Joe Kearney examines the elements of behavior awareness, change, and commitment for a healthier lifestyle.
Our next speaker is a joke Ernie, who is a clinical behavioral psychologist and certified lifestyle coach. He's also a professional trainer. He provides evidence based and results oriented skills strategies and motivational coaching to help individuals achieve and maintain a healthy body weight. He also provides professional training to healthcare providers who are interested in developing skills and behavioral weight management. He actually works at the same weight management clinics clinic that I do at scripts and I know that patients love him and I often refer to him, but I'm excited because I don't actually know what you do or recommend to patients. So I'm really eager to find out. So go ahead, joe I have to figure out what I do first. Now I'm kidding. Thank you for that nice introduction. And it's been wonderful listening to my speakers prior to coming and I've got some the task of working with patients, helping them achieve and maintain a healthy lifestyle. And so my my talk is going to be practical approaches to what does it take for people to gather the information that we give them and actually get it done and not just to get it done for a short period of time, but to get it done that it becomes part of a healthier lifestyle, you know, when we look at. Um and I don't have any disclosures, uh there's no conflict of interest of anything. So if I start with the first slide, the journey of 10,000 miles begins with a single step, it's a statement I made to all of my patients that this is going to be a journey. There's not an end to it. It's a journey that you continue to go and as the slide shows, I think it depicts it pretty well. There are some people that look at this is the mountain in the background, you know, difficult, ominous, something that they think, oh, I can't do this. And that's one very important message with behavior change is you've got to get the patient thinking about what really can I do. So I have them focus a little bit more on the slide or rather the picture of the mountain that's a little more colorful, a little bit more of a slope and say, you know what? Maybe we'll get to the top of that ominous look at mountain. But what we really want to do is first get through step by step up this nice little tree lined hill and we'll make progress because that's a very important part is that the patient feels like they're making progress. It's very important for motivation and all of us know when you, when you see a patient and they have various conditions, um, you provide the best knowledge, the best strategies, the best plan to help them get well. Uh, and to make some changes, but yet they leave the office and often times they become overwhelmed with the world around them. And I hear this from my patients all the time they said, you know, I get it. I understand that I understand this is very important for me to do, but it's so difficult. I keep seeing this mountain and so week to week, what I'm trying to work with people is how do we just not focus on the mountain but focus at one step at a time on the hill. Uh, exercise, nutrition, medication, surgeries, all the things that we prescribe to our patients. We want them to be engaged in wanting to do that engagement is very important Now. Oops, somehow we've got a rapid pace here. Let me back this up. Okay, first. Like, I mean, some people will say, you know, I want to make the change because you know, I just came back from my doctor and I really don't want a problem occurring. I want good health. I don't want the disease. I don't want the condition. I'm willing to take the medications. I'm willing to make the changes I want to be healthy. Others will say, well, I'd like to have change occur, not just to stay healthy but to really enjoy life and life could be in various ways this depiction of upon springs, People generally enjoying golf. Although those of you that are golfers out there probably will argue that point. Um, I just got back from Palm Springs and I kind of felt like 111 putt was good, two parts were not so good five puts or get off the course. So we often have to look at perspectives. But oftentimes people say after they have the absence of the disease or the what we're working on the medical condition. They said, you know what I want to enjoy my life and not only do I want to enjoy my life, but I want to enjoy life with others. People that are important to me. I can't tell you how many people come in and they say you know, I want to live a long, healthy happy life. Certainly I don't want to be ill, but I also want to be there for my wife. I want to be there for my husband, I want to be there for my Children, I want to be there for my grandchildren and so forth and so on. And that's a strong motivator because people want to move beyond just internally what am I got for? Just me. I want to look at what it is and how it impacts others around me also, you know, certainly we all want to live a little bit longer healthy happy life uh and some people are attempting to do that. Those of you that recognize keith right here. I I don't know if we, we talk about quality of life but he certainly has longevity. Uh So in any case everybody has different reasons and that's a very important part when I talk to patients. Initially, you know I asked them to tell me you've seen your medical provider, you've seen the clinical picture as it is. You want to make some changes. And so now you're coming to a behavior change program with this idea of I want to have these goals achieved. So we stopped for a few minutes and we talk about goals achieving personally rewarding goals. There's a couple of very important words in this. First goals are going to have to be and we'll get into this a little bit more in a moment. But I want them to be, I want them to think in terms of goals that are achievable goals that are achievable and that they're personally rewarding because we get motivated when we know we're going to get something out of it. Certainly we'd like to show our doctors that are blood pressures are normalized that are glucose levels are within normal limits and those are wonderful things and they are important. But we have to look at what are you going to get out of it? Because you're not taking your blood every single day. You're not looking at your blood pressure every day, although perhaps some do. But we want to have something that is more personally energizing for them to make the changes because as you saw with the mountain it can get a little hilly at times, it's not so easy to make these changes. And so we have to look at all the components of a lifestyle change. And this is one of the areas that we talked about early on and this is all kind of based on a collective amount of data over the years of working in this for the more and more years than I would tell you. But quite a long period of time gathering information from others, other clinics, other professionals, other people that have done the studies on behaviors, but also importantly on patients. And so they come to me, they say joe I want to have a healthy lifestyle. So I said, let's discuss what is a healthy lifestyle. Well, healthy lifestyle is going to be about developing healthy habits. Now if you go to the dictionary on habits, habits are healthy behaviors that are repeated. So when you're developing a plan, you're thinking to yourself, I want to work with this person so that they will take what we're talking about and bring it into their life so they can repeat it and repeat it and repeat it so that it becomes part of who they are. So for example, we just heard about physical activity and exercise. You know, people will say, oh I really want to have a much more healthy active lifestyle. I'll say do you have the habit of physical activity? Oh yeah, I've just started this exercise. I've done three days and I'll say, well yeah, you've got some exercise started um you have the exercise behavior. How well did you enjoy it? What are you doing? Why did you pick that particular physical activity? And they'll tell me a little bit about the behavior and I'm trying to get a little sense for this behavior is good, but is this something that you think that you can sustain, because we want to make this into a long standing activity? That becomes a habit and collectively, when you put all your habits together, that's what the healthy lifestyle is all about. So what it's a, what's important in a healthy behavior? Well, as I just mentioned a moment ago, the person has to be ready to make a change, you know, for whatever reasons they have, I want them to say, okay, firstly, are you ready to make a change? And there are quizzes out there. There are profiles out there that you can look at this. And the important thing is that they say, you know what, I have personal good reasons for making this change and I'm ready. I'm ready to do it. So now the next question is, are you ready to start this tomorrow? Because many studies will show that procrastination is the nemesis of success. If you wait too long, I'll start it on one November, I'm going to start it on January one. It loses a lot of the momentum. And so I'm always asking somebody all right, you can start doing something in January, you can start doing something in November. But let's talk about what you're willing to do tomorrow and I wanted to be positive. So we create sort of a scenario of positive thoughts and a readiness to change because they have meaningful goals. So when we look at a lifestyle change, they have meaningful goals, important to them, may be important to their family, important to their medical team. They feel very positively about the changes they want to make, they feel very positive about the goals, They're ready to kind of put it into action because so many times that we all do this, we get excited about something, but we never put it into action. I know I've fallen into that more than once. I'm sure everybody on this group here has probably fallen into that. I'm ready, I'm ready, I'm ready, but I just haven't done it. So get the readiness to be a behavior doing enough time to become a habit collectively put all those together and we're working towards a healthier lifestyle. Okay, um, I like to use the four cornerstones for laying down a solid foundation. I mean if we were building a structure of building, we'd want to have a good solid foundation. So I review this with patients and this is kind of based on a lot of data on how people change. Firstly, I always let patients know your mind is the most important ingredient to success. Certainly information you receive for your medical team, certainly perhaps your fear of the medical conditions, but your mind is the most important ingredient for success. So we know this just from the recent discussions on masks, no masks, you know, and all the other things that are going on in our current life right now, the bottom line is somebody is going to make a decision and it's got to be from them. So the most important ingredient for success is what they're thinking. And then next lee it's not about what you do, but it's about, I'm sorry, it's not about what, you know, but it's about what you do. And you know, we know that we educate patients when we see them, education is important patients and others want to know information. They want to understand they want to be engaged in this. But I'll say that's wonderful that you know it. But what are you going to do with that information? You learn about physical activity? Okay, wonderful. We can talk about the american College of Sports Medicine guidelines of physical activity. We can talk about what works really, really well for clinical data changes. But what are you going to do Within the next 24 hours in this particular case? Maybe physical activity. So take what you know, and do something with it. And then of course we've got number three, a body in motion stays in motion unless acted upon by an outside force. Think about your own lives and think about the lives of your patients. What is an outside force sometimes, that outside force of the people that they live with sometimes an outside force might be the weather, their external circumstances that pushed against them trying to make these changes? I mean, we all know that now we're all coming out of the, the uh, you know, the seclusion of what covid had. You know, people are starting to get back into activities and some of the people are going back to activities to a higher level than they did before because they've been cooped up for so long now, that's really great. Except as outside forces are forcing people to party more, They eat more than going out to eat more. They're really getting excited about being back in mainstream. So these outside forces push against some of the changes they're trying to make. So I often want people to think in terms of not only do you have to work on, you be staying motivated and having good, good reasons for making these changes, but also to look at dealing with and identifying first, but dealing with the outside forces. And then of course, as we just mentioned a moment ago, success is really going to be achieved by maintaining this healthy habit. And I tell people it's not a program because I've always been amazed that many years ago. You know, I would, you know, working in hospitals for many, many, many years, people would call and say you have a weight management program. Yes. Do you have a behavior change program? Yes. How long is it You know, is it eight weeks long? Is it 12 weeks long? Is it 16 weeks long? And I'll say, yeah, all of the above and then some And patients that join my program, they'll say, well, how long is your program? I said, well each year it's 52 weeks And I have some people that have been with me, you might say how successful can it be that have been with me for 10 years Now? Somebody says, well if they've been with you for 10 years now, you know, how good can it possibly be? I said because they're fine tuning, its like piano lessons, you don't take three months and piano lessons and then go into a concert. You have to continually develop and develop and develop and so often tell people it doesn't have an end folks and it's about time, you recognize it and they get to that point, not necessarily all at once, but they start to say, aha, there is a lot more things I didn't think about, think about the season changes, how different exercises in july versus exercise in february. If you live in the cold environment, you have to really change things up a lot. You know, we're lucky here in saN Diego. I mean people can exercise outside all the time because the weather is so great. So we're gonna work on a couple of different things here. One is I want people to be aware that there are five pillars that we're going to have to work on, that people in your patients that you can take home with. This things that they have to work with and those five pillars are certainly and we've talked about this about nutrition and eating important parts, all good health. So we have registered dietitians and we have educators and we have doctors and nurses and physicians assistants and so forth providing information and guidelines for nutrition and eating. Everybody has an eating plan that they want their patients to go on, patients understand that they see it as a reasonable nutrition and eating plan important. How about physical activity and exercise? And I use two different words that might sound like the same thing, but they are different. Physical activity is active. If his activity is just getting up and move. Uh My colleague before me mentioned that we should be all getting up between these talks and moving around a little bit. Unless it's our talk, we should be moving around. I was doing that, thank you for that reminder. As soon as you reminded me, I had my camera off, I got up and I started moving around Dr. Harris is moving your shoulders right now. I can see your picture moving around. So physical activity is moving. I have a little thing, I ask patients to do and I call it date with eight uh if my colleague Karen one of our our our ends that I work with her office is right next to mine. Sometimes she comes to my office and she says joe how would you like to go on a date? A date would eight. And all we do is we walk out four minutes and back four minutes for eight minutes. Now. That's not aerobic training, that's not burning tons of calories. But I'll tell you it changes the rest of the day. If you do the date with 84 times throughout the day, you have 32 minutes of physical activity. It's not 32 minutes of physical training, but it's 32 minutes of his activity. And patients can grasp that and say, you know, I'm not ready for 30 minutes, I'm not fit enough for 30 minutes, I'm too heavy, I have too many conditions. So what can I do? And I'll say well you can do a day with eight and they look at me and say well how how good can a date with a b, how good can eight minutes really be? And I'll say well Eight minutes can turn into 16 minutes and so forth and so on. So it's just a step by step approach, just like the first light. The journey of 10,000 miles begins with a single step. If you want to go 30 minutes, you first have to get used to do in eight minutes and then 16 minutes and so forth and so on. And importantly with this pillar as they strengthen it is that and this is nutrition and physical activity linked together. If they have good experiences with it, they're gonna do it again. If they don't have a good experience with it. Probably no matter how much they learn about it, they just say, you know, I don't like this. Um, I had a patient one time to ask me. So joe what's the best cardiovascular exercise where I can get super super fit because I really want to be fed. I'm serious about getting fit. I said, well, the highest vo two volume of oxygen consumed max vo two. The highest measurement of max vo two was measured from toward the front cyclists. So you're willing to do that. And laughed at me. Of course, of course not. What's the next 1? I said, well, cross country skiing and look at me. I'm not gonna do that. And I said, see, we can talk about what, where the high numbers are and where is the greatest training, but it's not where you are right now. So you have to look at where are you right now? What are you capable of doing? And let's build it? Okay, we give them nutrition plans, Eat more vegetables. How About one More Vegetable? You know, ask a patient. Why don't you just add one more vegetable to the plate, You know, those kinds of things, Simple things that they can achieve environmental control. If you live in the seas candy factory, you're probably gonna eat. See's candy, okay. If your environment doesn't support what you're trying to do, it's gonna make it difficulty because we know that will power doesn't work. So we want environmental control. I ask patients to think about making your environment as supportive as possible. And that brings in number four with social management. Social management is about dealing with the people around. You get a team of people, you know, bring in the people that you live with, bringing your friends, bring in others to become part of the team because this is a team approach. So if I have a social management team and I help get my environment in shape. It makes the physical activity, the nutrition eating and the other things that I'm trying to do a little bit easier and then mental mastery. Uh mental mastery. This is a key one. Here's some laws of mental master to help you. Bet. Law, valued individual, believes that making a change as a personal value has to be valuable. The law of belief. The individual believes that there's that they have the power to get it done. That's a very important part of making changes. They have to believe that they can get this done and law of expectations, they believe that if they do it, they're gonna get some results out. The law of attraction. We're trying to develop a plan that has some characteristics of a healthy lifestyle, but you're attracted to it, loss of control. You have the the start button, you know, accept the notion that a result achieved through self control and discipline. And the law of thought means that you just gonna have to put this on the on the burner that says I have to keep this thing going and move it along. Now the A. B. CS of behavior change and we'll go through these pretty much easy to understand. Health care provider, patient clearly defines the seriousness on the issue, the diagnosis, the problem, patient understands it. Health care provided, clearly defines the treatment options. Patient clearly understands the treatment options position. Are you ready to make the change? Yeah, I'm ready to make the change. Okay, great. We want to get you off to a strong start. Now this is a little more time consuming than I probably have today. That looks at the personality styles of eating the physical eaters. The thinkers, the emotional leaders, the social leaders and the environmental leaders. We are all part of this matrix of eating physical leaders. We call them foodie. Sometimes they love the taste of food, the crunchiness of food. They love this. The physical act of food. They love to look at food. The thinkers, they're thinking about how do I negotiate food? How do I negotiate doing exercise or not negotiate or not doing exercise. They're constantly thinking of ways that support maybe their traditions or maybe some of their habits that they've had with family members. We've got thanksgiving coming up, the thinkers will say, well, you know, it's important to have a very big meal on thanksgiving and I'll say, well, what's so important about the large meal? How about just the meal with a slightly different approach to it? The thinker will think about it a bit and if it makes sense to them, they'll do it emotional eaters, stress management is a big one. People that are stressed their emotional eaters, I don't feel so great, I'm bored, I'm tired, exhausted from things food's gonna taste good. So they get some, you know, emotional support from that. The socially, as we talked a little bit about already with the idea that there are people around us and then environmental ears where if the, if the food is visible available and accessible, it's more likely to increase the likelihood that you're going to eat. Now. I think what's very important on all of this is this, this concept of strong start and what's a strong start, a strong start is that they feel like they've made some progress very very quickly. So let's go through a couple of pat things about strong start, there's elements of a strong start, a strong purpose, confidence, stimulating vision, short term goals, clearly defined plan, which is very important, not just I'm going to do more physical activity, but clearly define what that physical activity is for example, so a clearly defined plan, a commitment to be in motion as we talked about already well defined progress markers, which are simple records and then a schedule of accountability, which is where in my particular role I come in as the coach, you know, we've already talked a little bit, a person needs to have a really good reason to do it. So they have a good reason, they have positive self talk and off they go, they believe that they can do it, they have confidence, they have what so called self efficacy, I can do it, I have the tools to be able to do it, I'm gonna do it, it's going to have a great success. Would I do it because I really believe that what I am attempting is going to work for me and the short term goal is very important. Now the middle button is really where I want you to focus on achievable short term goals. I call it the 44 plan. I asked them not to make more than four goals and those four goals have to be achieved in four days. That may sound like a big thing for people to say, oh my gosh, four goals in four days, I don't think I can do it. I want them to make achievable goals And to be surprised when they do four days and then they give me some information about how it's going, they get it done, Joe. I did the 10 minutes that you were talking about a physical activity. I added the one vegetable to the plate. Okay, those are two of the four. So they should be very, very simple. They can do more, but I wanted to be a goal that they can achieve in four days, why we all know when you achieve something, it excites you and motivate you and get you going. And so when they achieve it, they feel good. So if they feel good in four days, then the fifth day is gonna be a lot better and the sixth day is gonna be a lot better and the seventh day is going to be a lot better if they set these wonderful goals that we give them sometimes and it's a little too much and they keep having slips and slides continuously. They're not going to have a lot of motivation in about six weeks is about when people drop out of behavior change programs unless they've had motivated successes along the way. Clearly defined plan is just what it says here. You have clarity of direction, skills and strategies and tools that need, that you need to be able to pull it off. So I have people think about their plans, we'll talk about this in just a few moments, very clearly defined plan. We already talked about being motion on a daily basis so that no matter what you do is that you're doing something, it's attractive. It's convenient. It's achievable and it's rewarding. Progress market's gonna tell you a little bit about the progress market really quickly about a patient that had a very, very simple progress market, which is basically like daily records. She said joe I commit to you for one week To do 30 minutes of physical activity that I'm very sure I can do. And I'm going to report back to you about how I'm doing. And I said great. And so she reported back and she was doing well, doing well in about 34 weeks into it. She says, I discovered something from my progress Marcus, something about myself. And I said, what you discover? She said, I discovered that friday saturday and sunday were my most difficult non physical activity days, she says. And I know that because I was putting little gold sticky stars on a wall calendar every time I completed a particular activity. And one day I was sitting back and I looked at the calendar and I noticed, well I'm doing really good, but I'm not doing so great on the weekend. So I said, what would you do with that information? And her comment was, well, I would take that information and I'd see what the heck is getting in the way or friday saturday, sunday. So you start problem solving simple little markers. This wasn't a complex, you know, how many calories did I burn. What was my fitness level and so forth. Just simple, easy ways of making some changes. The accountability is an important piece of this because we know that people will slide when they don't have anybody looking at them. You know, oftentimes, you know, you're a provider, you know, come back in four weeks, come back in six weeks, come back in eight weeks. Sometimes they don't, I asked them to account to me on a weekly basis in their early stages because we need to get the momentum going. We need to get you moving. So the momentum there is accountability. We have phone calls, we have emails, we have different ways of accountability, but simple accountability. It's kind of like when you're in school and you had two teachers, one teacher gave you homework, another teacher gave you homework. Teacher a give you homework and graded on the homework. Teacher be gave you homework and never looked at it, never asked for it, never said anything about it. Students are overwhelming school who's doing the homework for teacher be now they're doing the homework for teacher because teacher is going to look at it. So I set up a supportive environment for accountability. Patients will say, you know what I like about accountability is that it's nonjudgmental. So that's an important key here, is to give them feedback, but not be judgmental, supportive feedback is great. You want to be supportive, you want to be constructive and you want them to want to celebrate what they are doing, not only what they're not doing because we know slips and slides happen and it's not the slip and it's not the slide, but it's how they view it. We want to get them back on track and to get back on track. Is they just like, where am I now? I'm gonna go back to making sure that my goals are on the front page that I have some revisit your goals and focus on what you're going to do today. And I want you to do something that you feel like you're gonna have good success with. Mhm. Let's talk about the tools you need to make it happen, divide and conquer if you need and reframe the way you approach it when it wasn't happening for you and if you need to support them, recruit a support team and what is cognitive retraining it. Sometimes you just have to look at it a slightly different way. And I had this discussion with a patient two weeks ago who set up a 30 minute program and she wasn't doing so well. I'm sorry now three, a four day program, a four day exercise program. She wasn't doing so well with it and we talked about it a little bit and her reframing was you know what, four days is not getting done. And I said, well how about two days? And she said I can do that and she had the successes with the two days. So in my last slide being oops, it's goin is basically training, it's taking time two get patients to put their mind in a training mentality. Okay, thank you. Thank you. I I loved being able to hear what you're actually telling patients and what you're doing with them. So I think that was some great pearls and I'm looking forward to going back through your presentation. Um I do have a question from the audience. Um you mentioned environmental control and I think with people working from home and during covid, um it's been really hard to have environmental control and sort of what tactics are you? Are you giving to patients to help them when they're struggling with that? Yeah. Well, you know, they can identify where the problem in case of foods, you know, where the problem foods might be, what those problem foods are and maybe remove the visibility of it, put it in something that is a little bit more difficult to say. I had people wrap things in tin foil and put it in the refrigerator and they forget about it. You know, you don't want a lot of people do refrigerator scans, they'll open up the refrigerator and they're just scan it and look for something that is, look at that, that looks good. So remove some of the visual triggers. Of course the argument could be, well don't buy it to start with. You know, if you want to give up potato chips, it's really hard to buy them and then start saying no to it if they have a spouse that wants potato chips and you don't want potato chips, have the spouse by potato chips, put it someplace where they won't see it or put it in a brown bag around the potato chip bag and maybe review, reduce some of the visual cue there. It's tough. It's tough when you're living with other people, it's a little easier when you're the only person because you're the one in command of the environment where when you live with other people, you've got some other circumstances. And I guess the last question. Um similarly, I think a lot of us in the field noticed that not great things happen after dinner when it comes to eating habits and just curious to know what your suggestions are for people with post dinner eating or snacking. Yeah, I call them the family of these. Okay. And you have to have the whole family together. Okay. We know that urge is probably more so in the evening to other times urges come on and according to the specialists that look at this kind of stuff, They say, you know what we really have about 10 minutes where we're at a real difficult time period. So I tell people okay, 10 minutes, the urge is going to be very very strong. So you're watching TV and you're bored or something happened You haven't heard for about 10 minutes. So the first d. is the delay for 10 minutes. Then you add on distance yourself from the trigger area you know the kitchen or the family or the association so you distance yourself followed by. Remember you have two quality. So I'm gonna wait 10 minutes. I'm going to distance myself from the high risk environment. I'm gonna distract my mind with a non eating behavior. In this particular case it might be get on the computer look at your emails you know go searching for different kinds of things, delay if you have to get to the fourth D. It's gonna be practice mental discipline. You know self talk. You know I can just wait. It's not gonna I'm not gonna shrivel up and die in a few minutes. I'm just gonna wait and then the last D. Is where I tell them if it's problematic you're going to the last day is you pick it up and you destroy it down the garbage disposal in the trash can or you can distribute it to somebody else. I can tell you it's a simple concept but I can't tell you how many times people have said wow I'm really really surprise that a simple get away from it has worked for me. We all know what happens when we get on computers. Right? Sometimes we're on there for hours and we think oh my gosh okay yeah I thought that I think those are really great. I was trying to write down the four these while you were saying them, so thank you so much.
