A Winnable Battle Little Steps = Big Successes

Selling health to the public Hochbaum, 1976 “[ …] the most challenging, most difficult problem is not how to sell the public on health-supportive practices […]. It is to persuade and help them to stick with new practices, to keep these up conscientiously and consistently for the rest of their lives.”

Healthy lifestyle: One small change at a time  a “lifestyle change” can be daunting  start where you are!  make clear and (somewhat) realistic picture of where you are now  make changes that love you back  assess, reassess and re-reassess

Small changes Food Intake Eating more for less

Energy Density

Energy Density and Volume 700 g320 g 475 kcal 11% protein 58% carbohydrate 31% fat

Lettuce Vegetable soup Skim milk Apple Black beans White fish Yogurt Veg. lasagna Roast chicken White bread Pretzels Cheddar cheese Bacon Butter Salad dressing Potato chips Energy Density (kcal/g)

SWEETENED BEVERAGES! Stop drinking your calories…

Starbucks Mocha Frappuccino (Grande)  400 calories  102 minutes of bicycling  51 minutes of basketball

Starbucks Mocha Frappuccino, Light (Grande)  130 calories  33 minutes of bicycling  17 minutes of basketball

Small changes Energy expenditure Moving more without knowing it

lifestyle physical activities  It’s difficult to add exercise to busy schedules.  Find ways to integrate more physical activity into your existing routine.  Mowing the lawn, vacuuming, cleaning the windows, walking to work or to the store

lifestyle Activities  doesn’t have to be continuous  Psssst… 10 min + 10 min + 10 min = 30!  easy to build into lifestyle  no equipment needed  no gym membership  no special clothes

lifestyle activities A dog owner:  Walk the dog for 15 minutes in the morning.  Walk to work, church, etc(15 min)  Walk the dog for 30 minutes after dinner.

lifestyle activities  8: minute brisk walk.  10:00 - Take the stairs instead of elevators.  12:00 - Take a 30 minute brisk walk during lunch.  3:00 - Walk to meet your friends instead of calling or ing them.

Small changes Determinants of health

Health Determinants  The type of WORK we do  jobs, careers, caregiving  Where we LIVE  our homes, neighborhoods, and commute  Our RELATIONSHIPS  family, friends, colleagues

Type of Work we do….

Lifestyle…

Food environment…

Neighborhood…

Small changes Make it happen How???

Assess, assess, reassess  people who record their eating and activities lose 25-50% more weight.  self-monitoring: most important tool to change behavior  increases awareness  gives feedback on change (or non- change…)  helps planning for the rest of the day

8:00 banana (medium) 2 whole wheat toasts coffee (black) 10:30Apple 12:00 2 c lettuce w/ grilled chicken diet coke + low fat yogurt 4:00 pretzels + grape (alone) 7:00w/ family ham (slices) peas (1/2 cup) 2 c lettuce + dressing (2 ts) 9:00 peanut butter toasts (2 toasts + 2 tbs pb)

Assess, assess, reassess  Measure the amount of oil you use to cook.  Record the number of walks you take.  Count the portions of vegetables you are eating in a week (this week!)  How many foods that have >20g of fat are you eating this week?

Small changes: be concrete  Decrease the time you spent sitting by 30 minutes.  Walk an additional 1000 steps tomorrow.  Try one new vegetable this week.  Replace frozen cappuccinos with ice tea once this week.  Try one new exercise class this week.

Small changes: changes that love you back  shape your environment to increase your control over the choices you make  If you don’t want to eat chips, don’t get chips!  fattening food that you eat but don’t really like?  vegetable that you like but don’t REALLY eat?  activity you enjoy doing and can easily incorporate in your schedule?

Small changes: start at home  use measuring cups  use smaller plates, bowls, cups and glasses  use portion-controlled foods  increase the variety of healthier foods  if your not a chef… stop being a chef for everybody! 34

Small Changes: big Benefits  improving one health behavior has multiple benefits  changes that are decreasing your risk of diabetes will also improve stress and coping  Small gains in many of the areas = exponential effects