Using Stages of Change "Tool" to Promote
Healthy Eating – Healthy Weights

Beginning the client intervention:

 Part of my job as a health professional is to prevent needless illness in my clients. Following a healthy lifestyle is a major way to reduce risks for many chronic diseases.

Take eating and having a healthy weight for example:
Eating well, being active and feeling good about yourself go together.

ASK about the client’s nutritional intake:

Suggestions:

• Do you think about the nutritional value of the foods you choose most of the time?
• Do you consider the fat and sugar content of the foods you eat?
• Are you eating the recommended amounts of vegetables and fruits a day?
• Have you compared your food intake with Canada’s Food Guide?

ASK the following staging question: Do you choose foods based upon their nutritional content most of the time? NO YES or I USED TO Check the Quick Reference to determine the client’s stage of change.

ADVISE The Client about the Need for Healthy Eating

Suggestions:

• Healthy eating and having a healthy weight reduces the risks for heart and blood vessel diseases, type 2 diabetes, some cancers and osteoporosis.
• Turn to In a “NUTSHELL” Healthy Eating Healthy Weight for additional points you may wish to advise clients about.

Click on the appropriate stage below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Quick Reference

Goal for Client Intervention:

• Encourage understanding of how healthy food choices decrease risks to health.

Intervention Options:

ADVISE:

• Increase awareness of particular risks apparent from medication history or visual impression that could be attributable to unhealthy eating practices.
  Your risk for ___________ is reduced when you make healthy food choices.

ASSIST:

• Encourage critical thinking about current food choices.
  How would you know if what you ate was a problem for you?  

• Support belief that healthy eating and a healthy weight improve health.
  Eating from the 4 food groups in the amount needed for your age, body size and activity level makes you feel and look good.  

• Foster belief that people can change behaviour.
  One small step in the right direction usually leads to another.  

• Provide resources if willing.
  This information is new for many people.
  Have a look and see how this compares with what you eat.

 Resource Options (Click to order):

• Eating Well with Canada's Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  

Future Intervention:

ASK:

Have you thought about the importance of healthy eating to lower your risk for __________?

NO		Still PRECONTEMPLATION
YES		CONTEMPLATION

Click on Contemplation (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goals for Client Intervention:

• Encourage the examination of pros and cons for better nutrition.
• Promote confidence in their ability to make healthier food choices.

Intervention Options:

ADVISE:

• Emphasize the benefits of healthy eating.
  Healthy eating reduces the risks for cardiovascular disease, type 2 diabetes, some cancers, osteoporosis, and being overweight.

ASSIST:

• Encourage talking about their reasons for being concerned about what they eat.
  What foods do you think you should eat more of or less of ?

• Encourage talking about how they could change the way they eat.
  What healthier food choice would be hardest (easiest) for you to make?

• Encourage examining some barriers to healthier eating.
  What is one thing that makes it difficult for you to change what you eat?

• Gently offer possible solutions that have worked for others.
  Some people have tried __________ to get around that.

• Foster a positive belief in their ability to do it.
  Starting with one small change at a time until that feels comfortable is how to gradually change how you eat.
  
• Provide information.
  Canada’s Food Guide gives good reasons for healthy eating and the resources below provide additional information and interesting quizzes.

Resource Options (Click to order) :

• Eating Well with Canada's Food Guide
  
is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.

Future Intervention:

ASK:

Have you thought more about the importance of healthy eating to lower your risk for__________?

NO		Still CONTEMPLATION
YES		PREPARATION

Click on Preparation (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Encourage choosing healthier foods based upon their past experience in changing how they eat.

Intervention Options:

ADVISE:

• Focus on meaningful benefits.
  Eating less saturated fat (fat on meat and in dairy products) would be better for your heart.
  Taking steps toward healthier eating reduces your risk for __________.

ASSIST:

• Assist to verbalize a plan with a starting point to improve nutrition.
  Tell me a food you like. What could you do to make it healthier to eat?
  When could you start to make this one change on a regular basis?

• Encourage the inclusion of family or peer support.
  Who will be eating this with you?

• Discuss what has worked and not worked in the past.
  When you have changed what you ate in the past, what did you do that worked well?
  What happened if the change didn’t last?

• Encourage avoiding, changing or removing cues that trigger frequent unhealthy food choices.
  What do you see as your biggest challenge?
  Do you see a way to overcome this?

• Normalize relapse as part of the process and a learning experience.
  Everybody experiences some set backs.
  It is how you learn from them and try again with a better plan that moves you forward.

Resource Options (Click to order):

• Eating Well with Canada's Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.

• Interactive Resources on Health Canada’s Website:
  
  
  • Canada's Food Guide  “Eating Well with Canada’s Food Guide” is available for download on Health Canada’s website.
  • Take the Guided Tour - Flash version  – The “Guided Tour” is an interactive walk through the various sections of the new Canada’s Food Guide that will help you understand how much and what types of foods you need, as well as the benefits of eating well and being active. 
  • “My Food Guide” – is an interactive tool that will help you personalize the information found in Canada’s Food Guide when you enter your age, sex, physical activity level and your  favourite choices from each food group.
    
    
• Interactive Resources on the Dietitians of Canada Website:
  
  
  • "One Day @ a Time" – takes  you through 9 daily scenarios that you may experience as you maintain a healthy and active lifestyle?
  •  Let’s Make a Plan! – gives you tips on menu planning, shopping and stocking up on basics and connects you to “Let’s Make a Week of Menus” – a blank menu planning form to help record your meal plans.
  • EATracker - another interactive tool which provides personalized feedback on the calories, fat and fibre in your food choices.
  • Let's Make a Meal Home – lets you build a one-day menu as you choose various menu items for breakfast, lunch, dinner and snacks. The “Food Guide Calculator” helps you quickly and easily see if you are Eating Well with Canada's Food Guide.
  • Healthy Eating is in Store for You™ (HESY) – visit this web site to learn how food labels can help you make healthier food choices.
  • Virtual Shopping Tour – Virtual Shopping Tour is an on-line grocery store to learn how to use the nutrition information on the label of packaged foods to make healthy food choices.

Future Intervention:

ASK:

The last time we spoke you were making a plan to __________.
Have you been able to choose more nutritious foods more often?

NO		Still PREPARATION
YES		ACTION

Click on Action (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Assist to set and meet daily goals.

Intervention Options:

ADVISE:

• Compliment decision and accomplishment of healthy eating.
  Making healthy food choices is a great achievement.
  It takes planning and perseverance. 

• Emphasize benefits.
  Emphasizing vegetables and fruit each day could decrease your risk for some cancers by 20%.

ASSIST:

• Encourage rewarding self.
  What have you done to reward yourself for eating so well?

• Encourage identification of what is working and existing barriers.
  What parts of your plan are working well? What is still a barrier?
  How could you plan to get around it?
  
• Promote self-confidence.
  You are making good progress. You should be pleased with yourself.

• Normalize relapse as part of the process – relapse is a learning experience.
  Everyone has times when they feel they should or shouldn’t have eaten something. Concentrating on choosing nutritious foods in the right amounts most of the time is doing well.

Resource Options (Click to order):

• Eating Well with Canada's Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.

• Interactive Resources on Health Canada’s Website:
  
  
  • Canada's Food Guide  “Eating Well with Canada’s Food Guide” is available for download on Health Canada’s website.
  • Take the Guided Tour - Flash version  – The “Guided Tour” is an interactive walk through the various sections of the new Canada’s Food Guide that will help you understand how much and what types of foods you need, as well as the benefits of eating well and being active. 
  • “My Food Guide” – is an interactive tool that will help you personalize the information found in Canada’s Food Guide when you enter your age, sex, physical activity level and your  favourite choices from each food group.
    
    
• Interactive Resources on the Dietitians of Canada Website:
  
  
  • "One Day @ a Time" – takes  you through 9 daily scenarios that you may experience as you maintain a healthy and active lifestyle?
  •  Let’s Make a Plan! – gives you tips on menu planning, shopping and stocking up on basics and connects you to “Let’s Make a Week of Menus” – a blank menu planning form to help record your meal plans.
  • EATracker - another interactive tool which provides personalized feedback on the calories, fat and fibre in your food choices.
  • Let's Make a Meal Home – lets you build a one-day menu as you choose various menu items for breakfast, lunch, dinner and snacks. The “Food Guide Calculator” helps you quickly and easily see if you are Eating Well with Canada's Food Guide.
  • Healthy Eating is in Store for You™ (HESY) – visit this web site to learn how food labels can help you make healthier food choices.
  • Virtual Shopping Tour – Virtual Shopping Tour is an on-line grocery store to learn how to use the nutrition information on the label of packaged foods to make healthy food choices
    

Future Intervention:

ASK:

Are you choosing nutritious foods in the right amounts most of the time?

NO		Still ACTION
YES		MAINTENANCE

Click on Maintenance (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Goal for Client Intervention:

• Assist to keep healthy eating-healthy weight as part of their lifestyle.

Intervention Options:

ADVISE:

• Recognize accomplishment and benefits.
  Making healthy eating part of your regular lifestyle protects your health and well-being.
  Good for you!

ASSIST:

• Encourage ongoing awareness of triggers and pitfalls.
  New people or new situations may bring new temptations. Be aware of pitfalls and adapt your plan if necessary.

• Emphasize importance of continuing to reward self.
  Make sure you remember to reward yourself for continuing. You deserve it!

Resource Options (Click to order):

• Eating Well with Canada's Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  

• Interactive Resources on Health Canada’s Website:
  
  
  • Canada's Food Guide  “Eating Well with Canada’s Food Guide” is available for download on Health Canada’s website.
  • Take the Guided Tour - Flash version  – The “Guided Tour” is an interactive walk through the various sections of the new Canada’s Food Guide that will help you understand how much and what types of foods you need, as well as the benefits of eating well and being active. 
  • “My Food Guide” – is an interactive tool that will help you personalize the information found in Canada’s Food Guide when you enter your age, sex, physical activity level and your  favourite choices from each food group.
    
    
• Interactive Resources on the Dietitians of Canada Website:
  
  
  • "One Day @ a Time" – takes  you through 9 daily scenarios that you may experience as you maintain a healthy and active lifestyle?
  •  Let’s Make a Plan! – gives you tips on menu planning, shopping and stocking up on basics and connects you to “Let’s Make a Week of Menus” – a blank menu planning form to help record your meal plans.
  • EATracker - another interactive tool which provides personalized feedback on the calories, fat and fibre in your food choices.
  • Let's Make a Meal Home – lets you build a one-day menu as you choose various menu items for breakfast, lunch, dinner and snacks. The “Food Guide Calculator” helps you quickly and easily see if you are Eating Well with Canada's Food Guide.
  • Healthy Eating is in Store for You™ (HESY) – visit this web site to learn how food labels can help you make healthier food choices.
  • Virtual Shopping Tour – Virtual Shopping Tour is an on-line grocery store to learn how to use the nutrition information on the label of packaged foods to make healthy food choices.
    

Future Intervention or Now:

ASK:

Do you have any concerns about maintaining the healthy way you are eating?

NO		Still MAINTENANCE Is there another lifestyle topic you are concerned about, e.g. active living, sun safety, smoking, etc.?
YES		Ask about concerns and assist.

If the client is in Maintenance, ask if they are ready to think about another lifestyle change to further reduce risks for chronic diseases.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Goal for Client Intervention:

• Assist to see relapse as a normal part of the process of change.

Intervention Options:

ADVISE:

• Normalize relapse as part of the process of change.
  Almost everybody slips back sometime.

• Emphasize the benefits that were gained.
  Your reduced risk for cardiovascular disease, type 2 diabetes, some cancers, osteoporosis, and obesity will last a while and continue when you get back on track.
  Most people find they gain knowledge about themselves that helps them in their next attempt.

ASSIST:

• Identify and discuss reasons for relapse and counter strategies for the next try.
  What did you like about yourself when you were eating better?
  Can you figure out what came between you and the better food choices?
  What could you do about that another time?  

• Reassess current stage of change and intervene accordingly now or at the next contact.
  Do you have any plans to build on the progress you have made?
  Do you have any plans to build on the progress you have made?

Check the Quick Reference to determine the client’s stage of change. Click on the appropriate stage below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.