LifeSteps

lifestyle change

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Small Changes Lead to Success

By Veronica Villa, Student Mentee

  • Do you want to see your clients improve in their journey?
  • Do you struggle to know what to say when they blame their lack of change on themselves?Small Changes
  • What strategies do you suggest they use to make change easier?

BJ Fogg, PhD, founder of Stanford’s Behavior Design Lab, tested different methods that helped people successfully make behavior changes through practical, applied, hands-on experience. He compiled his research into the best-selling book Tiny Habits: The Small Changes That Change Everything.

Tiny Habits provides many methods to help clients make behavior changes. One of BJ Fogg’s fundamental statements is his second maxim, “Help people feel successful.” This is essential when working on lifestyle changes. One method he finds helps clients is developing a set of skills he calls “behavior crafting.” Behavior crafting guides your clients to implement behaviors that lead to achieving their goals and feeling successful.

One “behavior craft” you can encourage your clients to use is to redesign their environment. It’s easy for us as health professionals to underestimate the impact of environmental change. However, research shows that changing their environment increases their chances of success, especially as it relates to changing their eating habits and making more healthful choices.

Helping clients develop a behavior crafting skillset is the foundation of the LifeSteps® program, including changing their environment.

The individualized small group program provides many options for how to successfully change their environment.  This allows the client to find the best design for them. LifeSteps® helps clients identify their current habits with the “Where Are You Now?” self-reflection questions. After pinpointing their own unique environmental challenges, LifeSteps® provides a variety of suggestions per problem area, so clients can find success in a manner that fits their lifestyle. For instance, in Step 9: Managing Lapses – Dealing with Your Environment, one of the strategies is “make food visibility and availability work for you.” Some participants might put fruit on the counter while others might put foods they don’t want to eat in the back of the cabinet.

To see another example of how LifeSteps® encourages participants to “behavior craft” click here

Help your clients on their journey of small steps toward a healthier lifestyle. Sign up for the LifeSteps® Leader Training today! Contact tracy@lifestepsweight.com for more information.

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Screening Isn’t a Checklist, It’s a Tool

By Veronica Villa, Student Mentee*

RDNs! An essential step you can take before starting your group program is to conduct an initial screening interview with your potential participants using motivational interviewing techniques.

Many factors lead to clients in groups reaching their goals. Some of these are having a great leader, effective communication, accessibility, and group cohesiveness.  One of the best ways to learn about potential group members is through an initial screening interview.

Why Screen Your Clients?

LifeSteps-Screening Client

When you know your clients’ intentions and needs, you can use them as you start your program.  This can lead to more focused and sustainable weight management sessions. tailored to your client’s needs.

There is very little research about screening clients specifically for weight management programs.  However, the Substance Abuse and Mental Health Services Administration Treatment Improvement Protocol discusses the importance of matching clients with groups. (1) Though this protocol is for substance abuse treatment, it still presents many great points for group weight management and lifestyle change program screening. It recommends that when you work with a group, it is essential that the group “moves as a whole”.  And trying to get everyone on the same page without any previous assessment can add some obstacles. 

The Screening Interview

According to the Substance Abuse and Mental Health Services Administration protocol, evaluating the following parameters during your screening interview helps you know if a potential client is suitable for participation in your group. These parameters can be adapted for weight management and lifestyle change initial interviews to include:

  • Characteristics and Needs- Key information about clients’ work and lifestyle,
  • Preferences -Specifically around food and activity
  • Readiness and Motivation for Change – Why now is a good time
  • History – Both health and nutrition history, including information about previous weight loss attempts

Using an open-ended, motivational interviewing questioning style elicits the prospective participant’s self-motivational statements and builds rapport.

Other Considerations

A group health coaching article notes that this kind of initial interview can be used effectively by also providing inclusion and exclusion criteria so you have clear referral pathways in place for those who might be better served by individual counseling or other types of services. (3)

A complete screening interview also incorporates anthropometric measures including BMI and waist circumference. The Academy of Nutrition and Dietetics Adult Weight Management (AWM) Guidelines (2), NHLBI and CDC all recommend using BMI as part of the initial screening interview, but caution that it does not diagnose body fatness or health. The following BMI and waist circumference cut points are recommended by all three for inclusion in weight management programs:

  • BMI
    • BMI is 25.0 to <30 falls within the overweight range.
    • BMI is >30.0 falls within the obesity range.
  • Waist circumference:
    • Men: More than 102cm (more than 40 inches)
    • Women: More than 88cm (more than 35 inches). (2)

When you conduct screening interviews that gather this information, it sets each client, the group, and you up for success.

LifeSteps®

A key component of LifeSteps® is a detailed Initial Interview that gathers all these pieces of information. With this tool, you will better understand your clients and plan accordingly.

Tracy Pfaffenberger, LifeSteps® Manager, notes that LifeSteps® Leaders not only find the Initial Interview helps to identify participants who will do well in a group setting, it has the added benefit of improving their program retention rate.

Learn More

If you would like to learn more about LifeSteps® and our Initial Interview process, please schedule a free information call with a LifeSteps® team member.

References:

  1. Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series, No. 41. HHS Publication No. (SMA)15-3991. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.
  2. Academy of Nutrition and Dietetics Evidence Analysis Library, Adult Weight Management Guidelines, Screening and Referral, https://www.andeal.org/topic.cfm?menu=5276&cat=4690, Accessed April 8, 2022.
  3. Armstrong C, Wolever RQ, Manning L, Elam R 3rd, Moore M, Frates EP, Duskey H, Anderson C, Curtis RL, Masemer S, Lawson K. Group health coaching: strengths, challenges, and next steps. Glob Adv Health Med. 2013 May;2(3):95-102. doi: 10.7453/gahmj.2013.019. PMID: 24416678; PMCID: PMC3833535

*Student Mentee from RD Mentorship Program, which partners Registered Dietitians (RD) with nutrition students from around the US.

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Show Us the Data!

Topics-in-Clinical-Nutrition-AbstractThose of us who have taught LifeSteps® know the program works!

Our participants know the program works!

And now, we have published data that shows LifeSteps® works!

The study was published in the July/September 2018  Topics in Clinical Nutrition: “Impact of the LIFESTEPS Weight Management Program on measures of adiposity, self-efficacy, and lifestyle behaviors” by Woolf, Kathleen, PhD, RDN, FACSM; Heller, Jenna E.,MS, RDN; et al.

The study evaluated measures of adiposity, self-efficacy, and lifestyle behavior in 1592 participants from 13 states enrolled in LifeSteps®.

Special thanks to Kathleen Woolf, PhD, RDN, FACSM. Dr. Woolf is an associate professor and director of the nutrition PhD program at New York University; and previously an associate professor in the Health Sciences department at Arizona State University.

LifeSteps® is a behaviorally-based lifestyle change program that can enhance your practice. Click here to learn more about LifeSteps®.

Results:

Measures of Adiposity

Mean weight, BMI, waist circumference and waist-to-height decreased significantly between the initial and final assessments for those completing the LifeSteps® program.

Adiposity Measure Initial Final
Mean Weight 98.2 ± 23.3 kg 95.0 ± 23.0 kg, p<0.001
BMI 35.7 ± 7.5 kg/m2 34.5 ± 7.5 kg/m2, p<0.001
Waist Circumference 108.8 ± 15.3 cm 104.7 ± 15.1 cm, p<0.001
Waist-to-height ratio 0.66 ± 0.09 .63.0 ± .09 , p<0.001
Measures of Self-Efficacy

Participants reported greater self-efficacy for weight management and physical activity upon completion of the program and self-efficacy was positively associated with percent weight-change.

Self-Efficacy Initial Score Final Score
For Weight Management 12.9 ± 3.1 14.0 ± 3.1, p<0.001
For Physical Activity 13.5 ± 3.3 14.1 ± 3.4, p<0.001
Lifestyle Behaviors Most Helpful for Weight Loss

After completing LifeSteps®, 754 participants completed the post-assessment questionnaire and identified three behavior strategies most helpful for weight management from a potential list of 15.  Responses were analyzed for three groups based on the amount of weight lost. The top five selected overall were ‘keep food records’ (n=480 [63.7%]), ‘measure serving sizes’ (n=303 [40.2%]), ‘do aerobic exercise’ (n=300 [39.8%]), ‘record calories’ (n=297 [39.4%]), and ‘eat a variety of foods’ (n=192 [25.5%]).

Top Three Helpful Lifestyle Changes for Weight Loss
Helpfulness < 5 pound weight loss  (n=433) 5-10 pound weight loss  (n=254) >10 pound weight loss (n=55)
Most Helpful Keep food records (n=266, 61%) Keep food records
(n=167, 66%)		 Keep food records
(n=39, 71%)
Second-most Helpful Measure servings
(n=170, 39%)		 Record calories
(n=112, 44%)		 Do aerobic exercise
(n=33, 60%)
Third-most Helpful Record calories
(n=155, 36%)		 Measure serving sizes
(n=107, 42%)		 Record calories
(n=27, 49%)

Read the complete study here: Impact of the LIFESTEPS Weight Management Program on Measures of Adiposity, Self-Efficacy, and Lifestyle Behaviors  or it can be obtained through Topics in Clinical Nutrition website.

Enhance your Practice

If you’re not teaching LifeSteps®, you’re missing out on a valuable tool. Find out how this program can help you boost your business, and help your clients change their lives.