A Commitment to Change

Making a commitment to change is a first step in successful thrivership. Changing dietary patterns and exercise habits is not easy. You need to have the time, the resources, and, most important, the commitment at a deep level to make these changes. Taking lifestyle change gradually and only committing to the changes you can sustain over the long-term is critical to success in this process.

The Decision to Change

When it comes to healthy behaviors, everyone knows what they should do. Eat well, exercise regularly, get enough sleep, stop smoking, and minimize stress. But if everyone knows this, why doesn’t everyone do it?

The simple reason is that change is one of the most difficult things for an individual to do. And lasting change is even harder. Unless you are ready and willing to modify behaviors — eat healthier food and exercise regularly — no amount of counseling or education will be effective. That’s why evaluating your readiness to change is a key step in the lifestyle decisionmaking process.

Readiness to change can be determined using the different stages of change theory, which proposes that lifestyle change is a gradual evolution in thought process and action. An individual’s stage of readiness can change overnight — a heart attack or a diagnosis of prostate cancer can be an extremely motivating event. Yet change based on fear and crisis do not lead to lasting change. The key is to utilize the “teachable moment” after such an event to turn motivation into action, and action into lasting change.

The transtheoretical model of change assumes that the average person goes through five steps in moving toward lasting adoption of new behaviors.

The first stage, known as pre-contemplation, is that necessary stage when you are not even thinking about changing as yet, at least not within the next six months. Some people can get stuck in this stage, and are resistant to obtaining information, discussing, or even thinking about the issue at hand. Obviously, one has to move beyond this stage to effect any significant changes.

When you can clearly state an intent to change within the next six months, you have moved to the second stage, known as contemplation. In this stage, you aware of the benefits of changing, but also aware of the costs or barriers to change. Those who are stuck in this stage are often procrastinators who are mulling over the idea of change but not are not ready to make the change.

Preparation, the third stage, is when you intend to take concrete or well-defined steps to change within the next month. Since this stage is a prelude to the next stage of action, it is more of a transition and most people do not stay in this stage for long.

Action, the fourth stage, is when you have made real and easily perceived diet and lifestyle changes over the past six months. At this point, actual changes in biomarkers such as body weight, waist circumference, or cholesterol can be measured.

In the final stage of maintenance, the changes have been made and a goal has been reached; the work at this point is to keep the diet and lifestyle benefits you have achieved. The stage is characterized by active steps taken to prevent relapse and to firm up any gains made during the action phase. Passive acceptance of any changes made is not sufficient for successful maintenance and long-term stability. Constant daily efforts are needed to keep from sliding back into old habits.

As you progress through each stage, you will find that different skills and strategies are required to achieve your goals. For example, exercise on a regular basis is the most important strategy to maintain weight but it is not sufficiently effective without dietary changes in the action phase, when weight loss is the goal.

The process of cycling through relapse and recovery and then maintaining behaviors for six months to a year gives a realistic view of the process of lifestyle change. This is not something you do once and forget. The changes are not earned until they are maintained for at least a year. Relapse is expected and planning for relapse prevention is critical. As you adopt healthier lifestyle choices, you will move through the stages, making progress and losing ground, learning from mistakes made over time, and using those gains to move forward.

Research has shown that individuals who regain weight do not ruin their metabolism but lose weight at the same rate on repeated attempts when the same diet is used. Cancer patients are often far more motivated than those who are simply overweight or have high cholesterol, and it is important to realize that a cancer diagnosis can be a very powerful motivator and may push you from “pre-contemplation” to “action” overnight. However, some cancer survivors have the urge to push the cancer out of their minds and behave as though it had never occurred. A realistic balance between the short-term stress of a cancer diagnosis that motivates behavior change over a few months, and the long-term realization that better diet and lifestyle can improve your quality of life, can lead to both real and important changes and the maintenance of those changes over the long-term.