When I work with patients on nutrition, my patients always goals at the end of our appointments. Some examples of the types of goals patients set are spending time preparing food, trying a new food, trying a new activity, reading up on a topic, watching a video on a topic, making an appointment, or anything else nutrition-related. These goals are set primarily by the patient with guidance from me. I guide my patients to set goals that are realistic, specific, and likely to help them improve their health.
Most of the time patients do not come to their next appointment having done everything on their goal list with absolute perfection, but usually they have started making progress towards some of the goals. We discuss the goals together and figure out what helped the patient advance towards some goals and what were the roadblocks to the other goals. We figure out if the goals were indeed realistic, and if not, we make adjustments to the goals. With this process, over time, the patient can slowly make progress to their health goals.
Sometimes I meet with a patient again and again, and they do not seem to be making any progress to the goals they are setting, and therefore, progress to their overall health goals is halted. Why is this? And what can we do to overcome barriers to changes in nutrition. Here are five reasons people have barriers to change their nutrition and don't make progress to their goals.
Why Patients Don't Make Progress to Their Nutrition Goals
The patient's self-perception is incongruous with the goals that were set. We all have a mental perception of ourselves that encompasses all aspects of how we view ourselves. A person might view themselves as someone who does not exercise. A person might view certain behaviors, such as eating whole grains, a something others do, but not themselves. Maybe the patient can't wrap their mind around the idea that they can be someone who invests money and time in their own body and health. As a dietitian, I have to help the patient expand their view of themselves and what they can do. I want them to see new behaviors as real possibilities for themselves. This work takes time, mental energy, and a willingness from the patient.
The patient needs to think about the changes. A patient might be theoretically open to a new idea or a new behavior to try, but they still need time to get used to it. I find that patients may make progressive improvement in one area, but seem to be stuck in another area. They may not be making any noticeable changes in that area, but often there is a mental change happening. Reviewing each goal at every nutrition appointment gives the patient another opportunity to mentally review the idea of that behavior that seems stuck. Over time, the talking about it and thinking about it brings that behavior closer to their reality, and they eventually feel ready to try it out.
Inadequately addressed mental health issues are getting in the way. Untreated mental health concerns can block people from achieving their goals for a variety of reasons. Anxiety can make a person afraid to try unfamiliar foods or go somewhere new. ADHD can drive behaviors of inadequate planning and impulsivity. Depression can feed into patients not taking care of their health. Binge eating disorder can lead to out of control feelings with eating. The good news is that these issues are treatable. Connecting patients to psychiatrists and therapists is an important prerequisite for patients to meet their goals.
The goals are not specific enough. A general goal of eat more vegetables or start exercising might sound good at first, but goals like this can leave patients unsure of what exactly they are supposed to do. Better goals might be to spend 10 minutes perusing the produce isle in the grocery store when you are there on Tuesday just to see what is there, add beans to your regular burrito order tomorrow, or take your dog out for a 10 minute walk on Saturday morning. These goals are not only specific, but they can be more easily achievable for the patient.
Life gets in the way. Many people go through seasons of life that are more hectic and unpredictable. Unpredictability makes finding a routine for a new habit very hard. This is often the case when a family has a new baby or kids who are constantly getting sick and during transitions such a move or a new job. When life seems to be getting in the way, we work on getting back into routine and getting practical help from family and friends when necessary. Then we double down on making sure the goals are realistic and doable in the situation the person is currently in. I use practical ideas and very specific suggestions to help the patient meet their goals.
Overcoming Barriers to Change with Nutrition
When I have a patient who does not seem to be making progress to their goals, I step back and make sure I understand my patient and what their barriers to change are. Really understanding the barriers to make nutrition change can help me guide the patient further or define new and more appropriate goals. Any behavior change is hard. Health-related behavior changes are no different. With appropriate interventions, even "stuck" patients are able to progress.