Special to The Hawai‘i Herald
More than nine months have passed since the start of 2015. How many of you have stuck to your New Year’s resolutions? You know what I mean: eating healthier, getting more physical exercise, keeping your life more organized, losing weight, watching less television, starting a new project of some kind, or whatever other activity you planned to take up (or stop) or behavior you resolved to change.
If you’ve kept to your New Year’s resolutions this far into 2015, congratulations! But you are in the minority. Researchers who study “resolvers” — those who make New Year’s resolutions — have found that the majority of people who make resolutions at the beginning of the year are not able to keep them. They may have good intentions, but the power of habitual behavior wins out in the end and most go back to their old ways. If this is you, welcome to the club. There are lots of us out there.
Change Often Takes Time
As we get older, it isn’t uncommon for our health care providers to recommend a change in diet, lifestyle and other behaviors to address an existing health care problem or to avoid problems that are likely to occur without making those changes. Treating diseases or conditions such as hypertension (high blood pressure), high cholesterol, diabetes, kidney dysfunction, unhealthy weight (either obesity/overweight or underweight) and others often involves changing the way we’ve been doing things for years, if not decades. When we’re advised to stop, or at least to cut down on something, such as decreasing our salt intake (including shoyu and salty foods), simple carbohydrates (such as white bread, white rice and processed foods) and unhealthy snacking, the advice is often easy to dispense, but hard to follow.
Remember years ago when nutrition experts recommended that people start eating more brown rice instead of white rice? For many locals, that was not a welcome change to their diets. There was resistance from those who had grown up eating white rice all their life. Many said they didn’t like the taste or texture of brown rice, even though it was supposed to be healthier because of its higher fiber and nutrient content. For some people, eating brown rice also carried with it a negative connotation, because at one time in Japan, unpolished rice was usually eaten by poor people.
But times have changed, and brown rice has finally found its way into the mainstream. (There’s even a cooking preparation method that produces germinated brown rice, which some argue is nutritionally superior to regular brown rice.) Many people who once vowed to never eat brown rice because it “tastes junk” now eat it regularly and may even prefer it to white rice because of how it tastes, not just for its nutritional value. You can even order brown rice at some Japanese restaurants and, occasionally, find sushi and musubi made with brown rice. However, there are some brown rice converts who draw the line and refuse to eat it with certain dishes, such as beef stew or oxtail soup. For those dishes and a few others, they say, “gotta have white rice!” In its defense, the quality of brown rice is sometimes due to its preparation. It has gotten a bad name, in part, because it is not cooked properly, so it comes out chewy and dry.
Other foods that are difficult to give up include ice cream, candy, french fries, chocolate, cookies, chips, cake, pasta, doughnuts and white bread, according to Prevention magazine article from several years ago. These foods are difficult to quit eating because of the high sugar, salt or fat content they contain, and, in some cases, certain foods have all three, such as the bacon ice cream sundae that was once popular. Our taste buds have gotten used to that kind of food, so eating something healthier often tastes bland and unappealing. At first you might feel sorry for people who are forced to cut down on salt and shoyu because they look sad and say, “No ‘ono without salt!” But people who have successfully changed their diets often say it takes several weeks, at least, to get used to it. Then it’s not as bad, especially if there are substitutions for the ingredient that has to be given up or reduced. Also, if the alternative is illness, sometimes a change in attitude is also required. The person is not living to eat, but rather eating to live.
Here in Hawai‘i, we can add an easy dozen irresistible foods to the list — Portuguese sausage, manapua, kalua pig, malasadas and that slab of canned processed meat that we fry and put on a rectangular base of white rice — everyone knows what I’m talking about. Then one day you go into the doctor’s office and he or she tells you that you have to stop eating that kind of food. You have to start eating “healthier.” The message you keep hearing is, “Eat more fruits and vegetables. Drink water, not soda or other sugary drinks. Cut down or eliminate processed foods. Get more physical exercise,” not only from the doctor, but from newspaper and magazine articles, television shows and public service announcements.
By now, most people know the good foods from the bad. But humans are creatures of habit. While there are some who can wake up one morning and decide they are going to make dramatic changes in their life and then follow through with that intention, most people take more time to make major life changes. Researchers who study self-change have observed that change is usually not the result of a sudden, overnight decision, but rather a process that involves a number of different stages that could take months. In other words, it is a process that may take a lot of time, not an event that occurs in an instant.
The Stages of Change
The Transtheoretical Model, for example, describes six stages of self-change: 1) Precontemplation; 2) Contemplation; 3) Preparation; 4) Action; 5) Maintenance and 6) Termination. This model suggests that we often take our time in changing, and even after we decide to change, we don’t always change for the long term.
In the Precontemplation stage, a person does not intend to take action on a particular behavior (e.g., a dietary change) within the next six months. There are many reasons a person may not be considering change, including a lack of information. A person’s diet may be contributing to a health problem, but he or she is not aware of that connection. The person — let’s call her Mrs. G — has no reason to change if she is unaware that her eating habits are contributing to her illness. Or, Mrs. G may be in denial because she does not want to change some of her favorite lifestyle behaviors.
However, when Mrs. G goes to her doctor for her routine physical exam, her doctor tells her that she needs to lose weight and start eating a healthier diet if she wants to avoid some serious health problems. Mrs. G listens carefully as her doctor explains why this change is important to her long-term well-being. At home later that day, she thinks about what the doctor said. She thinks about the advantages of weight loss and healthier eating and the disadvantages of not making those changes, including the impact it will have on her quality of life and the quality of life of her family members. Mrs. G decides she is going to start eating healthier and to lose weight beginning this month. She has now entered the Contemplation stage.
But talk is cheap (unless you’re paying for psychotherapy). The next stage is the Preparation stage. Mrs. G must now make plans to lose weight and eat healthier. She moves from the abstract to the specific. She signs up for free classes at her community pool where they offer water aerobics. She resolves to monitor her portions and to eat less junk food and more fruits and vegetables. She also plans to walk around the block every night after dinner. She has started a plan of action and is not just contemplating or thinking about change. Without a plan, it is like someone saying, “I am going to be a great photographer,” without having a plan to purchase a camera and to go outside and start practicing.
The stage after Preparation is Action. Enough planning, start doing! Mrs. G attends her water aerobics classes, eats healthier food, avoids late-night snacking on junk food, and buys good walking shoes and starts using them to walk a few blocks every night after dinner. This demonstrates literally walking the walk and not just talking the talk. She even buys a pedometer to count her steps and makes sure she walks 10,000 steps a day. (An interesting side note: A June 5, 2015, article in New York magazine claims that the 10,000-steps-a-day recommendation originated in Japan as a marketing strategy in the 1960s. An early Japanese pedometer was called “man-po-kei,” which translates to 10,000-step meter, or gauge.)
The next stage — Maintenance — can be especially challenging. How long can Mrs. G keep up with her regimen? You might be enthusiastic and committed at the beginning of a self-change process, but can it last? Our hypothetical friend, Mrs. G, really wants to quit. She gets discouraged, too, because she doesn’t always see the results she expects. But she perseveres. Her neighbors see her walking and encourage her to stay with it. To Mrs. G’s surprise, even though there were many times she wanted to quit, she has kept up her stated behavior changes for nine months and realizes that the benefits outweigh the costs.
The final stage, Termination, is when Mrs. G can make the personal changes feel like a normal part of her everyday life and not just something she is doing until she achieves a goal. The changes are permanent.
Termination sounds like a negative step, but it is actually a positive in the Transtheoretical Model, because it indicates that Mrs. G has no temptation to “relapse” and that she is confident about her ability to stick to the changes she has incorporated into her life. Termination is something to celebrate.
Psychologist John Norcross of the University of Scranton has been studying self-change for decades. In his book, “Changeology: 5 Steps to Realizing Your Goals and Resolutions,” Norcross recommends setting very specific goals for change. For example, rather than saying, “I am going to eat healthier,” or “I’m going to lose weight” — both of which are vague — Norcross recommends being specific and giving details. What, specifically, does “eat healthier” mean? What specific foods will be eliminated and what specific foods will replace the ones eliminated? How much weight does one intend to lose and what is the timeline for this weight loss?
Being specific makes it more real and shows actual commitment, not just vague talk. It’s like people who say, “I’m going to write a book one day!” That book will likely never get written until more specific and realistic objectives are stated, such as, “I am going to write at least two pages a day, every day, except Sundays” and “I am going to write to a publisher and pitch an idea for my book.”
Goals can be intermediate or long-term. A long-term goal might be to learn how to play the sanshin, the three-string Okinawan musical instrument. An intermediate goal that will enable a person to reach the long-term goal would be to find a good sanshin teacher, to inquire and sign up for lessons, to purchase a sanshin, and to practice, practice, practice. Goals should be realistic and attainable, measurable and time-specific.
As part of a self-change exercise, people can make two lists — one list specifying the pros (or good things) about the proposed change, and the other list specifying the cons (or bad things) of the proposed change. Change usually involves both good and bad. Making time for regular exercise, for example, may require getting out and moving (and actually perspiring, which some people have an aversion to) when you would rather be lounging around, watching television with a bag of chips. However, the pros of regular exercise could be feeling better about yourself, experiencing weight loss and more mobility and spending time with others who have similar goals.
Dr. Norcross has many other ideas for helping with self-change goals, including writing out contracts and action plans, posting weekly reminders, identifying “relapse triggers” (i.e., things that trigger old behaviors) and so forth. His self-change exercises and other resources can be found at www.changeologybook.com.
Peer support and family support are essential in attaining goals. Someone trying to stop smoking will find it difficult to do when friends who smoke try to sabotage the effort: “Come on, John, have a smoke with us. Just one won’t hurt.” Much of the academic research on self-change has involved behavioral modifications such as smoking cessation — the effort to stop smoking — which is difficult to accomplish for most people because of the addictive nature of nicotine. But trying to stop or decreasing any kind of behavior is difficult if people around you are not supportive. That is why with certain change efforts, outside help is required. If you watch television, you’ve probably seen commercials for the Hawaii Tobacco Quitline. This free program, funded by the Hawaii Tobacco Prevention and Control Trust Fund, uses methods that have been shown to help smokers quit if they are motivated to do so. The organization’s website (hawaiiquitline.org) says there are 140,000 smokers in Hawai‘i, and that 1,000 people die each year in Hawai‘i from smoking-related illness. Smokers ready to quit can call 1-800-QUIT NOW (1-800-784-8669).
Peer and family support are critical for someone trying to lose weight. When the whole family is involved, temptations can be removed from the house. However, sometimes only one person is trying to change. A person trying to lose weight, for example, should not be encouraged or tempted to eat cupcakes and junk food by other members of the house. That is like offering cocaine to an addict who is trying to quit to save his or her life. Medical and nutrition professionals can advise on the best diet program for particular health conditions, but information is not the only thing that’s needed to change behaviors that are already well-established. Self-change, especially for big changes, requires support from many different sources, often including spiritual, as the 12-step program of Alcoholics Anonymous (www.aa.org) suggests.
Self-change isn’t easy, and there is no one right way that works for everyone. That’s why there are so many different kinds of commercials on television, each trying to convince you to buy a certain product or program to help you lose weight, exercise, eat fruits and vegetables or whatever the case may be. They make it look fun and easy, but self-change experts know that big life changes are not easy. Changes in diet are especially difficult. People often fail at self-change. But the ones who persevere eventually succeed. They find the right mix of strategies and tactics that work for them. You may have heard exercise experts say that the best exercise is the one that you will actually do. For example, if you have no intention of ever getting into a swimming pool for exercise, then water aerobics is not the best exercise for you.
The other important take-away message about change is that it is extremely difficult to impose on another person who chooses not to change or makes only a superficial effort. You can’t force a smoker to stop, although you can create rules about where smoking can occur, as many businesses and government entities have done. You can’t force an alcoholic, an illegal drug user or a junk-food addict to change their behaviors unless they want to change. But you can let them know you have concerns and are willing to help, although you may need to focus on your own change.
Whatever self-change you want to make, remember that change usually takes time and may take way more than one attempt. And, always check with your health care provider before doing anything that may be risky to your health and well-being.
Kevin Kawamoto is a longtime contributor to The Hawai‘i Herald.