Ryan Bradley, ND, MPH is a naturopathic doctor, clinical researcher and epidemiologist in San Diego, CA. He is an Associate Professor and Assistant Director of Research at the National University of Natural Medicine in Portland, OR and an Assistant Professor in the Department of Family Medicine and Public Health at the University of California, San Diego.
Another New Year -
Another Opportunity for Success!
Ryan Bradley, ND, MPH
- How Do I Plan for Successful Change?
- Do You Love Yourself Enough to Change?
- Take Inventory and Align Your Positive Resources
- Set Your Own Goals
- Think Incrementally
- Visualize and Ask, “Is this Plan Realistic - for ME?”
- Don’t Go At It Alone
- Reward Yourself - Carefully
The New Year is an excellent opportunity to plan a strategy for successful change throughout the year - including how best to align resources for change. For many, the New Year is a time for making resolutions about things we are not happy with in our lives; for some, these resolutions are about family and relationships, for many others, especially those people who manage diabetes, resolutions are about health-related goals and commitments.
...it is difficult to address many years of living behaviors and habits and change them in a lasting manner overnight!
I tend to think New Year’s resolutions are over-rated. Let’s face the truth: it is difficult to address many years of living behaviors and habits and change them in a lasting manner overnight! Also for some, breaking a resolution equates to not being successful in a commitment, and this can lead to a spiral of guilt and negativity. So, in this New Year of hope -and challenge- for us all, I’ll leave aside the technical descriptions of nutritional supplements, herbs and drugs, and focus instead on the number one element for successful management of diabetes: planning to successfully reach your health goals!
Planning for success is subtly, but significantly, different than planning for a lack of failure. The difference is the mental shift required to put your success at the forefront of your thinking, rather than remaining in fear of failure and attempting to avoid it. Fear blocks our potential, and can keep us from realizing our dreams.
Successful behavior change requires identifying changes that are sustainable, incremental, self-reinforcing and provide both reward and challenge!
An incremental approach is usually much more conducive to success than an “all or nothing” approach. For example, losing 50 pounds in a few months by strictly reducing calories, avoiding your favorite foods and exercising every day (when previously you did not exercise at all) is unlikely to be successful. However, a goal to lose 20 pounds in three months by reducing your portion size on meals, replacing nutrient deplete but calorie-dense foods with nutritious whole foods, and starting to exercise three days a week for 30 minutes per day is more likely to be successful. Although you may not be down to the exact bathing suit size or waist size that you ultimately want to achieve, you have started the process, have been successful and still are able to feel better about yourself on vacation knowing you are reaching your goals!
Successful behavior change requires identifying changes that are sustainable, incremental, self-reinforcing and provide both reward and challenge!
Your end goal can certainly stay the same, but the approach and thought process to reach the goal can influence its chances of success. The differences in thought can be subtle! For example, a goal of 50 pounds of weight loss will result in many days not being successful, since 50 pounds takes a long time to lose, but an alternative goal of losing 1 pound per week allows for many small successes towards your goal. Although this amount of weight loss does not sound particularly significant, imagine this rate over 1 year. 52 pounds of weight loss over one year, providing 52 small successes during the process! By this time next year (Is one year really that long to change your health forever?), you have met your final goal, incrementally and sustainably!
Positive behavioral change requires motivation and, at some level, self-love. Because conditions like diabetes go on for a long time before they become symptomatic, many positive behaviors don’t immediately make us feel better* (although exercise usually does make us feel better right away). Changes toward a healthier lifestyle are not like drugs; the effects are not immediate. Unfortunately, eating 4 servings of vegetables per day for a week is not going to undo 30 years of eating only french fries and ketchup as vegetables (interesting that the USDA considers french fries and ketchup vegetables at all!). So where does the motivation come from? Why bother making changes that don’t make me feel better? This is hard question to answer, but I think the answer is self-love and love for others in our lives. So, given you aren’t going to immediately feel better following that extra serving of collard greens (and they don’t always taste better- fat and salt is tastes quite good!), it really takes a commitment to your health and a love of yourself to follow a healthy diet.
*Although I speak above about positive dietary and exercise changes not making us feel better immediately, after as little as a few weeks, eating more nutritious foods and getting regular exercise improves physical energy, mental energy, mood and often reduces pain, anxiety and depression.
In the context of diabetes, it really is the commitment to self-care that will allow you to be there for friends, family and loved-ones much longer and much healthier than self-sacrificing your health for the short term! In clinic, I often hear from patients that they cannot make some of the changes I recommend because of responsibilities to family members and friends that consume their time. I suggest a longer-term vision is needed; while sometimes we simply do not have time available because of responsibilities to others, often it is more the mental stress of caring for others that keeps us from caring for ourselves.
In the context of diabetes, it really is the commitment to self-care that will allow you to be there for friends, family and loved-ones much longer and much healthier than self-sacrificing your health for the short term!
Shifting to a longer-term vision helps you realize that not making short-term changes really does more harm than good to the loved ones in your life!
I understand there are many reasons why responsibilities to others, including children, spouses and loved ones, can take priority over responsibility to yourself, and your health. If this section of the article brought out sadness about yourself or your family, I apologize and encourage you to find a counselor, therapist or physician to discuss these feelings and to brainstorm little ways that your commitment to yourself can still shine despite other challenges - small changes can make large differences! Addressing emotional health, including depression and addiction, is critical to success. Resources, including medication and supplemental treatments, are available and are effective.
Like traveling in an unknown city, knowing exactly where you are starting is critical to ending up where you need to arrive! Sitting down and thinking carefully about the positive and negative influences, or “resources”, that you have in your life is essential for getting from Point A to Point B. These “resources” can take many forms; in some cases, these resources are physical resources like a new exercise bike, personal resources like your family or community support network, or health care resources like changing your physician if you are not satisfied with your care, or adding another provider type, e.g. nutritionist or complementary medicine provider, to your health care team.
It is important to think about positive “resources” that are available to you as well as the “negative” influences that are around you. Sometimes it may be hard to tell the difference at first glance! Consider making a list! Examples of positive “resources” maybe include: family members, friends, physicians, local parks, cooking classes, cookbooks, the local gym, community resource centers, diabetes support groups, programs offered by your employer and local clubs and organizations. A list may look like (but will likely be much longer!):
- Local swimming pool
- Friends - Judy & Ralph
- Local community center support group
- Daughter - Jill
- Dr. Arnold
- Diabetes Action Newsletter & Website
- Cupboards filled with white flour
- “Friends”- Jim and Eileen
- Snacks at work meetings
- Cost of fresh food
- Work stress
- Husband Jake's attitude toward vegetables!
- Forming a community around my diabetes,a diabetes support group
- Exercise clothing for the rain
- Nutritionist & cookbooks on Mediterranean cooking
- Time to cook!
- Smaller lancets to check my sugars
- A medication case organized by the day of the week
A quick review of this list above displays both positive and negative “resources” some of which are more easily changed. Time and money are recurring obstacles to change, yet some creative brainstorming can often provide some solutions.Challenges can arise with family food preferences and expectations on family responsibilities in particular. However, frozen peas and broccoli are inexpensive, nutritious and readily available and even if other family members aren't interested, this should not stop you from eating more healthily! Cooking in the evening or on a weekend afternoon for the entire week can help ensure you are eating good food throughout the week! A few dollars saved on a latte’ out provides enough cash to drop in at the local pool or gym to add variety to free exercise resources, like walks around a park or neighborhood trail. Reviewing your “resource list” with another person, especially someone else with diabetes, can help get another’s perspective on how they address similar challenges.
It is important to think about positive “resources” that are available to you as well as the “negative” influences that are around you.
Your physician can be an excellent part of your support network, and getting your physician’s advice on goals, like weight loss, can be helpful.
Setting your own goals, and obtaining them, is critical to successful behavior change. If you cannot visualize yourself reaching your goal when you make it, it is unlikely to be reached; therefore only you can create reachable goals for yourself!
Although physicians are skilled at telling patients what to do, and how many pills to take, it has been proven ineffective for doctors to take this type of attitude in recommending lifestyle changes. Your physician can be an excellent part of your support network, and getting your physician’s advice on goals, like weight loss, can be helpful. Hopefully your physician is willing to have some back-and-forth dialogue on how to achieve the changes he or she recommends, and is willing to set some incremental goals that you agree to and commit to reaching.
Lifestyle or health coaches can also be a good ally for holding you accountable to reaching your goals. Coaches should be interviewed about their training; a charismatic personality is not enough, coaches should have a health care background and understand the importance of diabetes clearly. Finally, a red flag to avoid is coaches, or trainers, who try to sell you health products or supplements; these recommendations are best made by trained providers only.
Creating an incremental plan for change is very important. I would recommend setting short-term goals in all the areas of your lifestyle that you feel need some change. This can become overwhelming, so start slowly.
Creating an incremental plan for change is very important.
Start with goals for the next day or week, then gradually begin thinking over the next 1-3 months. A good goal for the next day may be to eat one less snack during the day, or walk for 5 more minutes. A good weekly goal may be to add 5 minutes to each workout or add one more exercise session in for the week. A good once-monthly goal may be to be sure your doctors visits are in order for the next few months, and call to schedule those appointments that are not yet on the calendar.
Resist the urge to plan too ahead and consider reviewing your goals and progress on a regular schedule. Remember to give yourself credit for goals reached, and instead of criticizing yourself for goals not reached, critically evaluate your reasons for not reaching them, while finding possible solutions for reaching the next time around. This is a process that requires commitment to change - yet it also becomes easier and easier as the changes made become less foreign and more a part of your new lifestyle - so hang in there! After only a few weeks, these new behaviors become self-reinforcing!
The most important element of a plan for successful change is that you can see yourself completing each part of the plan; you must be able to visualize your success in order to achieve it! This may sound absurd or a little “woo-woo” or “fringy”, but all highly performing individuals, whether corporate CEOs or professional athletes, recognize the value of visualization in being successful. Structure studies have shown that visualization of sports performance, combined with moderate practice, is as or more effective than intensive practice without visualization.Granted, visualizing eating more vegetables is not as exciting as visualizing dunking the winning basket, or hitting a grand slam homerun, however losing 25 pounds, getting some energy back, or getting a good report from your doctor instead of another prescription sure is!
...you must be able to visualize your success in order to achieve it!
We can manifest anything we ask for in our lives, everyday we bring opportunity and obstacle into our lives. Consider practicing manifesting your improved health by visualizing yourself reaching your goals. If you are unable to do so, you have started too aggressively and it is time to review you goals and move in smaller increments.
...remember the ultimate commitment is to yourself and your health.
Friends, family members, counselors and local community organizations can provide a helpful support network to assist with making positive changes. Walking and exercise groups can be extremely motivating for dragging you outside on a walk when the weather isn’t very good, or picking you up for an exercise class when you don’t have access to transportation. Cooking classes can be great avenues for support and community, as well as provide new skills. Chances are there are others in your community seeking exactly the type of support you seek! If your community lacks a walking club, cooking class or diabetes support group, consider forming one. Place an ad in the newspaper and hold a meeting of interested persons. Considering holding a “Diabetes Potluck” where everyone brings healthy food and you consider new recipes as a group. Remember, you can assist others in meeting their goals too!
Although support from others can be extremely helpful, remember the ultimate commitment is to yourself and your health. If your walking buddy is out of town, get yourself out there anyway!
While trying to move ourselves to improved health through lifestyle change, it is important to consider “healthful” rewards.
Part of the fun of challenge and reaching your goals are the rewards that follow; rewards provide motivation for continued performance. For mountaineers, this reward is viewing the world from high above offering a different perspective on land and the people below (or perhaps on the triviality of the our day-to-day jobs!). For performance athletes, the reward may be monetary, fame or simply the inner joy of performing well. For the high-stakes activity of lifestyle change, rewards are also critical to success!
In our culture, we tend to “reward” ourselves with detrimental choices; often we “reward” ourselves with unhealthy food like dessert or a night on the town (often including a drink or two too many). While trying to move ourselves to improved health through lifestyle change, it is important to consider “healthful” rewards. For example, a healthful reward may be a new pair of shoes to exercise more comfortably, or a massage to relax those aching muscles. A reward may be a night out (minus the alcohol) to see a show, movie or a night dancing with friends. A reward may be spending a bit more for fresh ingredients at the local farmer’s market or for that fancier (but smaller) bar of extra dark chocolate! Rewards need not cost money either - a no-cost reward may be some time to read that new book you haven’t been able to start or a long bath at home. Ask your friends and family members to support you as well by assisting with your rewards - an hour of babysitting or some assistance around the house - can make the difference to continuing along your path toward health and personal fitness!
We are surrounded by many influences that seem to encourage following a less-healthy lifestyle: TV commercials promote artificially colored foods in boxes, drug ads tell us we don’t need to do anything differently to be healthy, city planners build more condos rather than create parka for free public exercise, and costly exercise facilities make physical fitness more exclusive. Like everything in life worth having, whether successful relationships or education, a healthy lifestyle requires hard work.
For people with diabetes, having a health lifestyle requires even more work because of the challenges of managing such a complex disease. Yet, with diabetes, having a healthy lifestyle is critically important to long-term health and fitness. Plus you provide an example for the growing numbers of children and young adults developing diabetes! I hope that this article helps you create and reach incremental goals for your long-term health. Change is a process requiring more than well-intentioned resolutions; instead, use your resolutions to stimulate your thinking and your personal process for successful, long-lasting change.
Happy New Year to you and your family! - Ryan Bradley, ND, MPH