It's incredibly difficult to get people to break bad habits, even if they're deadly. I'm reminded of this when one of my favorite patients, who has suffered several heart attacks, tells me that she ate fried Oreos with whipped cream before finishing her first pack of cigarettes that day.
Although Julia (not her real name) always listens to my requests to improve her lifestyle choices, she doesn't actually take my advice. Years into her battle with heart disease, she is following her own path — one that I fear will end tragically.
So why do some people make changes to improve their health while others stick to bad habits? Surely you know someone you wish would “wake up” and get with the program, whether it's changing his behavior around nutrition, exercise, smoking, stress management or sleep. Or perhaps you've struggled to implement a lifestyle that you know you should follow?
Thankfully, psychology can explain why some people finally break bad habits and others don't. James Prochaska, the Director of the Cancer Prevention Research Center, has created a model for understanding change that has helped doctors and researchers develop strategies for success. His research was inspired by his own struggles with an alcoholic father who wouldn’t make changes for his health.
Prochaska went on to study people who were successful at breaking habits like smoking, overeating and alcohol abuse. He observed similarities that fit into six stages, sometimes referred to as the Transtheoretical Model of Change. I will use eating habits as an example to outline how this works in practice.
Stage 1: Precontemplation
In this stage, the person has very little interest in changing a behavior. Julia knew, for example, that a plant-based, no-added-oil diet could reverse her heart disease but she just wasn’t interested in trying it.
When someone is in this phase, the best approach is to be supportive and provide general information about the improvements associated with the lifestyle change (more energy, weight management, fewer medications and hospitalizations). I use the Vegetarian Starter Kit.
Stage 2: Contemplation
In this stage, someone is considering making the change but hasn't yet committed to it. Obstacles like time, expense, and fear, are weighed against the benefits.
I offer patients more information, and recommend watching videos and documentaries that make the case that the gain is worth the pain. The documentary Forks over Knives has been the most effective in my practice. Another helpful tool has been the patient support group I co-founded.
Stage 3: Preparation Stage
In this stage, the decision to implement change has been made. It's akin to standing at the edge of a pool dipping your toe in the water, knowing you will jump soon. Some effective ideas include grocery store tours, shopping guides, and providing simple recipes. I ask my patients to sign up for the free 21-Day Kick Start program, which provides a detailed shopping list and menu preparation guide.
Stage 4: Action Stage
The key to success here is planning. In this stage, people need rewards for short-term successes, like passing on the ice cream at the work party and filling up on fresh fruit. Also useful are reminders on lunch boxes, work desks and refrigerators as well as words of support from family and friends.
Stage 5: Maintenance
Ever heard of someone falling off the wellness wagon? All too often the gains are not maintained. What can help at this stage is holding on to mental images of success, identifying problems and solving them (maybe you need to buy a larger lunch cooler for the extra pieces of fruit and the mid-day munchies?). It's also important to celebrate successes, like taking one less medication.
Stage 6: Termination
The change is now a solid habit and there is no turning back. Resiliency and conviction have been developed. A rare treat off the menu, maybe half a dozen sweet potato fries, is no longer a threat as the skill and willpower are both so high.
I once heard that “only babies with wet diapers enjoy change” and serving patients for 25 years as a cardiologist has shown me that this is usually true. However, understanding and using these steps for success has been rewarding and hopefully will help you, too.