Strategies for lifestyle changes: The stages of change

We all know that change doesn't just happen.  We go through different stages in our thinking and actions before we actually make change.  And knowing what stage we are in, can help us understand why we haven't quite made the change we want.


There are 6 stages of change described in the work of Prochaska and DiClemente (1986, 1992).  These are:
  1. Precontemplation - no intention to change in the unforeseeable future; unaware a problem exists
  2. Contemplation - aware a problem exists; seriously thinking of change; some ambivalence
  3. Preparation - intending to act in the next month; reduced ambivalence and exploration of options
  4. Action - taking action through modification of behavior, experiences or environment
  5. Maintenance - work to prevent relapse and consolidate gain
  6. Relapse - a recurrence of the undesired behavior or elimination of a desired behavior

Obviously, not everyone goes into relapse, but the goal, if you do, is to move back through the stages again and find the motivation to try again.  

As well as thinking about these stages and our own motivation, they are also useful to consider when we are trying to help others find their own motivation for change.  For example, if you have a spouse who is very overweight and it is affecting their health, you want them to make changes but maybe they are in the precontemplation stage.  What can you do to help move them into the contemplation stage?



Here are some ideas that may help:
In the precontemplation stage

  • phrase questions like "have you thought about......"; 
  • explore issues of "importance" and "confidence"
  • discuss past 'failures' and reframe them as learning experiences
  • heighten awareness but also provide options for reducing fear
     if these tactics don't work - just wait.

In the contemplation stage
  • provide information and facts
  • discuss outcome if there is no change
  • discuss alternatives
  • set a short term goal
     if these tactics don't work - keep reminding

In the preparation stage
  • discuss options
  • set a time and date to just do it
  • find a partner/club also wanting to make the change
     if these tactics don't work, provide evidence that underpins your concern

As you can see, if you use the suggestion for the preparation stage on someone who is pre-contemplation, you aren't going to get very far - and vice versa.

Aim to ask questions and listen more than give your point of view or tell them what to do.  Brain storm ideas together, discuss pros and cons etc.   And you can do this for yourself too....take some paper and start writing ideas or two columns - one with pros for change and one with cons for change.


What stage of change are you in right now?

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Strategies for making lifestyle changes: Slow down and chew thoroughly

This is one thing I need to keep working on: slow down when I eat.  I eat too fast and maybe you do too?  It's not a good thing.  The food we swallow should be well chewed so that it is liquid when we swallow it.


The first part of digestion begins in the mouth.  This is where the enzyme amylase, in saliva, is mixed with starches and their breakdown begins.  If you put food in your mouth and swallow it without proper chewing, you've missed this first step of digestion and the body has a harder time digesting that food later.

Yes, I know all the excuses: "I like my food hot. If I eat it slowly it'll be cool by the time I've finished". But if you are eating your food fast, after the first mouthful, you don't even taste it, never mind being aware of its temperature.

Or then there is "I don't have time to eat it slowly".  Well, we all need to make time.  It takes just a few extra minutes to properly chew a meal as opposed to wolf it down quickly.


Take some food into your mouth and chew it for at least 30 chews.  The more you practice, the easier it gets.

Here are some studies to consider:

  • Research conducted at the university of Pennsylvania determined that diners consumed more overall food and calories when they sped up their eating pace and consumed fewer calories when they slowed down.
  • Research on thousands of Japanese office workers showed that fast eaters ate more calories than slow eaters, tended to gain more weight, and were more likely to have insulin resistance.
  • Research shows that there is a lag in time from when you have consumed enough food to trigger fullness and when you actually feel a sense of fullness. The more slowly you eat, the more time you have for the fullness signal from your stomach to reach your brain.

So how can you practice this skill?  Here are some ideas
  1. Change something at the table where you normally eat - for example, put a candle or ornament on the table. When you see that, it'll trigger a reminder to slow down.  Each night, put something different on the table - it can be something nice or something odd like a ruler or box - anything that catches your eye and makes you stop and think.
  2. Put down your utensils between mouthfuls or if it is something you are eating with your hands, put the food down between mouthfuls.
  3. Don't fill up your fork until you've finished what is in your mouth.
  4. Eat without distractions. If the television is on, or you are reading - you tend to eat quicker - so slow down and think about the taste of each mouthful.
  5. Put a clock or timer on the table and watch just how fast you normally eat.  Then chew 30 times and see how long this takes.  Seeing the clock go round is a great reminder to slow down.
Not only will these slow down tactics help you eat smaller quantities, it'll also help your digestion.

The "chew" idea is also important with foods like smoothies.  A large part of smoothies is carbohydrates and starches, so when you "drink" your smoothie, make sure you also swish it around your mouth, and use chew like action with your teeth, so the saliva can start its amylase enzyme reaction to breakdown that carbohydrate.

Let's start with our next meal or snack.  Put something on the table now to remind you.  Lets give amylase a chance!
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Fig and Broccoli Tartine

One of the dishes we made in our Food as Medicine classes this week was Fig and Broccoli tartine. Tartine is the French word for open faced sandwich. It sounds so much nicer than just "sandwich".



These are lovely - and you can really be creative with your toppings, depending what is in season. I just happened to see some green figs for sale and our fig tree doesn't ripen until the fall, so thought it would be nice to use those - but you could put anything on top of the broccoli.


I don't generally eat a lot of broccoli - no specific reason, just that I don't seem to use it much - but this is a great way to serve raw broccoli and get all the benefits of some good cruciferous vegetables.

Here's the recipe:

Broccoli spread
1 head of broccoli
2 stems of basil
Juice 1/2 lemon
1/2 cup hazelnuts, toasted
2 garlic cloves
Approx 1/2 cup water
Pepper to taste

Tartine
Artisan 100% whole grain bread, thinly sliced
Fresh figs, sliced

Decorate/garnish: pea shoots, pomegranate seeds
Drizzle:  fig or pomegranate balsamic vinegar or pomegranate molasses

Combine all the ingredients for the broccoli spread in a blender or food processor with half of the water and puree. Add more water as needed until smooth, stopping and scraping down as necessary.
Taste and adjust the seasoning. Add more water if it seems dry.
Toast the bread.
Spread the broccoli spread generously on the toast.
Top with figs, pea shoots, pomegranate seeds and drizzle sparingly with balsamic vinegar or pomegranate molasses.

Instead of the pea shoots, you could try leafy sprouts or thinly sliced radish or anything that makes it look pretty!

As the bread we used was whole wheat, I made my own gluten free tartine using a square quinoa/rice cake - and it looked just as pretty - maybe even prettier, as you can see in the above 2 photos!



Another variation for those with nut allergies is using chickpeas instead of hazelnuts in the broccoli spread. I've made it using one drained can of chickpeas and no nuts.  The spread can also be used as a pesto for pasta or vegetables, by adding a little more water to it.

So get your creative hat on and think about some pretty tartines for summer lunches, or even dinners on hot evenings.
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A change in perspective

If things aren't looking good, or something in life is tricky - take a look from a different angle and different perspective - like this little birdie!


Hanging upside down means he can get to all the lovely insects he wants but he just couldn't get them when he was the right way up.
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Take time to smell the flowers on Friday

It's time for my new Friday blog post series - where I make time to go out into the garden and photograph the pretty flowers!

Today, this rose caught my eye.  It looks like it has been hand painted.


As small buds, just the tips have a dot of deep pink on them.....

And as they open out, the paintbrush adds a little more color.


Isn't it just stunning!  We bought it just a couple of years ago - and its a wonderful addition to our many roses.


I hope you had a little moment this week to stop and smell the roses...or other flowers.  Remember, lifestyle is important. Not just diet.  Spending time in nature is a wonderful calming and relaxing distraction to everything else going on in our day.
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One small change

After the holidays and maybe a few indulgences, many of us are trying to improve our diets and lifestyle. Whether you have made specific goals or resolutions, it often helps to just consider one small change.



Big goals are important, but in order to achieve them, it takes many small steps.

So instead of focusing on big goals, go for one small change every day - all in the direction of your big goal.



Here are some examples:

Split second changes:

  • order salad dressing on the side, and dip your fork into the dressing rather than pouring it all over the salad
  • at the supermarket, select brown rice instead of white rice
  • choose a smaller portion of meat
  • drink another glass of water
  • chose not to have dessert
  • select a fruit or vegetable from the store that you've never tried before
  • add a tablespoon of ground flax seed to your cereal
Five minute changes:
  • make your own oatmeal for breakfast and omit the sugar but add some fruit instead
  • make your own trail mix with dried berries and nuts
  • meditate for 5 minutes
  • chop up some leafy greens and dry (oil free) stir fry to add to your dinner
  • at the end of the day, write down three things that you are grateful for that day
Ten minute changes:
  • exercise for an extra ten minutes - or start out with ten minutes.  If you goal is to walk for 30 minutes a day, split it into 3 ten minute intervals. You'll get the same benefits.  
  • make a salad to go with, or replace, a meal
  • try a new recipe
  • play for 10 minutes! Have some fun.

All day changes:

  • gather up and throw out all the candy and chocolate in your house. If you don't see it, you'll think less about it and won't be able to eat it.
  • pour a large jug of water in the morning - flavor it with hibiscus tea for added antioxidants - and drink it throughout the day
  • take a break for 5 minutes every hour - and just move, stretch, relax your eyes by focusing on something in the distance, have some water
  • tell a friend about what you are doing to make healthier lifestyle choices and support each other throughout the day


Big Difference Poster
Think ahead and plan "what will be my small change today?"

Daily small changes will result in big lifestyle changes.  You can do it!  Just 7 small split second changes in one week can bring a difference.  Think what you can achieve with a whole year of daily changes!


Let me know what small change you make tomorrow.
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Happy Thanksgiving

Just wanted to wish you a Happy, Healthy (and plant-focused) Thanksgiving.


I am currently in England have a wonderful time with family.  Hope you are sharing this special time with special people in your life too.
R x


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Anti-cancer - a new way of life

One of my favorite books about cancer is "Anticancer - A New way of life " by Dr David Servan-Schreiber.  He got brain cancer at an early age and set out to understand the complex inner workings of the body's natural cancer-fighting capabilities. The book is both a moving personal story and also exposes the facts on the roles that environment, lifestyle and trauma play in our health.

The books is a wonderful preventive book for all of us, as well as a healing book for those with cancer.

Here's an interview with Dr S.S:



I highly recommend everyone read his book.
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What's in a name?

"Tickety-boo Health Coaching".

You may be wondering what 'tickety-boo health coaching' means....what is this blog is all about?   Well, allow me to elaborate.

Tickety-boo is a British word - now also commonly used in Canada.  It means things is going along just fine.....things are all tickety-boo. I think it has a nice ring to it and a sense of fun and ease.  It's a happy little word that makes you want to smile.  It doesn't mean everything is perfect, just that you have found a way to enjoy the positives in life.

So what about the "Health coaching" part? What is that all about? Health coaching is a way of guiding others to find the motivation to make changes that will improve their health.  The relationship between a health coach and their client is a supportive partnership where we can discuss topics such as:what is troubling most about a certain health condition; what would the person most want to change; what support do they have; what obstacles are there, etc, etc.  Health coaching focuses on the special issues and concerns unique to the individual person that are preventing them from leading a healthier life.

The simple goal of Tickety-boo health coaching therefore is to help you feel tickety-boo!


In my area of health coaching, I specialize in helping people with cancer and helping people improve their lifestyle to prevent cancer.  This includes diet (e.g. what should you eat during chemo or radiation therapy), what foods help with side effects of cancer and therapy, what exercise is good, ways of relaxing, guided imagery, biofeedback, spirituality, etc etc.

As my blog progresses, I'll tell you more about how we can work together and how tickety-boo health coaching can help you.  I'll be coaching people one on one and also running a variety of educational community programs.  I will also implement an e-coaching program too, for people who don't live local to me in Northern California.  All this to come soon.

But for now, take two minutes and watch this little video to help you understand just what feeling tickety-boo is all about. I bet you'll be singing along by the end of it!   It features Danny Kaye singing a song entitled "Everything is tickety-goo" from a movie called "Merry Andrew". 

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