What we can learn from models of change and stages of grieving when setting weight loss goals.
First introduced by American Psychiatrist Elisabeth Kubler-Ross in her 1969 book On Death and Dying, the 5 stages of grieving has been useful in navigating people through the grieving process. While these stages are not meant to be a complete list of all possible emotions they are helpful when facing a life-altering undertaking such as losing 100 pounds. In the transtheoretical model, change is a process involving progression through various stages. When setting goals that are life changing people forget to take into account the process and commitment that is involved. I feel that checking into these various stages can be helpful in committing to the process.
While both models are controversial in their validity I feel that both patient and practitioner can use these stages to gauge commitment and track change so as to best reach their goals.
1. Denial & Precontemplation (Not Ready)- The person is trying to shut out the reality or magnitude of his/her situation, and begins to develop a false, preferable reality. People are not intending to take action in the foreseeable future, and can be unaware that their behavior is problematic. This is unfortunately where most people sit for too long until health is negatively affecting them daily.
2. Anger & Contemplation (Getting Ready)- People are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions. They recognize that denial cannot continue and may become angry, the patient is very difficult to reason with due to misplaced feelings of rage and envy. The patient can be angry with self, or with others, especially those who are close to them. Certain responses of a person undergoing this phase would be: "Why me? It's not fair! I don’t want to give up my wine"; "Why do I have to do this. Jane lost weight without having to do any of this!”
3. Preparation & Bargaining (Ready)-Patients intend to take action in the immediate future, and may take small steps toward behavior change. This often involves bargaining where the patient hopes that they can somehow avoid going down the path the practitioner has chartered for them. Seeking to negotiate a compromise is normal and it is important for practitioner and patient to truly examine whether this patient is ready for the next stage. Example “OK so I’ve given up sugar but chocolate brownies made with honey are fine! Right?”
4. Depression & Action– I know this sounds like a stalemate but I often see patients acquiring new healthy behaviors only to withdraw. “What if I succeed in kicking my diabetes?” “What if I really do lose 100 lbs?” Their friends can change, along with their habits, their clothes, even their problems. It is natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation. Becoming a different person requires a huge amount of courage!
5. Acceptance & Maintenance – Patients have been able to sustain action for a while and are working to prevent relapse. At this stage they have come to terms that they are better off this way and the changes have become their new lifestyle. This typically comes with a calm, retrospective view of self, and a stable mindset. I often hear “I can’t believe how much better I feel. I won’t go back to the way I used to eat!”
6. Termination – Individuals have no temptation to return to their old unhealthy habit as a way of coping. They are happy with the path they chose to follow and are comfortable with themselves and have been accepted by their peers old and new. This is ultimately where a good practitioner would want their patients to reach.
Dr. Jerome Craig, DC