Step By Step

When I start working with a new client, they usually have one or more health or fitness goals. They have obviously realized that achieving these goals are important enough to seek help. I offer comprehensive services (body fat analysis, nutrition education, exercise assessment, and exercise training programs) to help them achieve their goals. However, one of the most important things that they must change are their underlying behaviors. Often, they need to make several behavior changes. Some people can be overwhelmed because they have to make multiple behavior changes and end up never achieve any of their goals.

Bruce is a client of mine, but also has an interesting perspective as a nurse practitioner working with cardiac patients. Here is his story and his perspective on making behavior changes:

Two and a half years ago i decided to take the advise I always give patients and changed my diet (I had a trigger which if you must know, ask me at the gym sometime). Since then, I have lost a total of 40 pounds. Please notice that I said I changed my diet, not that I went on a diet. While I applaud people who can change their diet in a day and stick with it, my experience has been that it works for very few people. What I tell my patients (and what I did) is to examine their diet and pick one thing to change tomorrow when they get up (this is only if they do not smoke--smokers must quit before all other changes). Do not change anything else for a month. In my case the first change was to give up my beloved ice cream which I ate (a rather large bowl) 3 or more nights a week after dinner. One month later, I made another change (stopped buying/eating sweetened cereals). At the same time I increased my exercise. At first I only walked on the treadmill (after moving the 4 years worth of stuff that had accumulated on it) 30 minutes 5 days a week. At first I worked up a sweat and my heart rate went up at only 3 miles an hour. If I tried to run I was gasping for air after only 4 or 5 minutes. After a year my diet had changed dramatically, I had lost my first 12 pounds and I was able to run for as long as 15 minutes. I also emphasize to my patients that slow and steady wins the race. You do not need to lose 1 or 2 pounds a week to be successful. In fact weight loss greater than 2 pounds a week can be very dangerous (despite what the infomercials will claim).

I decided to contact Dan six months ago, as I had lost a significant amount of weight and wanted to build some strength and muscle mass, and I was at a little bit of a plateau with my weight loss. When I started with Dan my percent body fat was 20%. I have no clue what it is now, but I know it has improved. Do I follow a prescribed diet? No--I loosely count calories (mostly left over from when I decided I need to learn what a proper portion was--something few of us really know unless we try) and try to eat high quality high protein meals after strength training. I avoid high fatty meals. I rarely eat fried foods (I think I had french fries twice in the last year--they make me feel bad now) and I typically take home more than half of my meal when I eat out. I am addicted to carbs and at times probably eat too many carbohydrates and not enough protein. I do not take vitamins or supplements (except for fish oil--the research on this for those with cardiac risk factors is extremely compelling) as I prefer to try and eat a balanced diet and do not believe in vitamins unless you are being treated for a diagnosed vitamin deficiency.

I am currently at my goal weight (my physician feels I have lost enough), but want to improve increase my strength a little more--Dan is working on me. I do not beat myself up if I eat too many calories on a Friday night--I just try not to do that more than once in a while. Rarely, I will overeat by a lot-and feel it for the next 24 hours.

(My questions for Bruce) Do you feel that your eating is now more intuitive than it has been in the past?

Yes, I feel I do not have to "watch" what I eat now as much as when I first started. In fact, when I was in Mexico in February, I did not track any of my food intake, I ate what I wanted, drank an alcoholic beverage or 2 every day (not my norm) and had a little dessert every night. I still lost about a pound that week.

Did you have to start out with any Calorie, fat, carbohydrate, or protein counting?

When I first started, that was not one of my early changes. I was just trying to make simple changes that would have an impact on my total caloric intake and weight. As the recently published study noted, It matters less what your diet is (if your goal is to lose weight) and more about calories in versus calories expended.

Do you try to eat a certain number of times per day?

Yes and no. I always, always eat breakfast (studies show people who eat breakfast every day are more successful with weight loss), and an evening meal. I usually eat a mid day meal. From there it varies. On a work day I sometimes cannot get away for lunch and as I cannot carry snacks with me I am at the mercy of what I can find easy in the hospital. I typically have a mid-morning piece of cheese (all the hospital units have the 3/4 oz. prepackaged pieces of cheddar cheese), and if I do not get to go to lunch, I can usually grab a container of fat-free fruit yogurt to eat on the go. On weekends I find I "graze" more between breakfast and dinner and most days do not have a formal sit down lunch. I will also usually have a light snack in the evening between dinner and bedtime--maybe a few nuts or grapes or a banana or a small cup of applesauce (love the Granny Smith in the single serving cups, I buy the no sugar added-apples do not need any more-and only 50 calories).

Best of luck to all of you.

Thank you, Bruce, for your perspective!


Does anyone else have any helpful strategies to make behavior changes permanent? Feel free to post in comments.