stage:

People in this stage do not intend to change during the next 6 months. They may deny that a problem exists and lack confidence in their ability to change behavior. This is the most common stage for program dropouts.

1. How the health belief model explains early stages of change:

The health belief model proposes that an individual’s health behavior depends on perceived susceptibility to a problem, perceived severity of a health problem, perceived benefits of health action, and perceived barriers to health action. In order to initiate change, precontemplators need to increase the perceived severity of the health problem and the perceived benefits of action.

1. Strategies for precontemplators:

Consciousness-raising (building awareness of the behavior that needs to be changed) is important to help precontemplators appreciate the potential severity of a problem. Because unhealthy foods are so easily accessible in our environment, it can be difficult to help someone perceive eating behaviors as a problem. Conveying a sense of acceptance is very important in this stage.

1. Behavioral strategies for people ready to act
2. Characteristics of the contemplation and preparation stages:

Individuals in the contemplation stage are preparing for change during the next six months. Those in the preparation stage have already made some modification in behavior. Some individuals become stalled in contemplation.

1. How the theory of planned behavior helps explain readiness for change:

This theory states that a person’s intention to perform a specific behavior is the best determinant of whether the person will adopt the behavior. Intent is influenced by general attitudes toward the behavior, belief in the importance of the behavior to others, and perceived control over the behavior. Weight loss is not under an individual’s control in the same way that increasing physical activity and changing eating behaviors are, so these behaviors should be the focus.

1. Strategies for people ready to act:

Preparing for action includes clarifying one’s beliefs and attitudes, developing a support system, and counteracting barriers with benefits that are consistent with the individual’s beliefs.

1. Behavioral strategies for people taking action
2. Characteristics of the action stage:

During the action stage, the individual adopts new behaviors. This stage lasts for about 6 months, beginning the day that the goal behavior is adopted. Some goal behaviors are more difficult to adopt than others, and weight management involves changing multiple behaviors.

1. How social-cognitive theory explains behavior change:

Social cognitive theory states that people adopt new behaviors that they feel confident about performing (self-efficacy) and that are reinforced. Reciprocal interactions among personal, behavioral, and environmental factors affect behavior change.

1. Strategies for action:

Action strategies based on social cognitive theory use goal setting, provide reinforcement for new behaviors, and include skill-building activities and activities that increase self-efficacy, such as stimulus control, self-monitoring, and cognitive restructuring.

1. Behavioral strategies for maintenance and termination
2. Characteristics of the maintenance and termination stages:

People in the maintenance stage have continued to practice the goal behavior for at least 6 months. For some behaviors, a clearly defined termination stage, in which the goal behavior has been adopted and undesirable behaviors have been eliminated, can be identified.

1. Strategies for maintenance:

Maintenance strategies focus on continuing skills adopted in the action stage, as well as coping with lapses in behavior and preventing relapse. Problem-solving skills are useful in preventing relapse. Changing the environment is also a useful strategy.

1. Secrets of success of people who keep off lost weight:

The National Weight Control Registry is the largest ongoing study of people who have lost weight and maintained weight loss for at least a year (often called weight suppressors). Successful weight suppression behaviors include reducing dietary fat intake, portion control, exercise, and weight monitoring. Those who react quickly to reverse small lapses are most successful in preventing relapse.

1. Culture and behavior change
2. What is culture?

Culture is defined as patterns of thinking, feeling, and behaving that are learned and shared by a group of people. Food choice and acceptability of physical activity are influenced by culture.

1. How culture influences weight management behaviors and beliefs:

Social values and beliefs impact what we view as beautiful, good, and desirable, including body size and eating and activity behaviors. Social norms exert a great deal of influence over attitudes toward change. Culture and social norms influence food selection, preparation, and pattern of consumption. Acculturation in the U.S. (shift away from cultural norms) has often led to less healthy eating habits. Differences in physical activity level may be related to cultural norms, as well as socioeconomic factors.

1. Making behaviorally based interventions culturally relevant:

Most health practitioners are non-Hispanic Caucasians and are probably most comfortable with approaches that support their own cultural values. Culturally-sensitive weight management approaches take into consideration different perceptions of large body size, food preferences, and language differences.

1. Expected outcomes from a lifestyle approach to weight management:

A lifestyle-modification approach to weight management considers clients’ readiness for change, assessment results, and cultural background. Modest changes in diet and activity can lead to improvements in comorbidities and health risk factors, 5-10% reduction in body weight, better stress management, and greater ease in moving around.

Suggested Activities and Applications

Application 11.1 What Stage of Change Are You In?

This application asks students to look back at their Physical Activity Assessment (Application 6.2) and their 3-Day Diet Analysis (Application 9.1) to:

• Summarize the areas of diet and activity that were identified as candidates for change;
• Discuss what stage of change they are in for each; and
• Discuss how they could advance to a higher stage of change.

Application 11.2 Skills for Action

This is a continuation of Application 11.1 that relates specifically to moving individuals into action. The instructor could create a summary of student ideas from Application 11.1 for advancing to the action stage of change for various physical activity and diet behaviors. In group discussion, students can refer to the list and brainstorm additional ideas.

Application 11.3 Social Norms for Body Size

Health at Every Size (HAES), which has been featured several times in this book, runs counter to social norms that promote a desire for thinness. This application gives students the opportunity to examine social norms for body size , which are illustrated in mass media print publications.

Each student should use sports, fashion, or news magazines to identify three different advertisements: (1) an advertisement that students believe illustrates feminine gender norms; (2) an advertisement that students believe illustrates masculine gender norms; and (3) a food product. All advertisements will be used to create a collage of ads (this can be done by simply taping advertisements to a wall or whiteboard in the classroom). Then, in groups, students can discuss and answer the following:

• Looking at these ads, what are the feminine ideals in contemporary American society? Masculine ideals?
• How do these advertisements perpetuate gender norms?
• How might these advertisements relate to the HAES movement?
• What kinds of food products are advertised?
• If students were outside American society looking for information about American culture, what would the food advertisements say about the typical American diet?
• What changes might be helpful to promote better health at every size?

Chapter 11

Lifestyle Modification to Promote Health and Weight Management

Test Questions

True/ False

1. Overweight individuals are a homogenous group. (True/ False)

2. In some cases weight losses do not have to be large to improve cholesterol, blood pressure and glucose control. (True/ False)

3. Significant changes in behavior, before people are ready for action, are likely to be maintained. (True/ False)

4. Precontemplators make up a large portion of the weight-management program dropouts. (True/ False)

5. Social cognitive theory is the most frequently used model in weight management programs. (True/ False)

6. An important part of normalizing eating is stressing that not all foods are acceptable. Creating categories of “good” and “bad” foods is helpful in this process. (True/ False)

7. The notion of being “good” when eating salad and “bad” when eating pizza will help establish more intuitive eating habits. (True/ False)

8. Intuitive eating does not lead to weight gain over time. (True/ False)

Multiple Choice

9. ____________________ is the first stage of change; individuals in this stage do not intend to change during the next 6 months, may lack confidence in their ability to make a change, and often deny that a problem exists.

A. Precontemplation stage

B. Contemplation stage

C. Preparation stage

D. Action stage

10. ____________________ is the stage of change in which individuals are preparing for change in the next 6 months; sometimes. People get stuck in this stage for a very long time.

A. Precontemplation stage

B. Contemplation stage

C. Preparation stage

D. Action stage

11. ____________________ is the stage of change in which an individual is ready for change within the next month and has typically already made some small change in behavior.

A. Precontemplation stage

B. Contemplation stage

C. Preparation stage

D. Action stage

12. ____________________ states that people adopt new behaviors that they feel confident about performing and that are reinforced.

A. Stage of change theory

B. Social cognitive theory

C. Theory of planned behavior

D. All of the above

13.____________________ is a behavioral contract with agreed upon rewards for specific behaviors.

A. Contingency contract

B. Reciprocal determinism

C. Cognitive restructuring

D. All of the above

14. ____________________ is a technique that helps people develop rational and positive self-statements to counteract negative self-thoughts.

A. Self-monitoring

B. Stimulus control

C. Cognitive restructuring

D. All of the above

Short Answer/ Fill in the Blank

15. ___________________ is sometimes also called the Stages of Change Theory.

16. List the stages of change in order from the first to terminal stage:

1.______________________

2.______________________

3.______________________

4.______________________

5.______________________

6.______________________

17. How can identifying a person’s stage of readiness for change help maximize the likeliness of success? How would this be helpful to a weight management professional?

18. What is the recommended weight-management approach for someone in the contemplation and preparation stages of change?

19. What is the recommended weight management approach from someone in the action stage of change?

20. What are the characteristics of the precontemplation stage of change?

21. ____________________ offers an explanation that health behavior depends on perceived susceptibility to a health problem, perceived severity of the health problem, and perceived benefits and barriers of health action.

22. How does the theory of planned behavior help explain readiness to change?

23. What are three weight management strategies for people ready to act?

24. Describe the action stage of change.

25. What are the three key features of social cognitive theory?

26. Provide an example of reciprocal determinism as it relates to weight management.

27. What recommendations might a weight management professional make to help a client increase his/her self-efficacy?

28. Jan is significantly overweight/obese and comes to you for advice. She is ready to begin a weight loss program. You talk about starting out by setting a goal. She would like to lose 25 lbs. What would be a more reasonable initial goal? Why might starting out with a 25lb weight loss goal be a bad starting point?

29. How does self-monitoring promote dietary compliance?

30. Provide an example of stimulus control that weight management professionals might use to help a client avoid a situation that promotes problem eating/ food related behaviors.

31. Provide an example of stimulus control that weight management professionals might use to help a client modify the environment and promote desirable eating/ food behaviors.

32. What is some advice that you might give to help someone modify rapid eating behavior?

33. ______________________ is eating when hungry, stopping when full, and choosing from a wide variety of pleasurable foods.

34. How can exercise help with stress management? Why might this be important for weight management professionals to consider?

35. What are the characteristics of the maintenance and termination stages of change?

36. What are some strategies for maintenance? What are some of the “secrets” to weight loss and weight management success?

37. What is culture? Why is cultural competence important for weight management professionals?