The five step secret to becoming the person you want to be

We all have our own ideas of success – perhaps climbing the career ladder, becoming fitter and healthier, or embracing new personal experiences – but there’s one thing we all have in common. We want to make the impossible possible.

​How can we do that? By setting workable goals to keep us focussed, every step of the way.

Experts in behavioural psychology say there’s an art to goal setting. Like George T. Doran, a city planning hotshot who made a name for himself by helping lacklustre managers get their projects off the ground. Doran pointed out that by using a specific technique, which he called S.M.A.R.T goal setting, we can create a practical structure for achieving things that aren’t easy to achieve.

The technique is invaluable for the Changing Health behavioural change coaches. We’ve found that it’s one of the best ways to help our clients lose weight, feel better and ultimately, transform their lives.

This is what S.M.A.R.T goal setting looks like:

  • SPECIFIC: target a specific area for improvement
  • MEASURABLE: quantify, or at least suggest, an indicator of progress
  • ACHIEVABLE: agreed and attainable
  • RELEVANT: reasonable, realistic and resourced, results based
  • TIME BOUND: time-based, time limited

Here’s an example: let’s say you want to lose weight. That’s great – but you could define your goal more clearly to boost your chances of success.

That means applying the S.M.A.R.T method:

  • SPECIFIC: “I want to lose weight so I can feel good in my favourite dress again”
  • MEASURABLE: “To fit into my dress I’ll need to lose around 3kg”
  • ACHIEVABLE: “If I can reduce my portion sizes, and cut-out sugary drinks, I can accomplish my goal”
  • RELEVANT: “I know I can do this. I lost some weight two years ago, so I know this is a realistic target”
  • TIME BOUND: “I’d like to wear my dress at the summer party on August 20th”

And suddenly, a vague ambition to “lose some weight” becomes a clearly structured goal with a timeline to make it happen. Showing off your lovely summer dress at the party just became five times more likely.

So remember: when you’re setting out your goals, think SMART!

Author Carl Lumsden is a Changing Health Behaviour Change Coach with a background in health and fitness.

Type 2 diabetes remission: how little swaps changed Janice’s life

 

Janice had Type 2 diabetes. She was stuck in some unhealthy habits – drinking four cans of coca cola a day, eating three-person portions of pasta, binging on pringles – and she needed help to make a change. In January 2018 she was diagnosed with an Hba1c level of 89, indicating a severe lack of glycaemic control.

And make a change is what she did. It began when, soon after her diagnosis, her GP referred her onto Changing Health’s Transform programme for diabetes management. Transform combines a course of digital education on diabetes with personalised behaviour change support from a lifestyle coach, and aims to give users the psychological tools to sustain a positive health behaviours over the long term.

She got off to a flying start. Kirsten, her lifestyle coach, was impressed; Janice had already begun prepping her meals in advance, swapping carbs at lunch for a healthier alternative, and dancing each night to an exercise routine – and lost a kilo in a week as a result. While it’s important to start with small changes, Janice felt she could do more, so Kirsten worked with her to set a clear, achievable short-term goal for physical activity: three brisk, 10 minute walks per day on the way to work, at lunchtime and on the way home.

By March, Janice had accelerated her progress, decreasing her portion sizes, increasing her fluid intake, cutting out crisps, swapping white bread for wholemeal and potatoes for sweet potatoes.

“She wanted to know more about the carb and sugar content of fruits and vegetables,” Kirsten says. “So I gave her a document about GI of foods and a link to a website that could be useful too. I told her carrots are quite high in GI and sugar, but they’re still vegetables and better than other things you could be eating!”

“I was very honest with Kirsten,” says Janice. “She was equally honest back, and without being judging – she was supportive and positive. I wasn’t very active – partly because I was ill and partly because of the weather, and we spoke about my frustrations with that. We discussed mini exercises I could do during the day.”

May rolled around, and it was time for another visit to the GP. There was some excellent news: Janice had reduced her HbA1c to just 55 in four months. She was well on the way to reversing her condition for good.

“I kept making swaps – I like to go to concerts, so I swapped beer for sparkling water. I haven’t touched Coca Cola, no red meat, no processed foods – I’m eating lots of fish, veggies, grilled halloumi. My partner enjoys the new diet too. I’d led him astray to be honest, but he’s just brilliant – he supports me every day”

The last time Janice and Kirsten spoke, in July, things were looking even better. Janice had reduced her HbA1c to 42 – meaning she no longer had diabetes! She’d now lost a total 14.8kg on the programme, and dropped two dress sizes to boot.

“Janice has been amazing throughout her journey on the Changing Health programme,” Kirsten adds. “She recognises that the changes she’s made are long-term lifestyle changes, rather than a short-term fix. She deserves this fantastic news!”

Does Janice have any advice for others in her position? “Be honest. That’s the key, that’s the tough thing. When I’ve been low, I’ve rung up Kirsten and beat myself up, but she looks at the bigger picture. She’s brilliant. I’ll miss her.”

Nudging for good: How health psychology can tackle child obesity

It’s a curious paradox that as the Western world becomes more prosperous and its population lives longer, some of the most preventable health crises are rapidly escalating. One of the first and foremost among them: childhood obesity.

The stats make for alarming reading: one in three UK children are overweight or obese before they finish primary school. Of these, 40% will become obese adolescents. The vast majority of whom – 75-80% – will become obese adults at severely heightened risk of developing Type 2 diabetes and other health issues.

The causes of child obesity aren’t homogenous; hereditary, physiological, social and environmental factors can all play a role. But there’s no doubt that ever since the end of WWII in the West, and more recently in developing countries, there’s been a surplus of calories in the food we consume. As Susan Jebb, professor of Diet and Population Health at the University of Oxford put it this week, the situation in which food is readily available for most people has arrived in the blink of an eye in evolutionary terms.

Industry appears indifferent. Take Starbucks, for example, which pledged to slash added sugar in its drinks in alignment with the Government’s Childhood Obesity Plan. That didn’t stop them marketing a “short-sized” hot chocolate for kids with a whopping 20.1g of added sugar – more than the entire recommended daily limit for 4-6 year olds. Starbucks is by no means alone.

So how can we address the problem? If the corporate world is unable or unwilling to step up to the task, we’re left with two options: ‘hard’ measures (regulation), or ‘soft’ measures (promoting, assisting and allowing healthier choices).

There’s a strong case for the latter. By applying psychological insights, or ‘nudge theory’, we can encourage or guide behaviour without mandating or instructing. “’Nudging’ has been used by advertisers for decades,” says Dr Leah Avery, Head of Health Psychology at Changing Health. “That has contributed to an over-consuming society, and in turn, the obesity epidemic. In a sense, we need ‘counter-nudges’ to combat those used by advertisers.”

Even the subtlest of nudges can be highly effective in facilitating positive behaviour change. In New Mexico, USA, a simple change in the design of a shopping trolley was shown to help people make better decisions about the food they buy. Researchers marked a line with yellow duct tape across the width of the trolley, and added a sign asking shoppers to place fruit and vegetables in front of the line and everything else behind it. The result was a 102% increase in sales of fruit & vegetables (at no loss of profitability to the retailer).

In Iceland, LazyTown, a popular childrens’ TV show, features a healthy superhero motivating children to eat healthily and be active. In partnership with the Icelandic Government, children aged 4-7 were sent a LazyTown “energy contract”, signed with their parents, in which they were rewarded for eating healthily, going to bed early and being active. One supermarket chain rebranded all its fruit and vegetables “Sports Candy” – LazyTown’s name for healthy food – and saw a consequent 22% increase in sales. Since LazyTown hit the airwaves in 1996, Iceland has become one of the only countries in the world in which child obesity levels have fallen.

There’s promise closer to home too. A partnership between LazyTown and the UK Nudge Unit led to the launch of the Change4Life programme, Public Health England’s flagship initiative for preventing childhood obesity. This year’s Change4Life campaign, encouraging parents to look for ‘100 calorie snacks, 2 a day max’ provides parents with money-off vouchers for healthier snack options including malt loaf, lower-sugar fromage frais, and drinks with no added sugar. A survey of 1001 mums who used the Change4Life Sugar Smart app found 96% of those with children aged 5-11 had reduced their families’ sugar intake.

Tesco, the chain which first embraced the behavioural insights approach by removing sweets and chocolate from its checkout aisles, has this month devised another way to nudge people into making healthier choices. Its ‘little swaps’ basket comparison will be displayed at the front of stores to highlight lower sat fat, salt and sugar alternatives to the most popular childrens’ products. The comparison busts the myth that healthier choices cost more too.

Image: Tesco PLC

Nudges alone, however, will not suffice. Government policy must also play a role. “Regulation is a powerful influence on behaviour,” says Stephen Greene, Past President International Society of Pediatric and Adolescent Diabetes. “Just as Government was central to the banning of smoking indoors in public places, the supply of food to children in schools, labelling, the use of unhealthy products – they should all be looked at both locally and centrally to influence what’s going on.”

“Legislation, nudges and group and individualised interventions are all needed to tackle the public health challenges we’re facing,” agrees Dr Avery. “Efforts on these fronts should be co-ordinated and robustly evaluated.”

Professor Greene adds that we need to see some real cultural shifts in how industry produces and distributes food, and how consumers eat it. Perhaps that’s not too far out of sight. “In the same way one dinner lady inspired Jamie Oliver to change attitudes to food in schools across the country, we’ll see a shift in attitudes to sugar over a generation. The understanding is dawning that sugar has played such a big role in childhood obesity.”

In a world in which the next generation is set, for the first time, to be less healthy than the last, that understanding can’t come soon enough.

Type 2 diabetes support for 150,000 Mancunians

Changing Health’s behaviour change programme is now available to provide 150,000 people living in Greater Manchester Type 2 diabetes support, as part of a suite of digital resources to help them better manage their condition and live healthier lives.

The NHS England and Innovate UK funded initiative makes diabetes support available from a range of providers any time, anywhere via a one-stop shop web platform, Greater Manchester Diabetes My Way. Users will benefit from digital education on lifestyle and personalised, one-to-one behaviour coaching, delivered by Changing Health, alongside tools for easier sharing of glucose monitoring data and care records with healthcare professionals.

The Idea Behind Changing Health’s Type 2 Diabetes Support Programme

The scheme was launched with the aim of giving people with diabetes all the skills and knowledge they need to play a more active role in managing their condition, by adopting positive diet and exercise habits and learning how to maintain lifestyle changes over the long term.

Type 2 diabetes support in Greater Manchester has in the past been limited to classroom education programmes, which are often inaccessible for those unable to travel or take time off work, or who have learning difficulties. Digital tools overcome these challenges, and in some cases, have been shown to improve uptake of diabetes support by more than 500%.

In addition to improving the support on offer for people with diabetes, the initiative is also likely to deliver significant cost savings for healthcare delivery in Greater Manchester, with fewer complications arising from the condition, fewer hospitalisations and fewer A&E attendances.

Here’s what the experts have to say

John Grumitt, Changing Health Chief Executive, said: “It’s great to be selected as one of the Greater Manchester Diabetes My Way providers and build on the evidence that with access to the right support, people with diabetes can make big changes in their lives and manage their condition more effectively.

“Health Secretary Matt Hancock shared his vision last week of delivering more patient-centric care, facilitated by digital tools. Greater Manchester Diabetes My Way will play a key role in making that vision a reality.

“We know that a large proportion of people with Type 2 diabetes want to make a change in their lives – but often, they simply aren’t sure how best to go about it. This initiative aims to change that.

“Where previous behavioural interventions faced some major practical and financial challenges, today’s launch is a win-win: people with diabetes are empowered to sustain long-term lifestyle changes, while healthcare providers benefit from better communication with their patients, better health outcomes and a lesser administrative burden.”

Naresh Kanumilli, SCN Clinical Lead for Diabetes, said: “This has the potential to be a real game-changer in Greater Manchester. With a large and growing Type 2 diabetes population, we need to adapt to the modern world and harness the power of new digital technology to embrace changes in how we support people living with diabetes.”

ENDS

Notes to editors

  • Wave 2 of the Innovate UK Test Bed funding programme has agreed a grant of £975,000 towards the £1.2m project cost, with the remainder contributed by the industry partners involved.
  • John Grumitt, Changing Health CEO, is available for interview
  • Case studies of people who have achieved diabetes remission using digital tools are available.

The Silver Bullet For Population Health? Personalised Care

Personalised care may be the solution, considering that most of us can’t exactly make rational decisions about what we eat. We, as a nation, know full well that consuming too much sugar and fat, and too few vegetables and fruit, is detrimental to our wellbeing and longevity. Yet the vast majority of us do it anyway.

The National Diet and Nutrition Survey (NDNS) published by Public Health England in March showed that in 2014-16, adults consumed on average 4.2 portions of fruit & vegetables per day, fewer than PHE’s recommendation of 5 per day – to which just 31% of adults adhere. As a result, only one third of the UK population is not overweight.

So why do we make these choices? Information and guidance on nutrition is widely available. The argument that “not everybody can afford to eat healthily” is – at least in 2018 – a myth, as was recently evidenced by Changing Health lifestyle coach Holly Hart in her mission to document an entire week’s worth of healthy, tasty cooking for just £20.76.

The answer lies in behavioural psychology. We often make rapid decisions on what to eat based on habitual, social and environmental factors – “it’s takeaway Friday”; “everyone’s heading to a steakhouse”, “I’m hungry, and I’m drive past McDonalds on my way home from work”.

Overcoming these psychological factors is not easy. Many people need support to do so. Some face-to-face interventions, such as WeightWatchers and Slimming World, can give people a better understanding of how they could eat more healthily and assist in weight loss, but don’t equip people with the repertoire of psychological tools needed to sustain such a change over the long term.

Changing Health Provides Personalised Care

More personalised care, however, can be highly effective in translating motivation into new behaviours that become firmly established over time. Changing Health’s team of expert lifestyle coaches, trained in health psychology techniques, help programme users to make this happen.

Coaches devise a unique programme to each user’s individual needs, which requires a thorough understanding of that user’s current lifestyle habits to identify barriers to change. Open-ended questions and active listening are therefore crucial from the outset.

As Carl Lumsden, Changing Health Coaching Team Leader, puts it: “Lifestyle coaching offers us the ability to explore every client’s needs and tailor make our behaviour change programme to suit them. I often find that many users have digested all the guidance on diet and exercise. They know they need to make a change. However, they’re rarely equipped to put this into practice.”

Setting SMART (Specific, Measurable, Achievable, Relevant, Timely) goals, from skipping takeaway fridays to walking home from work, is key to success. For example, research shows that those who write their goals down, share them with a mentor or friend, and provide regular updates on progress are 33% more likely to achieve them.

Reflecting on and summarising interactions shows users their coach has listened to them and understood, while feedback on performance, social support and prompts and cues are all important for continued motivation.

Personalised interventions have been proven effective in better engaging people with their health and healthcare, and facilitating long-term behavioural change. If they can be adopted at scale, the implications for public health are boundless.

Changing Health’s behavioural science white paper will be published on 16 May 2018 at the Primary Care Conference, NEC Birmingham. Meet the author Mark Williams on our About Us page.