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Assignment 1: Behaviour modification
Transcript of Assignment 1: Behaviour modification
My process goals to help me achieve the goal above include:
>Eat more fruits and vegetables-. NHMRC recommends that Australian adults should eat five serves of vegetables and two serves of fruits every day. When I reviewed my eating diary I found that on most days I did not meet this requirement. Diets high in fruit and vegetables are thought to decrease the risk of establishing cardiovascular diseases and many cancers such as lung, oesophageal, stomach and colon cancers (Southon and Faulks, 2011). Fruit and vegetables are low in calories and sugar also, which supports good health (Corbin et al, 2006)
>Choose foods that have low-moderate amounts of sugar or added sugars (NHMRC)-Foods with high amounts of added sugars and other sweeteners are empty calories often with little nutritional benefits (Shapiro, Hayden and Check, 1998; WHO, 2003, NHMRC). While more research still needs to be undertaken, there has been research to suggest a link between the increasing trend of high sugar, high GI diets and chronic disease (WHO, 2003). Shapiro et al (1998) reports that high GI diets can result in insulin resistance as the pancreas has to pump out more insulin and the cells become less sensitive, which is believed to be connected to adult-onset diabetes and increased risk of heart disease.
>Drink a glass of water with each meal. NHMRC suggests we should consume plenty of water, because two-thirds of body weight is made up of water. Water consumption is important to absorb nutrients from food and transport them throughout the body, remove waste products and prevent de-hydration (NHMRC, 2012). Constant and Jequier (2010) discuss that a number of factors influence how much water should be consumed including age, gender and activity but suggests that 2litres- or 8 glasses should be consumed each day for adults (Australian guide to healthy eating, 1998).
>Eat meals at the table, rather than in front of the television. Shelly and Swinburn (2008) reports that children can learn to associate television viewing with eating snacks and this is further reinforced by food advertising of energy dense foods such as McDonald’s and soft drinks (Harirs, Bargh, Brownell, 2009). By eating meals at the table I am hoping to reduce this learned association and become more aware of what I am eating (Corbin, 2006). What I ate Post intervention Understand barriers and how they will influence
In the past eight weeks I have challenged myself to modify an aspect of my health. I value good nutrition but it is something that can easily be forgotten, as I overindulge in sugary treats or add “extras” into my grocery trolley. I have therefore, made it my goal for the eight weeks to adhere to the National Health and Medical Research council (NHMRC) guidelines by following a healthy eating plan. Nutrition is a major determinant in the health and wellbeing of an individual (Corbin C, Welk G, Corbin W, Welk, K 2006; World Health Organisation). Poor nutrition can lead to increases in adipose tissue, high blood pressure, certain cancers, chronic cardiovascular diseases and obesity (Bowman, 2005; Corbin et al, 2006). Statistics of obesity prevalence in Australia are continuing to increase with reports of it doubling between 1980 and 2000 (Cameron, Welborn and Zimmet 2003; Walls, Wolfe and Haby 2009, as cited by Walls et al. 2011). Walls et al 2011 reports on an obesity epidemic with as much as 65% of Australia’s population likely to be obese by 2025. Improving the nutrition and eating habits of society it is hoped will bring about many positive attributes including reducing health care costs (WHO; Lenoir-Wijnkoop et al, 2011) and improving the health of the Nation (Walls et al, 2011).
To be successful in my change modification I used a number of behaviour change theories to ensure that I gave myself the best chance of succeeding but also to give me an understanding of the different reasons as to why many people may not succeed in achieving good nutrition. I used the stages of change model, and the Health beliefs model (Corbin et al, 2006) to adhere to my personal health-related goals. Behaviour Modification:
Underlying theories This theory suggests that people go through different stages in life before behaviour is changed (Stages of change, 2012). In order to alter my behaviour I had to identify what stage of change that best represented where I was prior to undertaking the healthy eating plan.
Prior to the behaviour change intervention I was at contemplation stage. I was aware that I probably was eating excess calories, over-consuming on sugary treats and not drinking enough water, but had not yet made a commitment to change.
I started to research the nutritional guidelines and recommended daily intake which led me to setting myself a number of nutritional goals to achieve over the following 8-10weeks. It is here I shifted into a preparation stage of change (Stages of change, 2012). I started to look up recipes and meal ideas that would help me to meet the NHMRC guidelines. I jotted down a two-week diary of what I ate, drank and exercised to work out a plan that would account for my personal bad habits and weaknesses. I also took a nutrition questionnaire to again identify areas of improvement. From here I began my 8-week healthy eating plan as I reached a stage of action.
The first 2-3weeks was great. I was completing adhering to my plan, I was motivated at the thought of trying new recipes that tasted great but yet were still good for me, or were a better alternative than what I was previously eating. Between weeks 4-6 I believe I probably drifted in and out of preparation and action stages(Corbin et al, 2006). At times I found myself buying a chocolate bar that was full of sugar or eating a number of pieces of cake/biscuits with complete disregard for my healthy eating plan, simply because they were there and it was convenient (Front-end experience, 2012). At times I felt I had not done enough research into how much of something I should be eating and would slip into the preparation stage and undergo more research. Then there were days when I was inspired by a new low kilojoule or low sugar recipe that I had found and I would move back up to a level of action. Motivation is a huge factor as to whether or not you are able to install change; do you really want to change? Stages of change: Health benefits model: Health Beliefs model suggests that a person is more likely to change depending on how the perceive it will impact their health (Corbin et al, 2006). For example if the health problem will have harmful effects. I believe that poor nutrition is likely to increase my chance of developing a chronic disease or becoming overweight (WHO). I also believe these problems associated with poor nutrition can be prevented (NHMRC) through modifying behaviour. At times I perceive that I do not have enough self-control to stop myself over-consuming, however in making an effort to control this and practising self-management skills (Corbin et al, 2006) I am consciously more aware than I was previously, therefore have a better chance of adopting the behaviour. Introduction: Self assessment
I used two methods to collect baseline and intervention data. A diary of my daily nutrition intake was recorded for the initial two weeks prior to intervention. This method gave a detailed insight into my nutrition to identify what needed modifying. This data allowed the formulation of specific goals that my healthy eating plan would be targeted towards.
Benefits of using a diary to measure my nutrition was that it gave me the chance to look at repeated behaviours that may have become habits over time, such as eating 3 or 4 snacks as soon as I get home from university, identify these habits and then work out the best way to change or modify them through set goals and healthy eating plan (Corbin et al, 2006). Diaries also gave me loads of detail to assess my eating behaviour (Piasecki, Hufford, Solhan and Trull, 2007).
A negative of the use of diaries however, it was very easy to forget to jot down what I ate, when I ate or what I ate earlier in the day. This meant sometimes I would go a couple of days without logging my food causing a reliance on self-recall of what I ate and when. This may have caused problems of reliability- the extent to which the measure yields the same or similar results (Gleason,2010). Sometimes I struggled to remember what I had eaten and how much and sometimes left my guessing (Piasecki, 2007). "Respondents do not typically retrieve all instances of a behavior from memory" (Piasecki et al, 2007)- which is a limitation for the use of diaries.
14 Pre-intervention Baseline data is important for a number of reasons:
>It allows you to identify areas to improve and weaknesses you might have
>helps establish a specific and effective program that is suited to the individual’s needs (Moon and Twigg, 1988)
>data collected pre-intervention also permits a comparison post-intervention to evaluate the effectiveness of the intervention (Moon and Twigg, 1988).
>Furthermore it allows you to make comparisons to the wider population. Baseline data was collected prior to behaviour intervention. To self-assess during the intervention I applied a similar method to the above used for pre-intervention. I logged and recorded what I ate, when and how much so that I could measure whether or not I was meeting the NHMRC guidelines and attempting to achieve my set goals. Again, I often faced the challenging task of recall when I had forgotten to log my eating patterns, which may have altered the results. Enough though some logs may have been slightly varied they were still a good indicator of whether I was reaching my target water consumption, making good food choices and achieving my goal of adhering to a healthy eating plan (Corbin et al, 2006)
The second method I used was a dietary habits questionnaire (Corbin et al, 2006 p328). I completed this prior to undertaking the behaviour intervention and then completed it again, one week after I had finished the program. This was a quick and simple way of firstly identifying some bad eating habits (Corbin et al, 2006) that I originally had and then was also a method of comparing my dietary behaviour post intervention. Given the timeframe of this assessment meant it was difficult to determine the lasting effects of the intervention, i.e. whether the healthy eating was maintained. Dietary habits questionnaire What I ate My healthy eating plan was based around the dietary guidelines set by the National Health and Medical Research Council. These guidelines identify healthy eating habits and patterns that are recommended for good nutrition and lifestyle for Australian’s based on research conducted by experts in health and nutrition (NHMRC).
NHMRC’s guidelines recommend that Australian adults (>19-60years) should enjoy a wide variety of nutritious foods including:
• eating plenty of vegetables, legumes and fruits,
• eat plenty of cereals and whole-grains
• include lean meat, poultry and fish,
• include dairy such as milk and cheese
• reduced-fat options should be chosen where possible
• drink plenty of water
Also suggests taking care to:
• limit saturated fat intake and moderate total fat intake
• choose foods low in salt
• limit your alcohol consumption
• consume only moderate amounts of sugars and foods containing added sugars
Program planning: Guidelines This is what my goals and eating plan were based around Having a my goals written on my whiteboard was a strategy to remind me to stick to my goals (Corbin et al. 2006). Snacks should be moderately low in sugar and saturated fat.
It is also important not to have too many snacks at once. Mix it up with a glass of water or two.
Piece of fruit
Low fat yoghurt- be sure to check nutrition index for sugar content!
Box of nuts
Low sugar muesli bar
Crumpet with jam
Salada with cheese, tomato and avocado
Occasionally, in small amounts may have as a snack:
Piece of cake
Chocolate Option 1: Homemade porridge- with any of the following: fruit such as diced apple or banana, handful of nuts, pumpkin seeds, cinnamon, handful of dried fruit.
May also have a boiled egg if needed.
Option 2: Vegetable omelette-vegetables may include: zucchini, tomato, potato, carrot, eggplant, herbs. Bacon may also be substituted. Served on a piece of multigrain toast with avocado.
Option 3: Fruit salad with a dollop of Greek yoghurt
Option 4: Low fat berry smoothie and grilled tomato and cheese toast.
Option 5: Baked eggs and bacon- see recipe. 3g carbohydrates
Healthy eating plan-
Menu Choose any of the following:
Salad, roll, sandwich or wrap
And include a range of ingredients including: lettuce, spinach, cucumber, carrot, tomato, spring onions, chicken, ham.
Caesar salad (see recipe)
Eggplant stack (see recipe)
Vegetable cous cous Lunch options Breakfast options Dinner ideas Include a number of vegetables, may include lean meat, fish or poultry, pasta or rice, and are relatively low in saturated fat and sugar.
Ideas for dinner:
Marinated steak and vegetables
Mousaka served with salad
Chicken and vegetable stir-fry
Chicken, pumpkin and asparagus risotto
Lasagne with salad
Greek style meatballs with yoghurt dressing and cherry tomato salad 6.5g carbs Snack options Food logs Post intervention data: When establishing my eating plan I had to keep in mind my goals, NHMRC guidelines, like and interests as well as keeping it interesting by having a number of options. I also need to understand the barriers that may impact upon. Barriers and strategies for dealing with them:
Time- One of the major influences on my eating habits was the perception that I never had enough time to make something healthy. For instance, every day prior to the intervention for breakfast I would have an Uncle Toby’s sachet of oats because it took me 60seconds to make which is why I enjoyed it- it was convenient (Corbin et al, 2006), however it did contain added sugars. In the planning of my eating options I had to make sure some options could be whipped up quite quickly if I had little time. Also this was a way of changing my perception, some meals it took me just as quick to make a healthy lunch etc. I had to change my thought that a good meal may take time, but that is okay because it is healthy and delicious. Habit- I had got into a routine that after work I would get a chocolate bar when I finished or during my break (or both). They were always on special so they were cheap, and they were delicious. A strategy I used to combat this was choosing something that was a better choice, for example a piece of fruit. This way I was closer to achieving my goals and meeting the recommended guidelines. Eating for the sake of eating- Sometimes I would eat simply because it was there to be eaten. For instance I might come home from university and eat a piece of toast, and then I might see that mum had brought raisin toast or crumpets so I would have one of them too. An approach to resisting this was instead of over-eating I would have one snack followed by a glass of water. Most of the time I was simply thirsty rather than hungry (Mattes, 2010). Evaluation vs Homemade oats Quick oats 10-15g added sugars no added sugars plenty of fiber (4g 1/2 cup serving) 6g protein Keeps you fuller for longer Winner: Homemade oats some fiber sparkpeople, 2010 can add your own flavour to it! quicker to make Daily food diaries 17 The data that was collected over the past 10 weeks was useful to determine my eating habits and a detailed insight into what I was eating. I was able to maintain and fairly well stick to my plan, with the occasional exception which was usually due to forgetting to drink water or a dinner that did not contain adequate vegetables. My breakfast eating habits have much improved and I am not consuming the large amount of food I was previously. I am also drinking more water, especially at the start of the day (Mattes, 2010; I now try to have a glass of water before or with each meal which is increasing my daily water intake overall. The use of diaries/logs was effective in some ways as it gave me detail as well as it gave me a clear indication of whether I was achieving my set goals and the NHMRC guidelines (Piasecki et al, 2007). However diaries were often forgotten and it would be based on my ability to recall what I had eaten (Piasecki et al, 2007) which may be affect the reliability of some. I tried to include many of the sugar values in what I ate, as to give me a better understanding of how much sugar I was consuming and how it compares with the recommended daily intake of 90g (as states on packaging nutrition labels). In terms of support, my mum was helpful in reminding me to drink more water, or choose better snack choices. Corbin et al (2006) discusses the use of support from family as a strategy to help in modifying a health behaviour; Mum even cooked me up a healthy breakfast when I needed more time in the morning.
If I was to undertake this or similar intervention again I would focus on serving size and portion, and try to stick to a specific calorie/kilojoule target. Corbin et al (2006) talks about adhering to a daily calorie target, that way I would be able to assess further whether my energy consumption was appropriate for the daily activity I do. I might also use a less subjective measure combined with a log to improve the reliability of my recordings (Piasecki et al, 2007). Improving my self-management skills to be able to maintain my modifications such as I might look at ways to improve my time-management skills so I feel good about taking slightly longer to prepare food, changing my mindset from “I don’t have time” to “I can prepare healthy foods in the morning, and I feel better because of it.” (Corbin et al, 2006).
The modifications I made during the intervention so far has been maintained however due to the brief nature of this behaviour change it is still too early to say whether the behaviour changes will be maintained for a period of time (Corbin et al, 2006).
Conclusion A well-balanced diet containing a wide variety of nutrients combined with regular physical activity is important for good health (Corbin et al, 2006; WHO; NHMRC). Good nutrition increases immunity, cognition, physical and mental development and reduces the likelihood of developing diseases such as cancer, cardiovascular diseases and diabetes later in life (WHO) By establishing good eating habits through behaviour modification I am setting up habits that if maintained are likely to improve my overall health and well-being (Corbin et al, 2006; Lenoir-Wijnkoop, 2011). Conclusion: References: Bowman, S.A (2005). Food shoppers’ nutrition attitudes and relationship to dietary and lifestyle practices. Nutrition Research, 25(3), 281-293, doi:http://dx.doi.org.ezproxy.lib.monash.edu.au/10.1016/j.nutres.2004.11.004
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I was eating bought oats that moderate amounts of sugars everyday prior to my intervention -(refer to table). I made a change to make my own porridge for breakfast as a simple way to reduce sugar. By Georgia Thompson