NASM CNC Chapter 14: Psychology of Weight Control and Behavior Change

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Chapter Goals:

• Discuss the model of the stages of change.
• Find the barriers people have to both diet and exercise.
• Know the most common disorders with eating.
• Discuss the comprehensive client profiles. This includes their different motives, behaviors, goals, and more.
• Know the different types of clients that we use to make customized programs.
• Discuss the psychological aspects in relation to fitness and wellness.

The Science of Psychology

Psychology is the study of the mind and people’s behaviors. There are a vast variety of fields of psychological study. While biology is more on the quantitative side, and psychology is more on the qualitative side. The outlook and study are on being able to observe behaviors and assess people on their own basis of what is being talked about. 

Communicating is a vital part of psychology since the correct questions need to be asked, the answers need to be heard, and the non-verbal cues have to be looked at. These non-verbal cues include tone of voice, body language, facial expressions, and any accompanying gestures.

Psychological variables are not tangible, like biology and other sciences, but they can still be firmly found.

Psychology is used in our fields of health and fitness in varying ways. This includes exercise, eating behaviors, and adjustments to health related lifestyles. Many of the psychology principles will be applied across these disciplines. 

Role of Psychology in Fitness and Wellness

This plays an important part in overall health because we do everything for some reason. Our role as nutrition coaches using psychology is not to diagnose the clients or even treat them; instead, we should aim to use psychology to become a better communicator, disseminate the right information, and support our clients.

Nutrition coaches can set themselves ahead of others by delivering the correct information well to their clients. Simply having knowledge is good, but effectively getting that knowledge to the clients is another. Psychology is used to make this communication more effective. 

The Desire to Change

Nutrition Coaches can help people every day, but it is unrealistic to force someone to change their behaviors. Instead, we should focus on influencing people by changing their habits through motivation and education combined. 

Motivation is defined as the reason that someone is driven to an action. And we have two forms of motivation at work. 

• Intrinsic motivation is a definition of when people are motivated by their own internal drive to get something done or to be successful. 
• Extrinsic motivation is the opposite type. This is when someone is motivated by the associated rewards and the associated recognition. These people will likely focus on the outcome of the behavior change and also look for recognition first. This is a less effective form of motivation, but still somewhat effective.
• Most people have a combination of the two forms of motivation. 

The first real step to success is the desire to change. With this, we should start by setting goals we want to achieve. We will discuss how those goals should be and the guidelines for how we should set those goals. After you have set the goal, you will work on behavior modifications and use those to achieve the set goals. This is the basic plan to success. 

Communication

As we said early in the chapter, this is super important for psychology and effectiveness. We will essentially be counseling people on how they can change their behavior, especially those relating to their overall health and well-being. With effective communication, we make this process more effective. 

Empathy, the ability to identify and connect with someone’s feelings, attitudes, and thoughts, is the most effective way for us to communicate. Here we will be putting ourselves in someone else’s life essentially. 

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Being empathetic means being a good listener, which is not easy for everyone. Clients need to feel that they are heard and the messages are being received correctly. Your body language and you facial expressions are used to convey empathy also. This is part of non-verbal communication, which is arguably more important than verbal communication. The parts of nonverbal communication to consider are posture, eye contact, gestures you make, facial expressions and changes, tone of voice, and body position. 

Posture = how you are sitting, standing, or if your arms are crossed.

Eye contact = making eye contact, maybe even rolling your eyes.

Gestures = pointing, thumbs up, or nodding.

Facial expressions = smiles, frowns, smirks, raising your eyebrows.

Body position = the spaces between people and how they position themselves.

Quality of Life

Having a solid quality of life will involve physical, mental, and social factors. It describes how happy or positive a person is in all of those domains. You should aim for quality in your years, not just living forever.

Stages of Change Model

Many theories look at how people can change their behaviors. Commonly we see the focus on the outcome of changes being valued by the person doing it. 

This model is also called the transtheoretical model. The stages of change are as follows:

• Pre-contemplation = this is when someone is not really desiring any form of change, and to get to the next stage, they must have some call to action.
• Contemplation = this is when someone begins to be aware of the need to change or the desire to change is persisting. So, they are thinking about how to change but have yet to change anything. 
• Preparation = this is when someone is taking the steps they need to change their behaviors. They may have started the steps slightly, but they are not regular and may have a plan to start in the next 30 days. 
• Action = this is the stage where the person is actually doing the change and has a solid plan for changing. But here, this has not lasted for more than 6 months yet.
• Maintenance = this is when the behavior is now consistent for more than 6 months without relapsing.
• Relapse = this is a very common occurrence in which someone reverts back to their old behaviors.

Applying the stages of change model includes many strategies for helping clients reach the next stage. The goal is to of course get everyone to reach the maintenance stage without having any relapse. But, there are many obstacles to overcome, and this is where the strategies come in handy. Each stage has its own set of recommendations for how to act with the clients and move on.

Psychology of Body Image and Low Self Esteem

Body reality is based upon someone’s measurable attributes like their weight, height, the circumference of their waist, and percentage of body fat.

Body Ideal is what someone believes or wishes for their own body to look like.

Body Image is how someone views their body as it currently is, but it may not be exactly how they are. 

We can look at these variables to define someone’s health status and also to place benchmarks and goals for them to reach.

Confidence and Self-efficacy

Confidence is how someone feels about their ability to get something done or even how they feel about their appearance. Confidence can range from low to high. Regarding eating and nutrition, this is the confidence that someone has in their ability to make the proper decisions when they are getting food. 

Self-efficacy is the confidence that someone has in changing or successfully engaging in behaviors to achieve that outcome. The level of self-efficacy changes based on many variables. These are mastery experiences, social modeling, social persuasion, and physical and mental responses. 

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Social modeling is described as vicarious experiences in that someone will model their own behavior based on. This is done by seeing someone doing something and then doing it or telling yourself that you can also do it. 

The Profile of a Weight Loss Client

Nutrition coaches work with a variety of client types, and this means that we should create a client profile of weight loss for the clients. This keeps coaches in their scope of practice and shows the need to refer to outside help. Before this client profile, the coaches should find the specific populations with which they are comfortable working with or the ones they have experience. 

Another important factor in the client profile is determining the client’s actual goal. Perhaps as a coach you have more experience or are simply more comfortable with a certain goal type. This would limit how much you work with other goals. 

We should use the client profile to look at the type of motivation. Determining the “why” for a client is important for getting to the “how”. 

Beyond Calories In Versus Calories Out

Real Life Struggles

It is important to look at the struggles that people face in real life. Some issues that people have will run much deeper than what it appears on the surface. Disorders in eating are a culmination of many potential things, and it is important to know that. 

Balancing the work you do, your family, exercise, and eating prove to be a tough task for someone to do when they consider making changes that affect each of these simultaneously. 

Combating Stigma

A struggle faced by obese and overweight people is that they are stigmatized as lazy automatically most of the time. There is an anti-fat bias that exists. This means that there is by default a negative judgment on the overweight and obese. 

Barriers to Diet and Exercise

The common barriers that people have are:

• Lack of time
• Lack of willpower
• Family and friends with different habits
• Lack of knowledge or expertise
• Social Influences

These are a constant part of our lives and will help and hinder our development and change. 

Social support is the ways that a person is supported by other people. This includes the factors of emotional support, providing information, and also assisting.

Emotional support is the simple provision of encouragement, accountability, or empathy to another person. 

Informational support is the provision of facts and educating others.

Social networks are social structures that are made up of various interactions or relationships that people or groups have.

Willpower

This is the ability for you to control your own impulses. 

For some clients, this is something that might be a big issue, and for others, it simply isn’t. understanding this will dictate how the client coaches them. 

Eating Behavior 

This can be defined on a spectrum from positive and healthy all the way to negative and unhealthy. 

Disordered Eating

Disordered eating is a pattern of eating that is not common, but this form of eating does not meet the criteria for diagnosis of an actual eating disorder. 

Triggers to disordered eating

There are many triggers for disordered eating that are seen. They can be environmental, or they can go all the way to long term psychological challenges people face. 

Distress is the experience of negative feelings. These are things like anxiety, sorrow, and pain. Stress eating, or eating due to stress, is a form of distress some face.

Depression is a mood disorder shown by feelings of sadness and/or the loss of interest in everyday life. 

Depression can be the cause for many different eating disorders. Depression also comes with a negative stigma just like being overweight and obese has its negative stigma.

Eating Disorders

People with eating disorders typically have very high mortality rates, and anorexia nervosa is the greatest threat. The three big eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. 

Anorexia nervosa is an eating disorder shown by a BMI that is considered extremely low for that person. 

Bulimia nervosa is a disorder of eating that is shown by episodes of binge eating that are then followed by compensatory behaviors like purging, using diuretics and laxatives, fasting, or other excessive things like exercise for the person to avoid gaining weight. 

Binge eating disorder is shown by frequently times when someone consumes an unusually large amount of food, followed then by feelings of loss of control and the inability to stop eating. 

Binge eating episodes often have three or more of these things:

• Eating much faster than a person normally would.
• Eating until you are full to an uncomfortable level.
• Eating large amounts of food when you are not even hungry.
• Eating by yourself and then feeling embarrassed by it. 
• Feeling depression or guilt after consuming food. 
• Symptoms of anorexia include fear of getting fat, a distortion of your body image, and then restriction of your calories severely. 
• Bulimia nervosa symptoms include everything in its definition. 

Modifying the Eating Environment

This is the most important strategy for changing behaviors regarding eating. We must modify how we approach our home environment, work environment, and social gatherings. 

One big shift that should be made is the shift from mindlessly eating to being someone who eat mindfully. This means you should be paying attention to the things that are entering your body.