1. A Winnable Battle Little Steps = Big Successes

2. 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.”

3. 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

5. Small changes Food Intake Eating more for less

6. Energy Density

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

9. 012345678 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)

10. SWEETENED BEVERAGES! Stop drinking your calories…

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

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

14. Small changes Energy expenditure Moving more without knowing it

15. 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

16. 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

17. 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.

18. lifestyle activities  8:00 - 15 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 emailing them.

19. Small changes Determinants of health

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

21. Type of Work we do….

22. Lifestyle…

25. Food environment…

26. Neighborhood…

28. Small changes Make it happen How???

29. 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

30. 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)

31. 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?

32. 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.

33. 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?

34. 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

35. 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