Over the last year I’ve written articles focused on the benefits of physical activity and healthy nutrition. But in my attempts to encourage people to be active and eat healthy, I may not have done justice on how difficult change is.
The other morning I was getting my breakfast, pouring out my cereal when I paused to look at the bowl and asked myself, is this it? Why do I continue to eat this cardboard-like food every morning when I know there are better alternatives? I even wrote about the value of breakfast a few weeks ago, so it’s not a case of me not knowing what else to eat.
It then dawned on me how difficult change is. A few years back I did move away from breakfast cereal every morning and replaced it with either hard boiled eggs or peanut butter on toast or yoghurt. I was trying to increase my protein intake after recognizing that the Raisin Bran I was eating had a mere 4 grams of protein with 240 calories, much of the protein coming from the milk. Compare this to a single egg which has 6 grams of protein and only 78 calories.
I was able to maintain this for about a year or so before I gravitated back to cereal, but instead of going back to Raisin Bran and Frosted Mini-Wheats, I changed to cereals higher in protein and fibre, plus if I’m feeling adventurous, I add in Craisins or blueberries. So overall a healthier choice than before, but not the best. It is just so easy when I get up in the morning to not have to think about what to eat. And just like a professional athlete shooting a basketball, my muscle memory takes over pouring the cereal into the bowl.
Changing one’s lifestyle is difficult. And while knowledge is important, more is needed for change (there are a number of doctors and nurses that smoke). We’re creatures of habit and like the status quo. It doesn’t mean that the habits we have are inherently bad. When we have a healthy habit, it’s hard to change that as well.
At the same time, change can be exciting and brings variety into life.
Some changes can be easier than others, like parking in a different spot at work, while others, like introducing exercise into your life, changing what you eat or quitting smoking can be quite hard. Also, the ease or challenges can differ from person to person. Just because one person started exercising without hesitation or problems, doesn’t mean it’s the same for everyone. And it doesn’t help when that one person tells everyone I started exercising no problem, or When I wanted to quit smoking, I just stopped. If things for us don’t go the same way, we think we’re failures.
Starting as early as infants we learn numerous behaviours from observing others. Take language as an example. The language we learn to speak is based on what is spoken around us. A child isn’t going to start speaking Italian living in an environment that only converses in French. We even get feedback, whether directly or indirectly, on how we do when we first start speaking. This provides further guidance. As we continue, and succeed, we start to get more confident in our abilities to speak.
Learning to speak highlights three keys to undergoing a behaviour change: the person, the behaviour and the environment (which make up Social Cognitive Theory; a leading theory on behavioural change). In the example above on learning to speak, all three of these things interact. The environment is the family and greater community speaking French, the person is the knowledge and attitudes the child has and gains, and the behaviour is the feedback the child gets when he/she does speak.
The same can be said for starting an exercise program (or a new healthy diet). If we see a lot of people exercising, we’re more likely to exercise ourselves. In some ways it normalizes the behaviour but it also provides numerous role models to draw upon and learn what works and what doesn’t. When I’m looking to do something new, I seek out people I know who are currently doing it for their guidance. Conversely, we can appreciate that a smoker trying to quit may have a tough time if surrounded by people who smoke. As a result, many patients I’ve worked with on quitting smoking have taken it upon themselves to change their environment by limiting time with friends and in places that may be conducive to smoking (like social gatherings, parties).
An important element of behaviour change is one’s confidence. Often this is referred to as self-efficacy; the belief in one’s ability to undergo that behaviour and do it well. Self-efficacy is prominent in the Social Cognitive Theory, as well as other theories of behaviour change like the Health Belief Model.
Previous personal experiences with change, like starting a new exercise program, can influence our self-efficacy. We draw on our previous successes and failures to inform how we will do in the future. Self-efficacy can also change based on the context; exercising when it is warm and sunny out tends to be easier for most people than when it is cold and rainy. We may also have high self-efficacy for some behaviours, like exercising but that doesn’t translate to all actions. I find it easier to exercise daily than I do to limit my amount of foods containing refined sugars (it’s a work in progress).
Increasing our confidence and self-efficacy is a crucial step in initiating a new behaviour. We can do this by recollecting previous successes so change doesn’t seem so daunting, analyzing failures to see what can be learned, and creating a supportive environment, whether that means an environment of supportive people or an actual supportive physical environment (not purchasing those foods with refined sugars, putting up motivational posters/reminders).
Next week I’ll continue with how we can plan and prepare for long-lasting behaviour change.