HOW SHOULD BE THE TREATMENT FOR BEHAVIOR CHANGE IN OBESITY AND WEIGHT CONTROL?
Behavior modification therapy has gained importance in recent years. It is especially applied in the fields of obesity and eating behavior disorder. Especially in the treatment of obesity, it is very important to change the behavior by giving up the wrong habits that cause the individual to gain and lose weight.
Studies indicate that the duration of behavior change treatment should be at least 16 weeks, and the duration of weight maintenance after treatment should be at least 1 year. For this reason, it is necessary to lose weight more slowly in order for this behavior change to be permanent and turn into a lifestyle. For behavioral change in obesity, healthy eating habits should be given to individuals, physical activity levels of individuals should be increased and it should be ensured that they become a lifestyle by reinforcing them. Thus, lifelong weight control is achieved and weight loss is maintained.
Behavior modification treatment may vary, but generally the plan consists of methods such as self-observation, stimulus control, goal setting, alternative behavior development, reinforcement-self-reward, stress control, cognitive structuring-social support.
- Self-Monitoring
At this stage, the individual is asked to describe the behaviors that need to be corrected. The individual determines the habits that cause obesity by observing himself. He is asked to record situations such as whether he has eating attacks according to his emotional state, what time of the day he eats more, and what he eats. A form in the form of a diary can be kept and this form includes what is eaten at meals, with whom, where, when and how much is eaten, the degree of hunger before these meals, what is felt when the meal is eaten; it also includes the type and duration of physical activity and what is felt after the activity is done. Then, this form is evaluated and the behaviors of the individual that cause obesity are determined. Trying to interfere with more than one wrong behavior at the beginning may have negative consequences for the individual, so we, as dietitians, should arrange these behaviors in order of importance and intervene in order. In fact, it is best to decide together with the client. Behaviors that cause obesity determined by the form of the individual; Behaviors such as eating large amounts and quickly, taking large bites, constantly snacking between meals, engaging in other activities (chatting, watching TV, reading, etc.)
In this case, it is important that the goals are achievable by the individuals while starting to correct the wrong habits. This is the basis of the previous failures of obese individuals in particular. As goals are achieved, their self-confidence will increase.
- Stimulus Control
It is very important to provide stimulus control in behavior change treatment. Obese individuals should be able to control the stimuli that cause wrong behaviors around them in order to get away from wrong habits. For example, while providing stimulus control; To be full when shopping for food, not to buy foods that should not be eaten, to go shopping by preparing a list, to prefer healthier and low-energy foods, to plan the times and amounts of food to be eaten in advance, to plan activities to evaluate free time during the day and to avoid snacking at that time, Routine drinking water, considering the water bottle, creating free space for exercise, raising awareness and support of people in the immediate environment to encourage the individual, regularly weighing and noting the weight, not spending too much time in the kitchen, not considering food, not keeping foods that should not be eaten at home using small plates in meals and large plates in salads, getting up from the table as soon as the meal is finished, chewing slowly, taking small bites, not doing other activities (such as watching TV, reading) while eating, identifying risky situations that encourage eating and avoiding these situations. trying to stay away, avoiding alcohol, rich sauces and decorations, preferring no-calorie or low-calorie beverages, preparing oneself to refuse food offers, not driving short distances, not taking an elevator, walking at a brisk pace, trying to do housework by oneself, making people around “sufficient” Suggestions can be given such as encouraging the issue of “balanced diet and nutrition”, reducing the amount of oil while cooking, boiling instead of frying, grilling or cooking in the oven, etc.), doing different activities instead of eating in cases of boredom.
- Alternative Behavior Development
In behavior change treatment, individuals should look for activities that they will enjoy. These activities make it easier to control eating. In fact, this situation is aimed at ensuring that the individual acquires the right behaviors instead of the wrong eating behaviors. Various lists and reminders can be used for this. New behaviors should be tried to be placed in a way that adapts to the person’s routine.
- Self reward (Contingency management)
In this method, the aim is to reinforce the individual’s achievements and positive behaviors by rewarding them. Small agreements between the individual and his dietitian provide reinforcement to lose weight and gain healthy eating behavior. These agreements may be in the name of rewarding the individual. The reward should be something that gives pleasure to the individual and should encourage him. Some dietitians designate this reward as a free-eating day or a favorite food, but this is individual. If he cannot return to the normal program after the free eating day, and if he moves away from the right habits he has gained, this reward is not suitable for the individual. In this case, the reward should be chosen from activities that he enjoys other than food.
- Cognitive Behavior Modification
Obese individuals who have tried many diets and failed before have negative thoughts about themselves. Many do not love their bodies and believe that their efforts will be fruitless. Cognitive restructuring is when individuals move away from negative thoughts and replace these thoughts with positive ones.
While doing this, environmental factors are very important. The support of the individual’s close environment and family increases the success of the treatment by reducing the negative effects. Many studies have found that the effect of paired therapy is greater. Behavior modification therapy can be done individually as well as in a group. Individuals are encouraged and supported by each other’s success.
Obese individuals should be supported in behavioral treatment, for example, not doing high-calorie things, not eating, not making fun of their bodies, not breaking their beliefs, trying to eat healthy with them, and exercising together are among the things that can be done.
Behavior modification therapy is a long and complex process. In this process, which should be carried out jointly by the individual, dietitian and therapist, environmental factors should also be controlled. Habit changing is difficult, but not impossible. You shouldn’t rush. It is necessary to complete the process slowly and decisively. At the end of the process, success satisfies the dietitian as well as the individual.
