• Eating less food by reducing portion sizes and learning portion control
• Eliminating or limiting soda, alcohol, desserts or “red light” foods
• Planning and shopping for healthier meals and snacks
• Keeping a food and activity journal
• Going for daily walks (or jogs or bike rides)
• Reducing TV viewing or computer time
• Treating your health and well-being as a top priority
• Learning how to anticipate challenges and solve problems
• Taking responsibility for the food and activity choices you make each day
• Monitoring your weight, body fat or fitness level at least monthly

Before addressing specific behaviors that may need to be changed, it helps to see the “big picture.” Here, we present an overview of the various stages of behavioral change specially tailored to weight loss. In this table, each stage of change summarizes just a few of the many issues, barriers and concerns that adults experience as they move through the weight loss process. Note that since an individual’s needs and concerns differ dramatically depending on the stage, strategies to move a person from one stage to the next must be tailored accordingly.

To move from one stage of behavioral change to the next higher level, it helps to: (1) increase your awareness of the importance or value of achieving a healthy weight and (2) increase your confidence that behavioral change is possible and achievable. Regarding the importance of weight loss, most health care practitioners strive for two key outcomes: protecting good health in those who are overweight but otherwise healthy and reducing disease symptoms or medication requirements in those who are overweight and already have weight-related illness (such as type 2 diabetes or sleep apnea).

Yet, for many overweight individuals, health considerations may not be a concern. They may not know that weight loss promotes health or may feel that excess weight is strictly an appearance issue and other matters, such as providing food and clothing for their family, take precedence. Instead of lecturing on the health benefits of weight loss, which may backfire, one practitioner asks her patients to rank how important weight loss is now, on a scale from 0 to 6. They then discuss the ranking to get the conversation going.

To increase individual confidence, it is helpful to focus specifically on HOW to move forward, keeping a close eye on the identification of strategies that will increase the sense of self-efficacy. As shown above, there may be many behaviors that need to be changed, but breaking the process down into small steps and placing these steps in a manageable order may help. It is counterproductive to tackle many behaviors at once because it is too overwhelming.

It’s important to choose the right behavior to focus on first. Here again, using a ranking system may be helpful. For example, on a scale of 0 to 6, how confident are you that you can keep a food diary, eat smaller portions, etc?

Probing individual attitudes and goals regarding weight is a sensitive undertaking and since many people manage their own weight loss process, it requires a self dialogue that must be conducted honestly and constructively. The following is a list of questions³ that may be useful when conducting this dialogue:

• Are you interested in weight loss at this time?
• Do you understand that weight management is a lifelong commitment?
• Have you attempted weight loss in the past?
• What is different at this time that may contribute to weight loss success?
• What factors may interfere with the achievement of successful weight loss?
• Do you have a plan to address those factors?
• Is excess weight interfering with your ability to be physically active?
• Is excess weight interfering with your job?
• Do you believe that excess weight has exposed you to prejudice such as employment discrimination or social disadvantages?
• Is excess weight altering your self esteem?
• Do you have the resources (e.g., time and money) to learn and adapt the new behaviors needed to achieve your goal?

In a future article, we will spend more time focusing on the Maintenance stage of change. For now, note that if a person loses weight but maintenance fails (relapse occurs) the individual re-enters the Precontemplation, Contemplation or the Preparation stage, and the process begins from there. In the event of a relapse, strive to capture any lessons learned so that what may appear to be a failure is converted into an educational and confidence-building process, instead.

In coming issues, we will discuss how to move through the various stages of change in greater detail. We will frame the discussion to help make it useful to individuals managing their own weight loss process, as well as to health care practitioners who are assisting their clients or patients.

This month, we put two seated movements together in what is known as a “superset” to work both the triceps (the back of your arms) and the shoulders. To complete this exercise, all you need is a chair and one soup can that you can grip firmly in your hand. To start with, select a can with a weight that allows you to complete the superset at least once. As you grow stronger, you can increase the weight. If you have a dumbbell, it can be used in place of the soup can.

The first movement in the sequence is an overhead triceps extension. Place the can in your left hand and, without moving your shoulders, extend your arm straight above your head. This is the starting position. Keep the part of your arm from the elbow to the shoulder still and bend your arm at the elbow and lower the can behind your head. This is the midpoint of the movement. Pause for one second and reverse the movement, straightening out your arm again. Repeat this movement seven more times for a total of eight reps.

The second movement is a shoulder press. You will start the movement with the can (or dumbbell) in your left hand, with your arm folded next to your body so that the hand with the can is resting on your left shoulder. Now press your arm straight up above your head, pausing at the top for one second. Lower the weight back down to your shoulder - that is one rep. Repeat this movement seven more times.

Now start over with the can in your right hand. Complete the superset of eight reps of each movement with your right arm.

What makes this a “superset”? A superset is two movements done back to back with little to no rest in between. The chart below outlines how the workout should progress.

Left Arm	Overhead Triceps Extension x 8 reps
	Little to No Rest
	Shoulder Press x 8 reps
	Little to No Rest
	Switch Arms
Right Arm	Overhead Triceps Extension x 8 reps
	Little to No Rest
	Shoulder Press x 8 reps
	Little to No Rest
	Rest 90-120 seconds and repeat 2 more times

You will notice that I specify “Little to No Rest” between movements. You should tailor your rest periods to your own personal fitness level. Starting out, you may need to take longer rest periods but as you develop a higher level of fitness, you can shorten the rest time. The key is to push yourself to work hard but, at the same time, listen to your body.

INGREDIENTS:

• 8 cups small green beans
• Cooking spray
• 2 cups sliced green onions
• 1/3 cup chopped walnuts
• 1½ Tbsp. chopped fresh or 3/4 Tbsp. crushed dried rosemary
• 5 Tbsp. fresh lemon juice
• 1½ Tbsp. grated lemon rind

DIRECTIONS:

1. Arrange green beans in a steamer basket over boiling water. Cover and steam 8 to 12 minutes or until crisp-tender. Plunge beans into cold water to stop the cooking process; drain.
2. Spray a sauté pan with cooking spray. Over medium-high heat, add green onions, and sauté until tender. Add green beans, walnuts, rosemary, and lemon juice; cook, stirring constantly, until thoroughly heated. Sprinkle with lemon rind.

Nutritional analysis per serving: 74 calories, 3 grams protein, 2 grams fat, 11 grams carbohydrates, 0 milligrams cholesterol, 4 grams fiber, 10 milligrams sodium

Source: 5 A Day recipe http://www.cdc.gov/nccdphp/dnpa/5aday/recipes