I recently finished the book “Changing For Good” by Drs. James Prochaska, John Norcross and Carlo DiClemente which details the six stages of change also known as the transtheoretical model of change.
The authors used this model to discuss how change that lasts affects smokers, drug addicts, chronic overeaters and alcoholics.
I wanted to take some liberties with the model to explain how (with the luxury of hindsight) the stages affected my ability to get clean from drugs.
At the end, I wanted to compare it against a hypothetical fat loss client about how they can make changes stick for themselves.
Per the model, the six stages of change are:
Within those six stages, there is another area referenced but not always listed as Relapse which could occur within the latter stages.
Here’s how the six stages directly occurred with my drug addiction:
Precontemplation: During this stage, people are not considering change. Often, they are in denial of the problem or have simply relegated themselves to their circumstances and don’t feel in control to change anything. In precontemplation, the person is not considering change for at least 6 months. For myself, I spent ten years with near daily usage of drugs. When copious amounts were available, copious amounts would be consumed. Even leading up to the year that I got clean (2006), I would still tell people that I would be a lifelong smoker (weed, not cigarettes). I also probably believed that I could successfully manage my cocaine addiction. I was unaware or simply blind to the fact that my addictions were affecting me socially, professionally and financially. Having the money for drugs superseded my ability to pay my bills which became the major catalyst for why I finally quit. In 2006, I had managed to put my drug use before paying my mortgage. Since my father was the co-signer on my house, when the past dues started showing up on the home, it wasn’t just my credit score that was negatively affected, it was his too. Once I saw that damage was being done to more than just me, I couldn’t bear the fact that I was harming him too. This circumstance quickly led to the next stage: Contemplation.
Contemplation: This is the stage where the people start looking at the benefits and possibilities of changing their behavior. They aren’t fully sold on committing to change but they realize that something has become problematic enough that it may need remedy. In the contemplation phase, the person is planning to change within 6 months. For myself, I didn’t spend a great deal of time in contemplation. As I’ll highlight later when I discuss fat loss, some people never leave the contemplation stage. Once I saw what my drug use and inability to stay current with my mortgage payments affected my father, I knew that my vices had finally gone too far. I threw away the last of the drugs I had on hand and started to right the ship that had gone completely off course. The next stage of change was one that I didn’t personally experience the way others might but I’ll cover it regardless. That stage is preparation.
Preparation: For many people, once they recognize the problem and have started to address the pros and cons of changing their behavior(s), preparation is where small changes may start to take place and more information is gathered to assist in changing the problem. During this stage, the person is planning on change within 30 days. I didn’t personally go through a preparation stage. There was no dipping my toes in the water and I didn’t start looking at N.A. (Narcotics Anonymous) meetings or books on how to quit. I just quit cold turkey. Others find that writing down goals or value statements as well as a given plan of action can be helpful. For myself, I would say I skipped this stage completely. After preparation, the next stage of change is Action.
Action: During the action stage, those who are embarking on change are actively moving towards a modification of behavior. For instance, a smoker may have purchased smoking patches, started a cessation program, etc. in efforts to quit smoking. It can be helpful for those who are in the action stage to reward the successes and to find a support system to align with. In this stage, change has started within the last 6 months. Since I had no stage of preparation, my next stage of change was action. The drugs I had on hand at that point were discarded and although I was still around drugs (my roommate was a user), I made my choice and stayed clean (temporarily, which I’ll discuss soon). My fiancée at the time (Jackson’s mom) was clean so it was easy to use her as a support because she wasn’t a user. One area I didn’t actively use during the action stage was rewarding my successes. It was more about repairing the financial state of myself and my father so that our respective credit scores could recover and my mortgage payments could be made current. This sets the stage for our next spot: Maintenance.
Maintenance: In the maintenance stage, a person is successfully taking action on the areas they want to change. They are distancing themselves from tempting scenarios and are actively developing coping strategies. A person in maintenance is still capable of lapse or relapse during this stage. Change has been in place for at least 6 months. While I didn’t realize it at the time, one of the most effective ways for me to maintain being clean was the fact that I was transferred to a different state a couple of months after I quit using. While it was still possible for me to find drugs in the new state, I had so many other things competing for my attention, that not having drugs nearby wasn’t as difficult to deal with. Had I stayed in the previous state, I’m not sure how successful I would have been in the short-term at staying clean. Temptation and being around the same friends I used to partake in drug use with may have been detrimental to my progress.
Termination: In the original model, termination was not a phase, rather Relapse (also known as Recycle), was. I’ll cover those shortly. It’s assumed that in the termination phase, the person changing has no desire to return to their former behaviors and no longer feels tempted by the same situations. It’s rare that individuals reach this area so the perception is that each person embarking on a long-term commitment to change is simply in maintenance phase.
Relapse/Recycle: It is likely that an individual attempting to change their behaviors will be tempted by and succumb to those temptations. A brief episode of the behavior is considered a “lapse” while a complete return to previous behaviors is considered a “relapse”. For these same people, it does not mean failure, it means a return to a previous stage. Think of these six stages working in a circle. The lapse/relapse shifts a person backwards to a previous stage. Most likely, there will be a return to contemplation, preparation, action or maintenance. There is no defined order. In my case, I had three lapses where I smoked again on separate occasions. There was no guilt, there was no full relapse. My last lapse was in 2009. Each episode put me right back into maintenance the following day.
Here is a point of consideration before I dive into how these six stages may affect someone who is trying to successfully lose fat and keep it off. I still have to “manage” my behavior to stay clean. I will sometimes feel an urge to do drugs although it isn’t a strong one. I am rarely, if ever, knowingly around drugs so I don’t have that temptation around me. That being said, about 5 years ago, I was around someone who I knew had very high quality product on them. I was “tempted” to ask and see what they had. I didn’t act on it. It was a thought and it passed.
Sometimes, people go into change thinking that once they are in maintenance phase that they will no longer succumb to previous behaviors. I don’t find this to be true, and especially not with food since we have to have food to live. The same cannot be said about street drugs, smoking or alcohol.
Now, allow me to craft a narrative about a woman who will be embarking on these stages for the purposes of fat loss. We’ll call her Sharon. Sharon is neither a current or former client of mine. However, Sharon’s story will share similarities with people I’ve worked with.
Precontemplation: Sharon has tried to lose fat several times over the last few decades. She doesn’t struggle with any clinical eating disorders but she has been on more diets than she can count and each one has a similar outcome: she can lose fat when she’s very adherent but once she reverts back to old habits, she regains the weight she’s lost and slightly more. She has all but given up hope that she will ever get to a weight she can be satisfied with. She’s married with 3 children who are each married as well. After her third child was born, she developed some symptoms of post-partum depression. As she has gotten older, she periodically gets “the blues” but she doesn’t take medication as she doesn’t think it’s severe. However, she has noticed that when those moments occur, she is more likely to comfort herself with snack foods like chips and crackers and she routinely finishes her evenings with some ice cream. She doesn’t care for exercise but she does like to go out for walks with her husband and their dog when the weather is nice. Sharon has noticed that with age and the additional weight that getting up off the floor is not as easy as it used to be and she gets out of breath when she’s bringing her laundry basket upstairs. Each time she thinks about going on another diet, she tells herself it’s not worth it and she’ll probably fail again.
Contemplation: Sharon’s daughter, Sheila, has just called the family to announce that she and her husband are expecting their first child which will be Sharon’s first grandchild. Overjoyed to see their family grow, Sharon can’t contain her excitement as she has always looked fondly on what it would be like to be a grandmother. A few days pass after the good news and she starts thinking about how active she’ll be helping Sheila once the baby arrives. She’s reminded about how getting up off the floor and carrying the laundry have become more cumbersome for her and she starts thinking again about possibly losing some weight before the baby arrives. There’s still a negative voice in her head that reminds her of when she’s tried and failed before but it’s relatively quiet compared to the happiness she feels when she thinks of what life will be like with a grandchild.
Preparation: Sharon decides that she’s going to commit to changing her weight. She’s not going to focus on a goal weight but she is going to start eating more nutritious meals and she realizes that not exercising more may be working against her. She spends some time online looking for places where she can work out and not feel self-conscious. She also subscribes to some recipe websites to help her make meals that look appropriate for her goals but don’t take long to make. She tells her husband, Joel, about her plans. Joel, always in support but also suspicious based on Sharon’s prior history, tells her he’ll do what he can to help.
Action: Sharon finds a small gym to join at a time when it’s not too busy. She hires a coach to teach her how to perform exercises safely and gets to train at her own pace as she doesn’t like perspiring when she works out. She’s decided that some of the foods in her house are not easy foods to navigate when she’s trying to succeed at fat loss so she throws away the crackers, chips and ice cream. She tells herself: It’s not like I can never have them, I just don’t want to think about them right now. Joel isn’t happy about the fact that his favorite chips aren’t in the house but he doesn’t want to discourage Sharon from her efforts. He knows that if he really wants chips, he can buy a bag to keep at his office.
Maintenance: Sharon is thrilled with herself. She’s set no expectations about how much weight she would lose, she just made a commitment to showing up at the gym no less than twice a week (sometimes she goes 4 days a week). She lost more weight than she anticipated through being mindful about her food intake and training consistently. She still has cravings for her salty snacks but since they aren’t in the house, the cravings come and go. While she is far from a weight that she wants to be at, she knows this is the longest she has spent working on improving her health. Shortly after she started the gym, she met a couple of ladies around her age who also trained at the same time when she was there. She liked having a community of people who were also trying to improve their health and weren’t in competition with one another. In the right lighting, she even noticed some muscle appearing in her upper arms. After a period of months, she came down with the flu and she wasn’t able to work out for several days after. When she was on the mend, she started back slowly because she didn’t want to lose too much momentum. However, Sharon found that after she recovered from the flu, she had lost some of her motivation to stay on her diet.
Recycle: One night, Joel surprised Sharon with her favorite ice cream. He knew she had been working hard to lose weight and exercise and he wanted to show her a token of love by bringing home something she hadn’t eaten in months. Sharon was appreciative of the gesture even though she wasn’t sure that she could moderate the food at that time. She had a small serving and loved every bit of it. After she finished, she felt a little bit guilty because of how hard she had worked to change the number on the scale. She asked Joel for another serving since he was having seconds and she finished that as well. The next day, Sharon felt that familiar pang of failure. That voice came back that said: This is how it always ends up. You go right back to how you were before. This is why you can’t keep the weight off. For the next several days, Sharon subconsciously ate a bit more than normal. She went grocery shopping and thought it might not be the end of the world if she bought chips and crackers and ice cream again. She still made it to the gym but something felt off. She knew that her granddaughter would be arriving any day now and yet she just couldn’t shake this slump she was in. Sheila made a remark about how she couldn’t wait to see what kind of grandmother her mom would be and a switch flipped in Sharon’s mind. She had been slowly reverting back to her old eating habits when it dawned on her what her original motivation was to change. Sharon slipped back a few stages to preparation and told Joel that she needed to remove those same foods from the house again. Joel asked: It’s not that big of a deal is it? I mean, I don’t have a problem eating chips so why can’t we have them in the house? Sharon doubled-down on her efforts. She said: I know that you don’t have a problem moderating them but they aren’t helping me reach my goals. I’m not asking you to stop eating them, I’m just not in a good place right now to navigate them when they’re in the home. Can I get your help with this? Joel sighed and said: You’re right. Is there anything else I can do to help you? Sharon, pleased that this conversation didn’t evolve into an argument, said: I appreciate it. I really do. I think I just need to find ways to reward myself that doesn’t involve food the way it used to.
Conclusion: Sharon is now the proud grandmother to Elizabeth and, while she doesn’t obsess over the weight she’s lost, she feels stronger and healthier than she’s felt through most of her adult life. Occasionally, she has lapses where she indulges in chips, crackers and ice cream but she’s found a way to manage those lapses without completely reverting to her previous habits. She gets cravings and urges just like anyone else but she pays attention to those feelings and she finds other ways to distract herself: that might include going on her walks with Joel and their dog, it might be by offering to babysit Elizabeth, and she still goes to the gym at least 2x/week. That negative voice is still there and sometimes she listens to it, sometimes she doesn’t. Sharon knows that it’s not a game of perfection, it’s a game of trying to pay closer attention to what her body and mind tell her and making the best decision she can at the time.
If I can offer any final wisdom to take with you, it’s this: expect change to take longer than you hope, expect to make mistakes, expect to have the feeling of: one step forward, two steps back. Make your goals known and define your boundaries to those who are close to you. The person you want to become won’t be realized until you make enough strides from the person you used to be. Manage temptations and be honest with yourself when you don’t feel strong enough mentally to resist what’s tempting you. This could be more problematic for drug addicts and alcoholics but the same concepts apply for fat loss as well.
(Special thanks to Jessica Cameron for the graphs in this article)