Behavior Strategies in
Diet Control
The Challenge and
the Cure
Dr Abeer Al Saweer
Consultant Family Physician,
Diabetologist
Kingdom of Bahrain
Learning Objectives
To appreciate the importance of
lifestyle modification in the
control of the diabetes epidemic.
To overview the different
modalities of behavior therapy.
To understand the role of
behavior therapy in diet control
and thus in diabetes control.
Introduction
Diabetes Mellitus is “one of the
most psychologically and
behaviorally demanding of the
chronic medical illnesses”.
Cox and Gonder-Frederick,1992
Introduction
Research about diabetes has
changed from imparting knowledge
about the cause and treatment to
diabetes self-management.”
(Clement 1995)
What are Behavioral
Strategies?
Strategies, based on behavioral
change theories which provide
patients/clients with tools for
overcoming barriers to compliance
with dietary or exercise therapy.
Do Behavior
Strategies work?
Evidence Statement: (A)
No one behavior therapy appeared
superior to any other in its effect
on weight loss; rather, multimodal
strategies appeared to work best
and those interventions with the
greatest intensity appeared to be
associated with the greatest
weight loss.
Do Behavior Strategies work?
Strongly Evident: (B)
Programs that combine diet, exercise,
and behavior modification have been
shown to be most effective over the
short term.
The NIH Guidelines reported that
behavior strategies in diet and
physical activity produced wt losses of
approximately 10% in 4-12 months.
0
Common Theories Relevant to
Understanding Human Behavior
Educational and Behavioral.
Health Belief Model.
Theory of Planned Behavior.
The Wheel of Change.
Conflict Theory.
Cognitive Dissonance Theory.
Operant Learning.
History of Behavioral Therapy
First applied in the late 1960's and
early 1970's.
Initial programs were 10-weeks in
length. Produced weight losses 4.5 kg.
History of Behavioral Therapy
Parameters
1970s
1980s
1990s
Length of treatment (wks)
10
14
27
Wt Loss (kg)
4.0
7.6
9.7
Length of F/U (wks)
22
53
64
Loss at F/U (kg)
4.0
4.8
5.6
Theoretical origin of
Behavior approach
Eating and exercise behaviors are
related to body weight.
Behavior can be changed by
environmental cues before or after
the behavior.
Components of Behavior
strategies
Assess Behavior.
Change contributors.
Change
consequences/Reinforcers.
Common Components of Behavioral
therapy in diet Control
 Set realistic goals.
 Self-monitoring.
 Cognitive restructuring and
Problem Solving.
 Stimulus control.
 Social support.
 Relapse prevention.
Self-monitoring
Involves the systematic observation and
recording of target behaviors.
Daily food and physical activity (PA)
records for the first two weeks.
After which to complete food records
at least two days per week and one
weekend, & continue to record the
frequency and duration of exercise.
Stimulus control
A process which involves identifying
and modifying environmental cues that
are associated with overeating and
inactivity (Changing antecedents and
consequences or reinforcers).
Stimulus control
Stress management techniques.
Environmental changes to control
cue eating and PA habits.
Cognitive Restructuring
Involves identifying and modifying
maladaptive thoughts and advising
more positive self-statements to
assist in behavior change.
Social Support
Studies show that persons
with higher levels of social
support tend to be more
successful at achieving and
maintaining weight loss.
What current strategies
look like?
Conducted in groups of 15 individuals.
Two co-therapists.
Weekly treatment meetings for 6 months and biweekly
or monthly meetings for the remainder of the year to
two years.
What current strategies
look like?
Continued contact is an important
component of the maintenance
program.
Recently there have been efforts to
deliver behavioral treatment programs
via television or the Internet.
What do strategies contain?
Standardized.
Group sessions include a private
weigh-in, review of self-monitoring
records, and presentation of the
week lesson.
Assignments are given and reviewed
next week.
Dietary prescriptions in
behavioral programs
Energy Intake.
Macronutrient intake.
Food provision and structured meal
plans.
Support for Healthy Eating
 Ongoing support for long term behavior
change.
 One approach is to continue treatment
contact over longer period.
 Another approach is to involve
the spouse.
 Another one is to involve friends.
 Incentives.
Tailoring Treatment to
Individual subgroups
Ethnicity.
Binge eating Disorders.
Media-based interventions for
wt loss.
Preventing Weight Gain
Wt gain prevention in young
adults.
Wt gain prevention at time of
pregnancy.
Wt gain prevention at
menopause.
Performance Objectives
Behavioral approaches are used to
help patients make long-term changes
in their eating.
Behavioral approaches stress
monitoring of dietary intake and
modifying the cues and reinforcers in
the environment.
Better results have been achieved
with longer periods of treatment
contact and more structured
approaches.