NAT11046005 - STUDENT RESOURCE GUIDE.v1.0

11046NAT - CERTIFICATE IV IN NUTRITION

NAT11046005: ANALYSE AND APPLY PRINCIPLES OF PSYCHOLOGY AND BEHAVIOUR MANAGEMENT VAST FITNESS ACADEMY RTO #41564 | ACN 607 258 748 | ABN 14 492 461 636 (07) 5443 4072 | ADMIN@VASTFITNESSACADEMY.EDU.AU | 1/84 WISES ROAD, MAROOCHYDORE QLD 4558 VAST FITNESS ACADEMY | NAT11046005: ANALYSE AND APPLY PRINCIPLES OF PSYCHOLOGY AND BEHAVIOUR MANAGEMENT | VERSION 1 - 11.11.2022

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CONTENTS UNIT INTRODUCTION

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INTRODUCTION TO PSYCHOLOGY FOR NUTRITIONAL ADVISORS

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UNDERSTANDING PSYCHOLOGY

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THE RELEVANCE OF PSYCHOLOGY FOR A NUTRITIONAL ADVISOR

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RECOGNISING HOW PSYCHOLOGY DEVELOPED

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UNDERSTANDING AREAS OF PSYCHOLOGY

11

IDENTIFYING PROFESSIONAL SPECIALTIES IN PSYCHOLOGY

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CLINICAL PSYCHOLOGY

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INDUSTRIAL AND ORGANISATIONAL PSYCHOLOGY

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COUNSELLING PSYCHOLOGY

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EDUCATIONAL PSYCHOLOGY

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UNDERSTANDING THE VARIOUS THEMES OF PSYCHOLOGY

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THEME 1: PSYCHOLOGY IS EMPIRICAL

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THEME 2: PSYCHOLOGY IS THEORETICALLY DIVERSE

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THEME 3: PSYCHOLOGY EVOLVES IN A SOCIOHISTORICAL CONTEXT

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THEME 4: BEHAVIOUR IS DETERMINED BY MULTIPLE CAUSES

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THEME 5: BEHAVIOUR IS SHAPED BY CULTURAL HERITAGE

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THEME 6: HEREDITY AND ENVIRONMENTAL FACTORS JOINTLY INFLUENCE BEHAVIOUR

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THEME 7: PEOPLE’S EVIDENCE OF THE WORLD IS HIGHLY SUBJECTIVE

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COMMON PERCEPTIONS OF NUTRITION, HEALTH AND BODY IMAGE WITHIN THE COMMUNITY AND MEDIA

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CULTURAL NORMS

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SOCIAL NORMS

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BODY IMAGE AND SELF-PERCEPTION

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RECOGNISING NEGATIVE BODY IMAGE

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RECOGNISING POSITIVE BODY IMAGE

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UNDERSTANDING THE PSYCHOLOGICAL EFFECTS OF SOCIAL MEDIA

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UNDERSTANDING BEHAVIOUR AND THE PRINCIPLES OF BEHAVIOURAL CHANGE

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UNDERSTANDING BEHAVIOUR

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THE BRAIN AND BEHAVIOUR

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GENETIC INHERITANCE AND BEHAVIOUR

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BEHAVIOURS AS ADAPTIVE TRAITS

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AN OVERVIEW OF BEHAVIOURAL PSYCHOLOGY (BEHAVIOURIST LEARNING THEORIES)

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CLASSICAL CONDITIONING (IVAN PAVLOV)

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UNDERSTANDING HOW CLASSICAL CONDITIONING WORKS

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OPERANT CONDITIONING (B.F. SKINNER)

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UNDERSTANDING THE COMPONENTS OF OPERANT CONDITIONING

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UNDERSTANDING AND IDENTIFYING STAGES OF BEHAVIOUR CHANGE (TRANSTHEORETICAL MODEL)

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THE PRE-CONTEMPLATION STAGE

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THE CONTEMPLATION STAGE

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THE PREPARATION STAGE

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THE ACTION STAGE

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THE RELAPSE STAGE

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IDENTIFYING FACTORS THAT MAY AFFECT BEHAVIOUR CHANGE AND/OR CLIENT ADHERENCE

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EXTERNAL SUPPORT (FAMILY, CULTURAL AND SOCIAL SITUATION)

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CURRENT HABITS

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LIFESTYLE FACTORS

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PERSONALITY FACTORS

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IDENTIFYING OTHER BARRIERS TO CHANGE

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UNDERSTANDING MOTIVATIONAL THEORIES AND CONCEPTS AND HOW THEY IMPACT BEHAVIOUR UNDERSTANDING MOTIVATION

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EXTRINSIC VS INTRINSIC MOTIVATION

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UNDERSTANDING SELF-MOTIVATION

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IDENTIFYING THE COMPONENTS OF MOTIVATION

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MOTIVATIONAL THEORIES

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UNDERSTANDING THE ‘DRIVE THEORY’

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UNDERSTANDING THE ‘INCENTIVE THEORY’

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UNDERSTANDING THE ‘EVOLUTIONARY THEORY’

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MASLOW’S HIERARCHY OF NEEDS

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PHYSIOLOGICAL: FOOD, WATER, SHELTER, AND WARMTH

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SECURITY: SAFETY, EMPLOYMENT AND, ASSETS

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SOCIAL: FAMILY, FRIENDSHIPS, INTIMACY, AND BELONGING

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ESTEEM: SELF-WORTH, ACCOMPLISHMENT, AND CONFIDENCE

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SELF-ACTUALISATION: INNER FULFILLMENT

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HOW TO APPLY THE MASLOW HIERARCHY OF NEEDS TO NUTRITION COUNSELLING (16)

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THE AROUSAL THEORY OF MOTIVATION

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AROUSAL AND TASK PERFORMANCE

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THE SCIENCE OF HOW FOOD AND NUTRIENTS IMPACT BEHAVIOUR AND EMOTIONS

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DIETARY FAT AND ITS INFLUENCE ON BEHAVIOUR

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TRYPTOPHAN AND ITS EFFECTS ON BEHAVIOUR

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FOLATE AND HOW IT AFFECTS BEHAVIOUR

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THE EFFECTS OF HYDRATION ON BEHAVIOUR

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VITAMIN B12 AND ITS EFFECTS ON BEHAVIOUR

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VITAMIN D AND ITS EFFECTS ON BEHAVIOUR

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HOW FIBRE CAN HAVE AN EFFECT ON BEHAVIOUR

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MOOD STABILISING NEUROTRANSMITTERS

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UNDERSTANDING SEROTONIN

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UNDERSTANDING DOPAMINE

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UNDERSTANDING GAMMA-AMINOBUTYRIC ACID (GABA)

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UNDERSTANDING NOREPINEPHRINE

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UNDERSTANDING THE EFFECTS OF NUTRIENT DEFICIENCIES ON A HEALTHY FUNCTIONING BODY

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RECOGNISING OTHER PSYCHOLOGICAL THEORIES THAT UNDERPIN DIETARY AND EXERCISE PATTERNS

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UNDERSTANDING THE MOTIVATION OF HUNGER AND EATING VAST FITNESS ACADEMY | NAT11046005: ANALYSE AND APPLY PRINCIPLES OF PSYCHOLOGY AND BEHAVIOUR MANAGEMENT | VERSION 1 - 11.11.2022

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BIOLOGICAL FACTORS AND THEIR RELEVANCE TO HUNGER REGULATION

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BRAIN REGULATION

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GLUCOSE AND DIGESTIVE REGULATION

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HORMONAL REGULATION

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ENVIRONMENTAL FACTORS AND THEIR RELEVANCE TO HUNGER REGULATION

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LEARNT PREFERENCES AND HABITS

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STRESS AND EATING

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UNDERSTANDING EATING, BODYWEIGHT AND OBESITY

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GENETIC PREDISPOSITION

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EXCESSIVE EATING AND INADEQUATE EXERCISE

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THE CONCEPT OF ‘SET POINT THEORY’

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IDENTIFYING STRATEGIES AND TECHNIQUES FOR POSITIVE BEHAVIOURAL CHANGE AND CLIENT ADHERENCE 73 STRATEGIES AND TECHNIQUES FOR OVERCOMING NEGATIVE SELF-TALK

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SUPPORTING CLIENTS BY UTILISING AROUSAL CONTROL TECHNIQUES

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ANXIETY MANAGEMENT STRATEGIES

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PROGRESSIVE RELAXATION

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STRESS MANAGEMENT

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VISUALISATION

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CRAVING CONTROL TECHNIQUE (‘RIDING THE WAVE’) HOW NUTRITIONAL ADVISORS CAN IMPLEMENT ‘RIDING THE WAVE’

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ENCOURAGING NEW YEAR RESOLUTIONS WITH CLIENTS

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FUNCTIONAL BEHAVIOURAL ANALYSIS (FBA)

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UNDERSTANDING AND ENCOURAGING MINDFUL EATING

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MINDFUL EATING VS MINDLESS EATING

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TECHNIQUES FOR MINDFUL EATING

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MINDFUL EATING PRACTICE

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MONITORING BEHAVIOUR CHANGE AND PROGRESS IDENTIFYING METHODS FOR MONITORING BEHAVIOUR CHANGE

89 90

FORMAL METHODS FOR MONITORING BEHAVIOUR

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INFORMAL METHODS FOR MONITORING BEHAVIOUR

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UTILISING REFLECTIVE MONITORING

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SPECIFIC INFORMATION TO MONITOR A CLIENT’S PROGRESS

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HOW TO MONITOR PROGRESS (COLLECTING DATA)

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RECOGNISING AND APPLYING PRINCIPLES OF COMMUNICATION AND COUNSELLING TECHNIQUES IDENTIFYING EFFECTIVE COMMUNICATION RECOGNISING COMMUNICATION STRATEGIES

COMMON COUNSELLING TECHNIQUES

94 94 96

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ACTIVE LISTENING

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BODY LANGUAGE

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QUESTIONING TECHNIQUES

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PARAPHRASING TECHNIQUES

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SUMMARISING

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NOTE TAKING

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BEHAVIOUR MODIFICATIONS SPECIFIC TO THE CLIENT

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ENCOURAGE A CLIENT’S SELF-RESPONSIBILITY

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EMPOWERING CLIENTS TO MAKE THEIR OWN DECISIONS

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GIVING AND RECEIVING FEEDBACK

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APPLYING THE PRINCIPLES OF GOAL SETTING TO SUPPORT BEHAVIOUR CHANGE

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CREATING SMART GOALS

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IDENTIFYING A CLIENT’S SHORT, MEDIUM AND LONG-TERM GOALS

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OUTCOME, PROCESS AND PERFORMANCE GOALS

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MODIFYING STRATEGIES AS REQUIRED, BASED ON CLIENT FEEDBACK RECOGNISING THE NEED TO MODIFY NUTRITIONAL SUPPORT STRATEGIES/INTERVENTIONS RECOGNISING NON-ADHERENT CLIENTS

UNDERSTANDING ETHICAL, SAFE AND LEGAL USE OF NUTRITION AND PSYCHOLOGY

111 111 112

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CLIENT CONFIDENTIALITY

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STORING AND DOCUMENTING CLIENT INFORMATION

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DUTY OF CARE FOR NUTRITIONAL ADVISORS

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CONTINUOUS PROFESSIONAL DEVELOPMENT

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INFORMED CLIENT CONSENT

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UNDERSTANDING A CLIENT’S RIGHTS AND RESPONSIBILITIES

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UNDERSTANDING THE REFERRAL PROCESS AS A NUTRITIONAL ADVISOR

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SCOPE OF PRACTICE

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UNDERSTANDING WHEN TO REFER TO AN APPROPRIATE HEALTH PROFESSIONAL

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IDENTIFYING NEGATIVE BEHAVIOURS AND THE NEED FOR REFERRAL

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IDENTIFYING APPROPRIATE HEALTH PROFESSIONALS FOR REFERRALS

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WHEN TO REFER TO AN ACCREDITED PRACTISING DIETITIAN

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WHEN TO REFER TO A DOCTOR (GP)

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WHEN TO REFER TO A PSYCHOLOGIST

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RECOGNISING TRAITS OF MAJOR MENTAL HEALTH DISORDERS AND THE NEED TO REFER TO A MEDICAL PROFESSIONAL UNDERSTANDING DEPRESSION

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MAJOR DEPRESSION

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ANTENATAL AND POSTNATAL DEPRESSION

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UNDERSTANDING BIPOLAR DISORDER

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UNDERSTANDING SCHIZOPHRENIA

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UNDERSTANDING AUTISM SPECTRUM DISORDER

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UNDERSTANDING OBSESSIVE COMPULSIVE DISORDER

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UNDERSTANDING ATTENTION DEFICIT HYPERACTIVITY DISORDER

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UNDERSTANDING EATING DISORDERS

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ANOREXIA NERVOSA (AN)

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BULIMIA NERVOSA

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BINGE EATING DISORDER

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REFERENCES

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UNIT INTRODUCTION Welcome to the unit Analyse and Apply Principles of Psychology and Behaviour Management. Initially, this unit may seem out of place within a nutrition course but understanding the basics of psychology and positive behaviour modification is helpful and necessary within consultation settings. This unit provides nutritional advisors with the skills and knowledge to provide clients with basic psychological and behaviour management support to assist in achieving their nutritional goals and objectives. Further, making changes to a client’s diet will require behavioural change on the client’s part, so obtaining the ability to foster positivity around these changes will greatly assist both the nutritional advisor and the client.

This unit begins by introducing psychology and how it developed over the years, outlining the different areas and themes that fall under psychology. This unit explains the relevance of psychology to nutritional advisors by covering common perceptions of nutrition, body image, and health prevalent within the community and media.

This unit then dives into the many facets of understanding behavioural change. Nutritional advisors will begin by learning the basics of behavioural change before identifying the different stages of change a client will go through and what other external and internal factors may contribute. Nutritional advisors will also gain the skills to implement various motivational theories and concepts while coupling these with specific strategies and techniques for positive behavioural change and client adherence. Nutritional advisors will learn how to assist the client in ‘breaking unhealthy habits’ whilst monitoring their behavioural change across several different consults.

This unit also covers the science of how food and nutrients impact behaviour and emotions by learning exactly how specific nutrients can improve or worsen a client’s mental health. This exciting new area of research demonstrates that nutrition significantly impacts individuals’ psychological states and gives nutritional advisors greater insight into their client’s needs. As well as the science, this unit also covers other psychological theories that underpin dietary and exercise patterns, including the significance of enhancing motivation.

This unit then provides nutritional advisors with the skills to recognise and apply communication principles, counselling techniques, and goal-setting techniques to support behaviour change. It also educates nutritional advisors on how to recognise traits of major mental health disorders and when/how to refer to another allied health professional.

This unit may be applied in a range of job roles across the health and fitness industry, including health coaches, sales staff within health and supplement retailers, sports and performance coaches, and fitness professionals. Nutritional advisors will operate without supervision and work within their scope of practice.

This unit only provides nutritional advisors with the skills for health and nutritional counselling and does not provide nutritional advisors with the required skills or knowledge to: or treat clients with identified mental health disorders or conditions • Diagnose Work with suffering from mental health conditions requiring specialised dietary advice • Work with individuals individuals under the age of 18 years (for psychological and/or behavioural support).

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Suppose a nutritional advisor is faced with any of the aforementioned population groups. In that case, they are required to work collaboratively with allied health professionals by referring these clients, who fall outside the scope of practice, to these professionals. This ensures that both the client and the nutritional advisor are safe guarded should any issues arise.

This unit will allow a nutritional advisor to:

a thorough understanding of the relationship between psychology and nutrition • Obtain Explain the impacts of psychology on a client’s health and nutrition goals • Assist clients in establishing and maintaining behavioural change strategies • Apply knowledge of effective communication and counselling techniques • Monitor client performance against behavioural change strategies.

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INTRODUCTION TO PSYCHOLOGY FOR NUTRITIONAL ADVISORS UNDERSTANDING PSYCHOLOGY Psychology is broadly defined as the study of the human brain and the reasons why individuals act and respond in different ways. Weiten more intricately defines psychology as ‘the science that studies behaviour and the physiological and cognitive processes that underlie behaviour, and it is the profession that applies the accumulated knowledge of this science to practical problems.’ (1) Whilst psychologists are the professionals who assist with psychological issues, most professionals will be exposed to psychology in one way or another, especially when interacting or consulting with other individuals.

Health professionals, including nutritional advisors, will be exposed to psychological issues daily, for example, emotional eating, fear of failure, breaking habits and creating new health-focused routines. Therefore, it is essential that foundational principles of psychology are recognised and understood by all nutritional advisors.

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THE RELEVANCE OF PSYCHOLOGY FOR A NUTRITIONAL ADVISOR Understanding the foundation of psychology is essential for any nutritional advisor. It is a nutritional advisor’s responsibility to assist clients to best achieve their goals, and, in doing so, they will require the knowledge and expertise to assist clients in overcoming psychological barriers and setbacks. A sound understanding of and an appreciation for the various psychological aspects which may affect a client, as well as knowing how to best approach and overcome psychological obstacles, will increase the likelihood of client success and retention.

For example, a nutritional advisor can create a nutritionally sound meal plan for their client which will assist them with reaching their longer-term goals of improving overall health and reducing weight; However, if the nutritional advisor is unable to assist their client in overcoming various psychological barriers, behaviours and obstacles, the client may not be able to implement the meal plan.

The case study below provides an example of factors that might need to be considered when approaching the barriers and obstacles some clients may face.

CASE STUDY: MANDY Mandy is a busy 19-year-old student who studies full-time at university. She lives in a shared house with four other first-year students. She is overweight and would like some help to lose weight and get fit. She does not have any cooking skills, wants to ‘fit in’ with her housemates (who eat out a lot) and works 10 hours a week on top of studying 30 hours a week.

From the information above, a nutritional advisor could start to form a list of what may be some barriers for Mandy stopping her from achieving her goals: of cooking skills • Lack pressures • Social Time poor • Financial constraints • Cannot afford gym membership/does not feel comfortable going to a gym • Transport • Distance to shops • HOW A NUTRITIONAL ADVISOR CAN ASSIST: There are many places that a nutritional advisor could start to support Mandy with her goals. But first, her ability to address these barriers, behaviours and obstacles needs to be explored. A nutritional advisor could consider the following: Does Mandy want to learn to cook, or is there an option that avoids energy-dense convenience foods (ready-made meals from the supermarket)?

Does Mandy understand the concept of energy balance?

Would Mandy like to learn about healthier takeaway/fast food options to eat with friends?

Can Mandy create time in her busy schedule for food preparation and exercise?

Would Mandy like to learn tips on healthy eating on a budget, or simply how to budget?

Does Mandy need help with simple exercise ideas that are free (walking, hiking, jogging, council run classes in the park etc.)?

Does Mandy have a car? Which shops are nearby?

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RECOGNISING HOW PSYCHOLOGY DEVELOPED Psychology has developed rapidly over the 19th and 20th centuries thanks to the work of many prominent psychologists. Some influential pioneers of psychology include:

CHARLES DARWIN (1809-1882)

GREGOR MENDEL (1822-1884)

WILHELM WUNDT (1832-1920)

Darwin was a naturalist and biologist known for his theory of evolution and the process of natural selection. Darwin’s theory of the process of natural selection and evolution later became known simply as ‘Darwinism.’

Mendel was an Austrian botanist and scientist who discovered the basic principles of heredity through his famous pea plant study.

Mendel’s findings quickly became the starting point of modern genetics and the study of inheritance. He is widely known as a pioneer in the specific field of genetics.

Wundt was a German physician (doctor), physiologist, philosopher, and professor. He is known as one of the founding figures of modern psychology. He noted that psychology was a science, distinct from philosophy and biology, and was the first person to call himself a psychologist.

‘Wilhelm Wundt opened the Institute for Experimental Psychology at the University of Leipzig in Germany in 1879, which was the first laboratory dedicated to psychology.’(2)

WILLIAM JAMES (1842-1910)

James was an American psychologist and philosopher and has been labelled the ‘father of American psychology.’ He was the first to offer a psychology course in the USA and was one of the most influential philosophers in America.

IVAN PAVLOV (1849-1936)

Pavlov was a Russian physiologist known for his work in ‘classical conditioning.’ His experiments in animal behaviour (Pavlov’s dogs) were pioneering and influenced the behaviourist school of psychology.

SIGMUND FREUD (1856-1939)

MARY WHITON CALKINS (1863-1930)

Freud was an Austrian neurologist and the founder of psychoanalytic theory. He is known as one of the most influential and controversial minds of 20th-century psychology.

Calkins was the first woman to be president of the American Psychological Association and American Philosophical Association. She developed the ‘paired-associate’ technique in psychology, which was widely published.

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MARGARET FLOY WASHBURN (1871-1939)

JOHN B. WATSON (1878-1958)

LETA STETTER HOLLINGWORTH (1886-1939)

CARL ROGERS (1902-1987)

B.F. SKINNER (1904-1990)

ABRAHAM MASLOW (1928-1970)

Washburn was a leading American psychologist best known for her work in animal behaviour and motor theory development.

Watson was an American psychologist who conducted pioneering work in the field of behaviourism, one of the most influential schools of psychology.

Hollingworth was an American psychologist who conducted pioneering work in three areas: The psychology of women, educational psychology, and clinical psychology.

Rogers was an American psychologist who conducted pioneering work in the field of humanistic psychology, another of the most influential schools of psychology. He developed his perspectives in answer to the limitations of psychoanalytic theory and behaviourism.

Skinner was an American psychologist, behaviourist, inventor, and social philosopher. He developed ‘behaviour analysis’ and worked on strengthening behaviour using operant conditioning.

Maslow was an American psychologist known best for creating ‘Maslow’s Hierarchy of Needs,’ known as a theory of psychological health, based on fulfilling innate human needs, in selfactualisation.

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UNDERSTANDING AREAS OF PSYCHOLOGY Health professionals, such as psychologists, may focus on one area specifically when consulting with clients or may have a broad range of knowledge in all areas.

There are seven major areas and theories in psychology: 1. Developmental psychology.

2. Social psychology.

3. Experimental psychology.

4. Physiological psychology.

5. Cognitive psychology.

6. Personality psychology.

7. Psychometrics.

The table below has been adapted from Weiten and identifies the focus of the seven major areas in psychology:(1)

AREA

FOCUS OF PSYCHOLOGY

DEVELOPMENTAL

Focuses on an individual’s development across their lifespan. Initially, developmental psychology focused primarily on childhood; however, it is now more encompassing of all ages up until old age.

SOCIAL

Focuses on interpersonal behaviour and the effect of external social influences on human behaviour. Areas of interest include attitude, behaviour in social settings, aggression, attraction, and intimate relationships.

EXPERIMENTAL

Focuses on sensation, learning, conditioning, perception, motivation, and emotion. Despite its name, ‘experimental,’ it is important to note that all areas of psychology can undertake experiments, not only the ‘experimental’ area.

PHYSIOLOGICAL

Physiological psychology focuses on the genetic influences on behaviour and the role of the brain, nervous system, endocrine system, and body chemicals in the regulation of behaviour.

COGNITIVE

Cognitive psychology focuses on an individual’s mental processes, such as memory, reasoning, information processing, language, problem-solving, decision making and creativity.

PERSONALITY

Personality psychology focuses on understanding the consistency in an individual’s behaviour, the factors which shape the personality and personality assessment.

PSYCHOMETRICS

Focuses on the measurements of behaviour and capabilities, and assessments of personality, intelligence, and a wide range of abilities.

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IDENTIFYING PROFESSIONAL SPECIALTIES IN PSYCHOLOGY Psychology is a broad field of study, as shown by the seven major areas (outlined on the previous page). For this reason, most psychologists specialise in one or two areas of practice and become experts in that field. By doing so, psychologists gain an in-depth understanding of the area and apply the learning with clients to produce the best outcomes.

There are four major areas of professional specialisation, including: 1. Clinical psychology.

2. Industrial and organisational psychology.

3. Counselling psychology.

4. Educational and school psychology.

Each of these specialisations is distinct from the others, and each has a different application in real-world practice.

CLINICAL PSYCHOLOGY Clinical psychology is based on the assessment and treatment of individuals with mental health disorders and emotional disorders, such as those suffering from eating disorders. Clinical psychologists are commonly found in rehabilitation centres, hospitals, and private practices.

INDUSTRIAL AND ORGANISATIONAL PSYCHOLOGY Industrial and organisational psychology is focused on work-based environments. This type of psychology focuses on employers and/or employees’ attitudes and behaviour at work and uses various principles and strategies to enhance the workplace environment and an individual’s work-life.

COUNSELLING PSYCHOLOGY Counselling psychology is focused on counselling and psychotherapy. It uses a variety of techniques and therapeutic approaches to assist with mental health disorders and program development for specific areas such as addiction, mediation and conflict resolution.(3) Counselling psychologists help individuals with various issues, including stress management, conflict resolution, dealing with grief, recovering from eating disorders, increasing self-esteem and selfworth, and managing emotions and emotional eating triggers.(3)

DICTIONARY PSYCHOTHERAPY Psychotherapy is a holistic approach to treating psychological, developmental, relationship and wellbeing issues. Psychotherapy focuses on building an understanding and acceptance of an individual’s mental, emotional, relationship and spiritual health to create solutions to new and old empirical problems.(3)

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EDUCATIONAL PSYCHOLOGY Educational psychology involves the work of psychologists in an educational setting. In addition to consulting and teaching students about psychology, these psychologists may assist with: Crisis management Policy intervention Academic program analysis Student orientation Special needs policies The development of various programs, learning aids and assessment programs.

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UNDERSTANDING THE VARIOUS THEMES OF PSYCHOLOGY Psychology is both the study of behaviour and the scientific discipline that investigates behaviour and mental processes. There are seven unifying themes of psychology, and each theme introduces several different ideas, principles and concepts through various areas of research. Since the study of psychology can be extensive and complex, understanding various psychology concepts by first breaking them up into different ‘themes’ can assist a nutritional advisor in comprehending the topic as a whole.

In turn, having a sound understanding of psychology and its principles can benefit a nutritional advisor to develop individual nutritional plans for clients and support and understand their clients on a deeper level. Having this skillset and the ability to put into practice what is learnt throughout this unit are attributes that can set a nutritional advisor apart from other health professionals.

The seven unifying themes of psychology include: 1. Psychology is empirical.

2. Psychology is theoretically diverse.

3. Psychology evolves in a sociohistorical context.

4. Behaviour is determined by multiple causes.

5. Behaviour is shaped by cultural heritage.

6. Behaviour is influenced jointly by heredity and environmental factors.

7. People’s evidence of the world is highly subjective.

The above seven themes of psychology can be broken into two categories. The first three themes highlight crucial aspects of psychology as a way of ‘thinking’, whereas the last four themes are broad generalisations of psychological subject matter and the behaviour and cognitive physiological processes which underpin it. As such, the seven unifying themes can be categorised as:

CATEGORY 1: CRUCIAL ASPECTS OF PSYCHOLOGY AS A ‘WAY OF THINKING.’

CATEGORY 2: BROAD GENERALISATIONS OF PSYCHOLOGICAL ‘SUBJECT MATTER.’

1. Psychology is empirical.

2. Psychology is theoretically diverse.

3. Psychology evolves in a sociohistorical context.

4. Multiple causes determine behaviour.

5. Behaviour is shaped by cultural heritage.

6. Behaviour is influenced jointly by heredity and environmental factors.

7. People’s evidence of the world is highly subjective.

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THEME 1: PSYCHOLOGY IS EMPIRICAL ‘Empiricism’ is the premise that knowledge should be acquired through observation. While it is not uncommon for most individuals to have their own ideas as to why certain people act in the way they do (e.g. why a person may be overweight, why a person may suffer from depression or why a person may stay in an abusive relationship), the concept that ‘psychology is empirical’ relates to the observation of certain situations before reaching a conclusion. Therefore, this is beneficial as conclusions are not based on reasoning, speculation, traditional beliefs, or common sense.(1) This aspect of psychology as a nutritional advisor is fundamental for good practice and a true understanding of an individual’s situation.

THEORY CREATE OR MODIFY THE THEORY.

USE THE THEORY TO FORM A HYPOTHESIS.

OBSERVATION

HYPOTHESIS

PERFORM THE RESEARCH.

DESIGN A STUDY TO TEST THE HYPOTHESIS.

RESEARCH

THEME 2: PSYCHOLOGY IS THEORETICALLY DIVERSE Following on from the above theme, while psychology is based on observation, it is important to understand that psychology can be theoretically diverse when these observations are unrelated. This means that psychologists seek to explain and understand what it is they have observed through a theory. A theory links these unrelated observations in an effort to explain them.

DID YOU KNOW? A theory is considered to be a system of interrelated ideas used to describe a set of observations.

THEME 3: PSYCHOLOGY EVOLVES IN A SOCIOHISTORICAL CONTEXT Progress in psychology affects trends, events, issues, and values in society; thus, psychology evolves in a sociohistorical context. The term ‘sociohistorical’ refers to aspects which involve social history or a combination of social and historical features.(1) For example, historically, obesity was seen as a badge of wealth and was sought after by individuals and their friends, family, and partners. Fast track to the current social views and obesity is seen as undesirable and unhealthy, and a slim figure is viewed more favourably.

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THEME 4: BEHAVIOUR IS DETERMINED BY MULTIPLE CAUSES As psychology progresses, it is more widely understood that behaviour is extremely complex and that there are multiple causes that can determine certain behavioural patterns and responses. Behaviour is often not a response to one single cause but rather a multitude of various causes, which all impact the outcome of a situation For example, some may think that an individual is overweight because they do not exercise, but in fact, the individual may be overweight because they do not exercise due to an injury. Also, they may not be eating ‘healthy’ foods due to low food security. Further, this individual may have hormonal issues which are impacting their overall weight, energy, and motivational levels.

As a nutritional advisor, understanding that behaviour is not always the result of one cause, but rather a number of causes, is essential to comprehensively understand an individual’s situation.

THINKING PROCESSES LEARNED BEHAVIOURS

UNCONSCIOUS PROCESSES BIOLOGICAL PROCESSES

THEME 5: BEHAVIOUR IS SHAPED BY CULTURAL HERITAGE An individual’s cultural background will greatly influence their behaviour. The term ‘culture’ refers to the widely shared customs, behaviours, values, norms, institutions, and other products of a community that are transmitted socially across generations.(1) Culture is not only influenced by the demographics and geography of where an individual is raised, but also by the family, legal, political, ethnic and religious views with which they are surrounded by as well. Cultural heritage is understood to have a great impact on thoughts and feelings, and, as such, shapes an individual’s behaviour.

As a nutritional advisor, understanding that an individual’s cultural background will affect their behaviour is essential for creating a nutritional plan which will suit that particular client.

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THEME 6: HEREDITY AND ENVIRONMENTAL FACTORS JOINTLY INFLUENCE BEHAVIOUR ‘Heredity’ refers to specific genetic traits and characteristics which are based on inheritance (passed down in the family); whereas ‘environment’ refers more to the upbringing of an individual (e.g., short-tempered, or calm parents, financially stable or living in poverty, type of school attended, weekend activities). It is widely understood that both the heredity and environmental factors will jointly influence an individual’s behaviour.

Another way to understand heredity and environmental influences on behaviour is to look at the ‘Nature Vs Nurture’ debate, which is said to be one of the oldest philosophical issues within psychology.(1) ‘Nature’ is another way of explaining ‘heredity’ factors, such as genetics, which influence an individual’s behaviour (from an individual’s physical appearance to personality characteristics).

‘Nurture’ is another way to explain environmental variables that impact the type of person an individual becomes (i.e., early childhood experiences, how they are raised, their relationships, and their surrounding culture).

Nature

Genes and hereditary factors Physical appearance personality characteristics.

Nurture

Environmental variables Childhood experiences how we were raised social relationships surrounding culture.

For example, identical twins separated at birth will have vastly different behaviours based on their environment (nurture), but similar aspects based on heredity factors (nature). The first twin may live in a poor area with little access to healthy food, have no education and be great at soccer, while the other twin may live in a rich suburb, attend private education, and also be great at soccer. It is both the environmental and heredity factors which will jointly influence behaviour.

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Another example is outlined in the image below, where it shows again how the behaviour of identical twins can be influenced by both heredity and environmental factors: Jennifer & Karen

Identical twins born with genes that absorb fats twice as fast as the average person.

Jennifer

J J

Eats healthy low fat food.

Jennifer

Obesity genes not triggered.

J

K

Karen

Karen

Eats fatty unhealthy food.

K

Obesity genes triggered.

As a nutritional advisor, having a sound understanding that it is both heredity as well as environmental factors which will be influencing the health and behaviours of individuals is essential when counselling and educating individuals on nutrition for their personal situation.

THEME 7: PEOPLE’S EVIDENCE OF THE WORLD IS HIGHLY SUBJECTIVE This theme of psychology simply refers to the observation that the way one individual perceives incoming information may be different from how another individual perceives that same information. For example, one individual may view a nutritional advisor as someone who tells others what to do without taking their personal situation into account; this may be as a result of another individual providing them with that view before they go to see a nutritional advisor.(1) Another individual, on the other hand, may view a nutritional advisor as a beneficial health professional, who will take the time to understand their own situation and apply realistic and achievable recommendations to improve their overall health. This view may be because of a more positive interaction with a nutritional advisor that either the individual or someone they know has had.

WHAT YOU SEE

OBJECTIVE FACTS

WHAT CONFIRMS YOUR BELIEFS

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COMMON PERCEPTIONS OF NUTRITION, HEALTH AND BODY IMAGE WITHIN THE COMMUNITY AND MEDIA CULTURAL NORMS Cultural norms are the patterns of behaviour and attitudes towards those behaviours that are considered normal in a society or community. Cultural norms vary between countries and communities and influence the attitudes and behaviours of individuals within a community. For instance, in Western countries, a thin body is idealised in the fashion, media and health industries. This strongly influences the perception of health, diet, and attractiveness for many people.

In countries like Samoa, Tonga and Fiji, a large body is idealised because of the perception that it demonstrates wealth and abundance. Due to the prevalence of larger bodies, it is seen as attractive and normal.

It is important for nutritional advisors to understand that different individuals possess different perceptions due to culture. As such, nutritional advisors need to be culturally sensitive with their clients, especially where their clients’ perceptions differ from their own.

SOCIAL NORMS Social norms are the informal rules that govern behaviours in a group, community or society. Some examples of common social norms include: ‘excuse me’ when passing someone • Saying Saying when an individual bumps into someone or is bumped into by someone else • Tidying‘sorry’ in a shared workplace kitchen • Giving aup‘thank you’ wave when letting someone enter traffic.

•

Social norms help people, who otherwise would be strangers, communicate and operate within their community with a similar level of expectation as to acceptable behaviour.

Concerning nutrition, some social norms include:

social peers choose to eat • What Messages to eat more fruit and vegetables • Believing that one specific nutrient causes obesity.

•

Social norms can differ within social groups such as friendship groups, colleagues in workplaces, members of sports clubs and at a community and societal level. Being aware of the social norms is important for a nutritional advisor because, although norms can be helpful, they can also be harmful. For instance, a client whose friendship circle does not eat meat because of the belief that humans are not omnivores, may risk nutritional deficiencies if they do not eat a nutritionally adequate diet because of their belief.

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BODY IMAGE AND SELF-PERCEPTION Body image is an individual’s perception of their physical self and the thoughts and feelings surrounding that perception. The way an individual sees themselves is not always a true reflection. For example, an individual may see themselves as fat when looking in the mirror; however, they may actually be thin. Another example is an individual who thinks they are unattractive, and this can damper their confidence; however, others may perceive this person as an attractive and friendly individual.

The National Eating Disorders Association defines body image as ‘how an individual sees themselves when they look in the mirror or when they picture themselves in another person’s mind. It encompasses:

an individual believes about their own appearance (including memories, assumptions, and generalisations) • What How an feels about their body (including height, shape, and weight) • How an individual senses and controls their body as they move • How an individual individual feels in their body, not just about their body.

• (4)

There are four major aspects of body image, including: body image • Perceptual Affective body • Cognitive bodyimage • Behavioural bodyimage image.

•

These four aspects are outlined and explained in the table below.(5)

ASPECTS OF BODY IMAGE

DEFINITION

PERCEPTUAL BODY IMAGE

The way an individual sees themselves.

AFFECTIVE BODY IMAGE

The way an individual feels about their body.

COGNITIVE BODY IMAGE

The way an individual thinks about their body.

BEHAVIOURAL BODY IMAGE

Behaviours that are undertaken as a result of body image.

EXAMPLES sees themselves looking in the mirror •(e.g.,Howfat,anslim,individual pale, attractive) An individual may think they look ‘fat’ in those jeans •whereas others do not share that opinion an individual feels when seeing themselves (e.g., •sad,How frustrated, disgusted, happy) Identifies various parts of the body as ‘unattractive’ for •reasons which others may not agree with Emotions •the body and feelings regarding weight and shape of an individual thinks when seeing themselves in •theHow mirror (e.g., need to become thinner, need to gain more muscles, need to tighten abdominal muscles) An individual may feel as though they need to look a certain way, with a specific body shape, to fit in with the crowd or become popular.

•

How an individual behaves as a result of their body •image (e.g., wears baggy clothes, negative self-talk, avoids the beach, begins dieting) An individual may isolate themselves or undertake destructive behaviours such as excessive exercising to look a particular way.

•

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RECOGNISING NEGATIVE BODY IMAGE Negative body image occurs when an individual has negative thoughts about themselves, highlighting perceived flaws in their own body. Negative body image does not necessarily reflect the views of others but is rather an inward negative self-assessment. Negative body image can become detrimental to an individual’s health, increasing the likelihood of eating disorders such as anorexia nervosa and bulimia nervosa.

Someone who suffers from negative body image may struggle with the following:

distorted perception of their body shape, seeing parts of their body not as they really are. For example, a slim • Aindividual looks in the mirror and thinks they have a fat bottom. This is their distorted perception, and it is not

• •

true. In reality they are very thin.

Constant negative judgement and comparison of themself to others. For example, an individual may compare their own summer body to a photoshopped woman on a magazine cover.

Self-consciousness, feelings of anxiety and shame regarding their body, secondary to the distorted perception and comparison of themself to others.

RECOGNISING POSITIVE BODY IMAGE Positive body image occurs when an individual can respect and appreciate their own body and not focus on negative attributes or distorted perceptions of themself. Those with positive body image have higher self-confidence and are less likely to suffer from eating disorders.

Positive body image has the following attributes:

perception of own body shape and size • True that every person is a different shape and size and that does not deflect anything from personality • Understands or character and confident in their own body and therefore does not spend excessive amounts of time • Comfortable comparing themselves with others or searching for ways to improve their body.

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UNDERSTANDING THE PSYCHOLOGICAL EFFECTS OF SOCIAL MEDIA DID YOU KNOW? An individual’s body image can be heavily influenced by their own personal beliefs and attitudes and what society, the media, and their peer groups portray on a day-to-day basis.

As a nutritional advisor, it is important to understand that in many cases, the idea of perfection displayed either on social media or by the mainstream media, quite often does not match reality. The media, especially with the dramatic increase of exposure to social media, can portray the ‘norm’ to be quite different from what it actually is. Televised commercials and models shown on magazine covers are perfectly lit, perfectly timed, posed and photoshopped images.

Individuals are constantly showered with images, video clips and ideas of what ‘perfect’ is. In the long term this can have detrimental effects on an individual, including negative mood, body dissatisfaction and an altered perception of ones own shape and weight, especially for those who are particularly susceptible to ‘fitting in’ or those with low self-esteem.(6) Being aware of the effects of the media on mental health allows a health professional to not only support and encourage their clients with individual nutritional goals, but it also promotes realistic expectations from their clients.

Educating clients and creating awareness of how the media can depict altered perceptions by promoting realistic lifestyles and authenticity can improve the client’s self-esteem and willingness to adhere to their own nutritional goals.

Social media has become a platform that reinforces cultural beliefs and projects strong views on how people should look. The more an individual looks at perfect images of others and then tries to emulate the unrealistic standards themselves, the worse they feel about themselves. These feelings can not only cause an immediate upset, but long term it can develop into self-loathing and cause the onset of an eating disorder or a mental health illness, like depression and anxiety.(7)

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The table below outlines the psychological effects (either positive or negative) that social media can have on an individual:(7)

POSITIVE PSYCHOLOGICAL EFFECTS

NEGATIVE PSYCHOLOGICAL EFFECTS

Provides an individual with a sense of ‘belonging.’

Feelings of inadequacy can increase.

Individuals feel as though they ‘fit in’, are included or accepted when a friend or family member reaches out or comments on a post.

Individuals that use social media often compare themselves to other people. This can potentially leave them feeling as if they cannot keep up with the ‘idyllic’ lives that the people they follow consistently depict.

Finding a ‘role model’ or someone to look up to becomes easier.

Increased levels of anxiety.

Social media enables its users to connect with people who share the same interests or concerns. This can provide inspiration or motivation for some individuals.

Social media can leave its users feeling anxious for many reasons. Common reasons include: Not feeling smart enough to engage Anxiety about appearing to be ‘boring’ Not being as successful as others A fear of not being involved with other conversations or activities.

Increases happiness and spreads happiness to others.

Increased signs of depression.

Contrary to popular belief, social media does have the potential to make an individual feel better and increase their happiness, however, only while actively engaged.

Studies show that the more use of social media, the more likely they are to experience a drop in their mood, despite the number of friends they have on a particular social media platform.

University of Missouri psychologists discovered that the actively engaged test subjects experienced a physiological response that indicated an increase in happiness. This increased happiness, however, went away once subjects switched back to passively browsing.

Decreases loneliness while increasing interpersonal relationships.

When individuals have one-on-one interaction via social media, there is the potential for them to form a bond (i.e., emotions such as affection and trust).

• • • •

On the surface, Facebook provides an invaluable resource for fulfilling the basic human need for social connection. But rather than enhance well-being, it was found that Facebook use produces the opposite result.(6) Communicating in person can become more challenging.

Social media has the potential for an individual to develop a phobia of social interaction, due to fewer face-to-face interactions with others.

Increases chances of becoming disconnected from the ‘real world’.

Social media has the potential to become very addictive by triggering the release of dopamine. This can ultimately cause the brain’s ‘reward pathways’ to change in a similar way to someone addicted to drugs.(8)

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UNDERSTANDING BEHAVIOUR AND THE PRINCIPLES OF BEHAVIOURAL CHANGE UNDERSTANDING BEHAVIOUR Behaviour can be described as how an individual conducts themselves and how they respond in certain situations. It can be impacted by their environment and other systems or organisms around them.

There are many factors influencing behaviour, including: brain and central nervous system • The (CNS) inheritance • Genetic Adaptive traits (how an individual has • been actively taught to behave).

FOREBRAIN Telencephalon Diencephalon

MIDBRAIN Mesencephalon

THE BRAIN AND BEHAVIOUR The nervous system is subdivided into two major systems: the central nervous system (CNS) and the peripheral nervous system (PNS).

The CNS consists of the brain and the spinal cord, whereas the PNS consists of all other nerve cells in the body. (1)

HINDBRAIN Metencephalon Myelencephalon

When it comes to behaviour, it is the CNS that is most responsible for how one behaves and reacts in various situations.

The brain is divided into three main regions: the hindbrain, the midbrain, and the forebrain. It is important to note that these refer to their location in the embryo’s nervous system and are not a true reflection of their exact location in an adult brain. (1)

HINDBRAIN

Involved in crucial functions such as breathing, vomiting, salivating, regulating the cardiovascular system, controlling levels of arousal, and maintaining consciousness, balance and movement.

MIDBRAIN

An essential role in the routes for sensory information (e.g., taste, touch, smell, sight, and sound).

FOREBRAIN

Involved in thinking, the use of language, perception, motivated behaviour such as eating, aggression, anxiety, avoidance, emotions and sexual behaviours, voluntary motor responses (such as waving), and thermoregulation.

DID YOU KNOW? ‘Sensory’ comes from the Latin word ‘sentire’, which means to perceive or to feel. Sensory information, therefore, relates to information from the external environment, such as sound, sight, taste, touch, and smell.

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GENETIC INHERITANCE AND BEHAVIOUR How genetics is involved with an individual’s behaviour is explored in what is known as evolutionary psychology, which stems from Charles Darwin’s theory of natural selection. Darwin argued that offspring are more like their parents than other members of the same species through inheritance.(1) When explaining why the offspring most resembled their parents and family line, Gregor Mendel explained genetic inheritance. Genetic inheritance can be explained by the understanding of dominant and recessive genes. When species procreate, there is a sharing of deoxyribonucleic acid (DNA) which will form the basis of the offspring. DNA is received from both the mother and the father of the offspring. DNA bears each parent’s genetic coding, which is then passed to the offspring. Genetic coding can be dominant or recessive, which refers to how likely that gene is to be expressed in the offspring.(1) An individual’s genotype (DNA makeup) will affect how an individual looks, their susceptibility to disease and personal strengths and weaknesses. The phenotype of an individual refers to observable characteristics resulting from an individual’s genotype reacting to the environment. As such, an individual’s genotype/genetics, combined with environmental influences, will influence behaviour.(1)

DID YOU KNOW? It is understood that children share 50% of their genes with their parents, 25% with their grandparents and 12.5% with their first cousins.

Below is an example of how a single gene trait would be expressed in the offspring: Dominant trait + dominant trait = Dominant traits are equally expressed.

Dominant trait + recessive trait = Dominant trait is expressed.

Recessive trait + Recessive trait = Recessive trait.

A dominant gene is expressed when paired genes are different, and a recessive gene is masked when paired genes are different. The example below shows if the parents have brown (dominant) and blue (recessive) eyes, what the chances of their offspring’s eyes being a certain colour are: For parents with brown eyes (Bb), their offspring has a 3 in 4 chance (or 75%) of having brown eyes; and a 1 in 4 chance (or 25%) chance of having blue eyes. For one parent with brown eyes (Bb) and one parent with blue eyes (bb), their offspring has a 1 in 2 chance (or 50%) of having brown eyes and a 1 in 2 chance (or 50%) chance of having blue eyes. (9)

FUN FACT An allele is a form of a gene that is responsible for hereditary variation. Alleles refer to the DNA coding from parents, which is then passed down to their children. Each gene will have one allele from its mother, and one allele from its father, and these two alleles combined will provide specific genetic coding for that individual.

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B b

B

b

b

b

BB

Bb

Bb

Bb

Bb

bb

bb

bb

B - Dominant brown eye allele

b - Recessive blue eye allele

B b

BB

Brown eyes

Bb

Brown eyes

bb

Blue eyes

BEHAVIOURS AS ADAPTIVE TRAITS Adaptive behaviour refers to behavioural changes which allow an individual to interact with their environment with the greatest success and least amount of conflict. Adaptive behaviour is learnt over time, and it is suggested that almost all human behaviour is learned. Where an animal, such as a lion or bear, lives life mostly through instinctive behaviour (e.g. hunting food, avoiding predators, seasonal migrations), humans live mostly through learnt adaptive behaviour.(1) Adaptive behaviour means that humans constantly evolve to match their new environment and settings. Most human behaviour is adaptive and is learnt through experience, or from important role models in an individual’s life (e.g., caregivers or parents). Humans are taught how to interact with others, how to behave in certain settings, and how to nurture themselves and others.(1)

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AN OVERVIEW OF BEHAVIOURAL PSYCHOLOGY (BEHAVIOURIST LEARNING THEORIES) Behavioural psychology, known as Behaviourism, is a learning theory based on the idea that behaviours are learnt through conditioning. Conditioning refers to being repeatedly exposed to an environment and the behaviours that this exposure produces. Behaviourists believe that environmental stimuli shape an individual’s responses and actions.

FUN FACT Behaviourism is based on the premise that all learning occurs through interaction with the environment, and the environment, in turn, shapes an individual’s behaviour.

“Learning is any relatively durable change in behaviour or knowledge that is due to experience… behaviours are the product of experience—that is, they represent learning.”

Behaviourism proposes that behaviours can be studied in a systematic and observable manner, regardless of an individual’s internal mental state. This means that only observable behaviour should be considered; therefore, cognitions, emotions and moods are too subjective.

DID YOU KNOW? The ability to observe and measure behaviours is one of the strengths of behavioural psychology. However, this approach has weaknesses, including failing to address cognitive and biological processes that influence actions.

While the behavioural approach is not as dominant as it was in the 20th century, it has significantly impacted the understanding of human psychology. The conditioning process has been used to understand many different behaviours, such as how people learn and how language develops.

The most significant contribution of behavioural psychology lies in its practical applications, as it can play a decisive role in modifying problematic behaviour and encouraging more desirable behaviour.

Strict behaviourists believed that within their physical capabilities and with proper conditioning, an individual could be trained to perform any task, regardless of personality traits, internal thoughts, or genetic background.

There are two major types of conditioning: 1. Classical conditioning 2. Operant conditioning.

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CLASSICAL CONDITIONING (IVAN PAVLOV) Russian physiologist Ivan Pavlov discovered classical conditioning, a learning process that occurs through associating naturally occurring stimulus with an environmental stimulus.

This technique pairs a neutral stimulus with a naturally occurring stimulus. Eventually, the neutral stimulus produces the same response as the naturally occurring stimulus, even without the naturally occurring stimulus being used. The associated neutral stimulus is then called the ‘conditioned stimulus’, and the learnt behaviour is called the ‘conditioned response’.

UNDERSTANDING HOW CLASSICAL CONDITIONING WORKS Classical conditioning entails associating two stimuli to produce a learnt response. There are three phases of this process which are outlined in the chart below, as well as the image provided below:

PHASE 1:

First, a naturally occurring stimulus is required, such as the smell of food, which produces an automatic response, which is salivating.

At this point, the unconditioned stimulus (UCS) results in an unconditioned response (UCR). For Pavlov’s dogs, presenting food (the UCS) naturally and automatically triggered a salivation response (the UCR) in the dogs.

At this point, a neutral stimulus that currently produces no effect is also produced. Once this neutral stimulus is paired with the UCS, it will eventually be associated with and generate a response.

PHASE 3:

PHASE 2:

The UCS unconditionally, naturally, and automatically triggers a response. For example, the smell one of a favourite food (UCS) may immediately induce feelings of hunger (UCR). The UCR is the automatic response that occurs naturally in response to the UCS. For example, feeling hungry in response to the smell of food is the UCR.

During this second phase, the previously neutral stimulus is repeatedly paired with the UCS. As a result of pairing, an association between the previously neutral stimulus and the UCS is formed and the once neutral stimulus becomes known as the conditioned stimulus (CS) - the subject has been conditioned to respond to this new stimulus.

The CS is a previously neutral stimulus which, after becoming associated with the UCS, eventually triggers a conditioned response. In the example above, if the sound of a whistle was paired multiple times with the smell of food, the sound would eventually trigger the conditioned response.

In this example, the sound of the whistle is the conditioned stimulus.

Once the connection has been established between the UCS and the CS, presenting the conditioned stimulus alone will produce the same response even without the UCS. The resulting response is called the conditioned response (CR) which is a learnt response to the previously neutral stimulus. In the example above, the CR would be feeling hungry upon hearing the sound of the whistle.

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BEFORE CONDITIONING

UNCONDITIONED STIMULUS

NEUTRAL STIMULUS

UNCONDITIONED RESPONSE

DURING CONDITIONING

+

NO RESPONSE

AFTER CONDITIONING

CONDITIONED STIMULUS

UNCONDITIONED RESPONSE

CONDITIONED RESPONSE

There are various real-life applications for classical conditioning; some of these examples are listed in the table below:

TRAINING ANIMALS

Many dog trainers use classical conditioning techniques to train dogs.

COPING STRATEGIES

These techniques can be useful for helping people cope with phobias or anxiety problems. Therapists can, for example, pair something that provokes anxiety with relaxation techniques to create an association.

TEACHING

Teachers can apply classical conditioning in the classroom by creating a positive environment to help students overcome anxiety or fear. Pairing an anxiety-provoking situation, such as speaking in front of a group with pleasant surroundings, can help students learn new associations. Instead of feeling anxious in this situation, the child will learn to stay calm and relaxed.

As a nutritional advisor, it is important to understand how conditioning and reinforcement principles work in practice.

Using the techniques, the nutritional advisor can assist their clients with practical behaviour change ideas to achieve their goals.

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OPERANT CONDITIONING (B.F. SKINNER) Operant Conditioning (also known as instrumental conditioning) is a learning method that uses reinforcements and punishments. Operant conditioning associates a behaviour and a consequence of that behaviour.

When a desirable outcome follows an action, the behaviour becomes more likely to occur again in the future. Responses followed by adverse outcomes, on the other hand, become less likely to happen again in the future. For example, when a rat (observed in a laboratory) presses a blue button, it gets food pellets as a reward for doing so, but when the rat presses the red button, it gets a gentle electric shock. As a result, the rat learns to press the blue button in the future and to avoid the red button (depicted in the image below).

Operant conditioning plays a powerful role in everyday learning, not just in experimental lab training. Reinforcement and punishment occur almost daily in many settings, such as the playground, classroom, or therapy sessions.

OPERANT CONDITIONING Specific consequences are associated with a voluntary behaviour.

Rewards introduced to increase a behaviour.

Punishment introduced to decrease a behavior.

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UNDERSTANDING THE COMPONENTS OF OPERANT CONDITIONING Several elements in operant conditioning are useful to learn, and these include: in operant conditioning (positive and negative reinforcement) • Reinforcement • Punishment in operant conditioning (positive and negative punishment).

REINFORCEMENT IN OPERANT CONDITIONING Reinforcement in operant conditioning is considered to be an event that strengthens or increases the behaviour it follows.

There are two types of reinforcers: 1.

Positive reinforcers are favourable or pleasing events/outcomes that are presented or introduced after a desirable behaviour has occurred. In a situation where positive reinforcement has been used, praise or reward is offered to strengthen a desirable behaviour. For example, a manager giving a bonus to an employee who has met performance targets.

2. Negative reinforcers involve the removal of an adverse event/outcome after the display of undesirable behaviour. In this type of situation, an unwanted behaviour or response is strengthened by the removal of something considered unpleasant. For example, stopping a child from screaming at a doctors surgery by giving the child a treat; this stops the behaviour at the time but increases its likelihood in the future. The actions that have led to removing the unfavourable condition (the child screaming), negatively reinforcing the behaviour of the person handing the child the treat. *The behaviour increases in both of the cases of reinforcement that are mentioned above.

PUNISHMENT IN OPERANT CONDITIONING Punishment is known as the occurrence of an adverse event or outcome that causes a reduction in the behaviour it follows.

There are two types of punishment: 1.

Positive punishment is commonly referred to as ‘punishment by application’. This type of punishment presents an undesirable event/outcome in order to weaken the response it follows. For example, smacking a child for bad behaviour is considered to be punishment by application.

2. Negative punishment is commonly referred to as ‘punishment by removal’. This type of punishment occurs when a desirable event/outcome is removed after an unwanted behaviour occurs. For example, taking away a child’s toys following misbehaviour is considered to be a negative punishment. *The aim of both of these cases of punishment is the reduction of unwanted behaviour.

While behaviourism has become less popular compared to the early part of the 20th century, operant conditioning remains an important tool in the learning and behaviour modification process. Natural consequences can lead to changes in behaviour, while in other instances, rewards and punishments may be consciously given to create a change.

Operant conditioning is recognisable in many life situations and can be useful for the nutritional advisor in assisting clients to change diet-related behaviours. It is important to remember that, as with any type of learning, it takes time to learn new behaviours. The type of punishment or reinforcement that might work best for each client may be different.

So, assessing which type of reinforcement schedule might lead to the best results needs to be carefully considered.

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UNDERSTANDING AND IDENTIFYING STAGES OF BEHAVIOUR CHANGE (TRANSTHEORETICAL MODEL) Changing a ‘behaviour’ is a complex and challenging task. The transtheoretical model or stages of change model, developed by Prochaska and DiClemente, attempts to explain an individual’s motivation to achieve change.(10) The transtheoretical model helps identify the stage of change a client is in and is beneficial in helping clients to break habits and create healthy lifestyles.

This model outlines the five stages of change, now commonly known as: 1. Pre-contemplation.

2. Contemplation.

3. Preparation.

4. Action.

5. Maintenance.

6. Relapse The Stages of Change model is beneficial in helping clients to break habits and create healthy lifestyles. When a nutritional advisor understands these stages, this can help identify the stage that the client is at and their readiness to change. In turn, by having this knowledge and being able to identify which stage the client is mentally at, this can help a nutritional advisor to apply the best approach to benefit their client and ensure client adherence.

PRECONTEMPLATION

No intention on changing behaviour.

RELAPSE

CONTEMPLATION

Fall back into old patterns of behaviour.

Aware a problem exists but with no commitment to action.

UPWARD SPIRAL Learn from each relapse

MAINTENANCE

PREPARATION

Sustained change; new behaviour replaces old.

Intent on taking action to address the problem.

ACTION

Active modification of behaviour.

WATCH NOW The 6 Stages of Behavior Change

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THE PRE-CONTEMPLATION STAGE In the pre-contemplation stage, the client has not yet acknowledged that change is required or may simply have no desire to change. They are resistant to change and may be in denial about the existence of a problem. They often become defensive towards anyone who suggests that change is needed. They do not intend to take any action in the foreseeable future. In this stage, a client may be uninformed or demotivated by previous unsuccessful attempts to change. If an individual in the pre-contemplation stage presents for a nutrition consultation, it will usually be due to the pressure of significant others in their lives. Typically a client in this stage will make comments like, “ I don’t see a problem, and there is no reason to change anything”. (10)

There are many reasons for a client to be in the pre-contemplation stage; some of these reasons refer to the ‘four Rs of pre-contemplation’, which include:

RELUCTANCE

Reluctance can stem from the client’s lack of motivation or knowledge to consider changing a situation. Generally the client will not consider change until a problem has come to the surface.

REBELLION

Rebellion can stem when clients heavily rely on their unhealthy habits and generally can not handle being told how to live their life.

RESIGNATION

Resignation refers to a client not believing change is possible and giving up hope without trying.

This behaviour is typically experienced by clients who have tried or attempted to change but previously failed.

RATIONALISATION

Rationalisation is displayed when a client has reasons (or sometimes excuses) for why they do not need to adopt changes or combat bad habits, they rationalise why it’s not necessary for them to change a situation.

An example of a client in the pre-contemplation stage would be an individual who was advised by their GP to lose weight. They attend an appointment with a nutritional advisor but have no intention of following any of the recommendations. In the past, the individual has dieted unsuccessfully and believes it is pointless to try again.

In this stage, the client is not focused on seeking help. When a client is in the pre-contemplation stage, it is more important to work on moving them towards the contemplation stage than to make any recommendations. The nutritional advisor can help the client gain insight by evaluating current behaviours and considering if these behaviours serve the client positively or negatively. A client will move into the contemplation stage only by gaining awareness of problematic behaviour.(10)

THE CONTEMPLATION STAGE In the contemplation stage, the client understands the problematic behaviour and acknowledges that change is required. The client considers the pros and cons of change, and they have reasons why change is needed; however, they may not yet be ready to make the necessary change.

In this stage, the client experiences ambivalence. Ambivalence occurs when a client recognises the need for change and expresses a desire to change, but there are still too many perceived obstacles to overcome. The client is indecisive, and the cost of change still outweighs the benefits. Clients in this stage are open to receiving information and finding solutions for their behaviour. They may try out some changes, but the barriers they experience lead them to quickly give up and continue in their old behaviour patterns. Ambivalence is a complicated part of behaviour change and a client can be in the contemplation stage for a long time. Typically a client in this stage will make comments like, ‘ I know I have a problem, and I think I should do something about it”.(10) An example of a client in the contemplation stage is someone motivated to lose weight and has engaged the help of a nutritional advisor. They attend an appointment and agree to follow a healthy eating plan. At home, the client understands the benefits of the eating plan, but realises they do not know how to plan and shop for meals. They cannot see a way forward and give up because it is too hard. At the next consultation, the client informs the nutritional adviser that they have not followed the plan because they do not like the food and have no time to make it. They are still in the contemplation stage, where the cons of change still outweigh the pros.

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Clients in the contemplation stage generally require further assistance to move them on to the preparation stage. The nutritional advisor can help the client by working through the ambivalence and offering support and encouragement in the form of: about the health benefits of a whole food diet • Research Statistics about health risks associated with a low-quality diet • Recommended readings about nutrition • Education about the benefits of change • Raising awareness around problematic • Address perceived barriers to change andbehaviours find solutions.

•

THE PREPARATION STAGE The preparation stage is also called the ‘determination stage’. In this stage, the client has acknowledged that a behaviour is problematic and is committed to changing. Now the client agrees that the pros of change outweigh the cons and may take steps to assist with these intended changes. A nutritional advisor can support a client in the preparation stage by:

the pros and cons of change •• Listing Determining the cost of personal time involved in making the change strategies to implement change •• Researching Speaking to friends and family about intended change • Locating available resources to assist with intended changes, for example locating gyms or fresh food outlets in their community.

Gathering information is an important step in this stage, and the nutritional advisor can help their clients plan for change. They can offer them appropriate knowledge of what to expect, so the client can prepare for the next stage of change. The knowledge includes letting them know what risks are involved, what problems may arise, and how to avoid these issues. Clients in this stage usually intend to act within the next thirty days and may even have taken some steps toward change. A typical client comment in this stage is, “I still go to McDonald’s for a burger, but I have started making some healthy burgers at home”.(10) An example of a client in the preparation stage is someone who has decided they want to lose weight. They book an appointment with a nutritional adviser and sign up for the 12-week weight loss program. With the help of the nutritional advisor, they have a solution to any future obstacles and feel confident they will be able to follow the plan. They go home, purchase all the ingredients from the plan, join a local gym and plan to start the diet the following week.

THE ACTION STAGE The action stage is where a client will make specific lifestyle changes, and there will be an observable modification of behaviour over a few months. This stage is typically under six months. The client has gained confidence and believes they are capable of change. Clients may also let others know of their commitment to gain accountability for their actions. A typical comment in this stage could be, “I am cooking for myself every evening now, and I have not been to McDonald’s in four months”.

However, behaviour change has not become second nature yet. It will still require willpower and an investment of time and energy to stay on track. During this stage, the client may experience unexpected obstacles or triggers that can cause a relapse.(10) An example of someone in the action stage is a client who has been following a meal plan for the past few weeks and has made some positive changes in their diet. They are cooking healthy food at home and have cut back on fast food and other discretionary items. They go to a restaurant for a birthday celebration and end up over-eating and indulging in dessert. The next day they feel like a failure; they give up and go to McDonald’s for breakfast. After a quick phone call with their nutritional advisor, they are reminded of all the positive changes they have made so far. Together with the nutritional advisor the client puts a plan in place to navigate eating in restaurants in the future. The client is motivated to resume the eating plan and feels confident they can stay on track. They are still in the action stage.

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Regular contact with the nutritional advisor will prevent the client from fully relapsing and reverting to old behaviours.

The nutritional advisor can offer support and develop plans to overcome hurdles so the client can continue to commit to the plan and achieve their goals. Also, in this stage, developing short-term positive reinforcement to reward the new behaviours will help to sustain motivation.(10)

THE MAINTENANCE STAGE In the maintenance stage, the client has continued the new behaviours without lapsing into old ones for at least six months. The client has become more confident about their ability to sustain the new behaviours. Progressively the new behaviours have become a lifestyle. They have thoughts about returning to the old behaviours but resist temptation and remain on track. The client has developed skills to anticipate potential triggers that may cause a relapse and has coping strategies to deal with these situations.(10) As a nutritional advisor, it is important to remember that ongoing support may be necessary to keep the client motivated. To avoid relapse, a client’s commitment, and ability to overcome barriers to change is essential in this stage of change. Both the nutritional advisor and the client can work collaboratively to stay in this stage of change.(10)

THE RELAPSE STAGE Relapse is the regression from the action or maintenance stage to an earlier stage. It is characterised by a return to previous problematic patterns of behaviour. Relapse is often a return to the pre-contemplation stage and to justifying the original problem behaviour. However, because behaviour change is not a linear progression, but a spiral or recycling of stages, relapse is normal in any behaviour change process. A client may average three or four attempts before achieving long-term behaviour change.(10)

When a client goes through a stage of relapse, it is also important for nutritional advisors to be aware that the client might experience many different feelings; examples include: feeling of failure • The Disappointment • Frustration.

• However, despite the negative feelings that may arise for the client, the relapse stage should be regarded as positive for the client. It is an opportunity to reassess the motivation for change. It is a chance to evaluate the barriers to change or any triggers. The nutritional advisor can develop strategies with the client to get back on track for sustainable change.

An example of a client in the relapse stage is someone following a meal plan and losing weight over three months. They are in the action stage; however, their meal plan involves a considerable investment of time and energy to shop for food and to cook at home. The new behaviour went well until the client started a new job. The new job is very demanding and involves working late after work. The client feels very stressed and has no time to follow the plan. They start to go back to their old habits of ordering a takeaway. Also, the stress has triggered cravings for chocolate and ice-cream treats in the evening. They feel further frustrated as they cannot follow the plan, which escalates into feelings of hopelessness.

They discontinue the nutrition consultations and revert to their old habits. They have gone into the relapse stage.

Nutritional advisors should be mindful that relapse is a process that starts with a setback or ‘lapse’.(11) A lapse is considered a brief setback and does not constitute a relapse. If a client ‘lapses’ this does not automatically lead to the client fully relapsing; however, it can be a step in that direction.

An example of someone experiencing a lapse, as opposed to a full relapse, would be a client in the same situation as above. They have stopped following the plan and started returning to old behaviours; however, they have booked a nutrition consultation this time. In the session, they work with their nutritional advisor to overcome their current obstacles and afterwards they can get back on track with a new plan. By these actions, they go back into the action stage and have avoided a full relapse.

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IDENTIFYING FACTORS THAT MAY AFFECT BEHAVIOUR CHANGE AND/OR CLIENT ADHERENCE There are several factors that may affect how a client behaves or their adherence to lifestyle recommendations. While some of these factors may positively influence the client, others may be negative and slow the client’s progress.

As a nutritional advisor, it is important to identify the client’s barriers to change, as this will provide insight into what may prevent the client from achieving specific recommendations or goals. When barriers to change are discussed in an open and non-judgemental manner, solutions can be identified and put into action.

Some of the factors affecting a client’s ability to change their behaviour may include: support (family, cultural and social situations) • External Current habits • Lifestyle factors • Personality factors • Self-esteem • Barriers to adherence, for example, a lack of time.

•

EXTERNAL SUPPORT (FAMILY, CULTURAL AND SOCIAL SITUATION) External support can be from various areas, including immediate friends and family, workplace, religious settings, social settings and places an individual frequents regularly.

All external support will have an impact on the client. Some people may offer positive support and encouragement, while others may have a more negative influence.

Generally, the people whom the client spends the most time with and values their opinions the most, will have the greatest impact on their outcome. For example, if a client goes home following a consultation and their partner and children think what the client is doing is silly, tasteless, boring or selfish, the client is not as likely to place the importance on their changes. However, if a client goes home following a consultation and the partner is enthusiastic to help with modifications, the children enjoy the new dietary changes, and overall, the client feels nurtured and supported, they are far more likely to continue and succeed with dietary changes.

External support involves all the people the client interacts with regularly. This includes:

• Friends and • Colleagues, Acquaintances.

•

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CURRENT HABITS The term ‘habit’ refers to a behaviour that is frequent, persistent, or repeated over and over.

There are two types of habits that depend on the type of situation or consequences that an individual is faced with, these include: HABITS (that have positive effects on an individual’s life).

• HEALTHY UNHEALTHY HABITS (that negatively impact an individual’s life).

•

A client’s habits will significantly impact their ability to achieve their goals. Some habits can be beneficial and assist with the recommended changes; whereas other habits can prove detrimental and make it difficult for clients to achieve their goals.

For example, an individual used to meal prepping may find it a lot easier to create healthy changes in their diet than an individual who relies heavily on takeaway options.

LIFESTYLE FACTORS An individual’s lifestyle will significantly impact their ability and motivation to carry out dietary recommendations to achieve their goals.

Lifestyle factors may include anything which the individual is used to doing regularly, including but not limited to: types of food consumed • The Frequency, • Social life type and intensity of exercise conducted • Positive or negative self-talk • Financial status • Work environment • Level of education • The type of people who influence them.

•

As a nutritional advisor, it is encouraged to gain a deeper understanding of a client’s lifestyle so that recommendations can be made based on known limitations and strengths. In some situations, some lifestyle factors can change. In this scenario, it can be helpful to work with the client to change a particular lifestyle factor; however, in other scenarios, the lifestyle factors cannot be changed, and it is equally as important to ensure that recommendations are made with this factor in mind.

An active social life Stress management Quality sleep

Regular exercise Healthy diet Mental stimulation

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PERSONALITY FACTORS An individual’s personality can fundamentally impact their ability to work their way through the stages of behavioural change and maintain lifestyle changes. An individual may have a positive mindset with a confident personality or, in contrast, a negative mindset with an insecure personality.

Individuals with a positive mindset are more likely to have the confidence in themselves to follow through with dietary recommendations and may not require as much support.

Individuals with a negative mindset may find it more difficult to make dietary changes. These individuals may benefit from further education regarding why the changes are beneficial, re-visiting why they want to achieve particular goals and offering regular contact for motivation and support.

The table below represents positive and negative mindsets and the associated attitudes and beliefs:

NEGATIVE MINDSET

POSITIVE MINDSET

I CAN’T DO THIS.

I CAN DO THIS.

I WILL FAIL.

I WILL SUCCEED.

I NEVER SUCCEED.

I WILL TRY MY HARDEST.

I AM NOT GOOD ENOUGH.

I DESERVE THIS.

I AM NOT WORTHY.

I AM WORTHY.

I AM NOT ENOUGH.

I AM ENOUGH.

IT IS TOO HARD.

IT WILL GET EASIER.

No matter what type of personality a client may appear to have, it is always best to identify their motivation and drive for change. All individuals will require differing amounts of support, and all clients must be reminded of their motivation and why they are making these lifestyle changes.

As a nutritional advisor, it is important to support a client with an insecure personality and a negative mindset toward healthy eating by: their client’s motivation and drive as to why they want to make the change.

• Understanding barriers and creating solutions to overcome them will encourage them and keep them motivated and • Identifying determined to achieve their goals. the level of support the client needs will enable them to see that their nutritional advisor is • Understanding committed to helping them to create change.

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IDENTIFYING OTHER BARRIERS TO CHANGE There are a number of barriers that clients may find will impact their ability to create change in their day-to-day life.

Nutritional advisors are expected to assist clients in identifying barriers to change and develop potential solutions to overcome these barriers.

Examples of these barriers are provided in the table below:

LACK OF TIME

PHYSICAL LIMITATIONS

FEAR OF FAILURE

LACK OF ENERGY

PSYCHOLOGICAL LIMITATIONS

LACK OF SKILL

LACK OF MOTIVATION

AGE

FEAR OF INJURY

FINANCIAL CONSTRAINTS

HORMONAL ISSUES

FEAR OF SAFETY

LIKES AND DISLIKES

CURRENT HABITS

LACK OF CHILDCARE

FEAR OF CHANGE

ENVIRONMENTAL FACTORS

INSUFFICIENT ACCESS

POOR SELF-ESTEEM

SOCIAL ISSUES AND PRESSURE

LACK OF SUPPORT

FAMILY SITUATION

SOCIAL DIFFERENCES

LACK OF TRANSPORTATION

ILLNESS OR INJURY

CULTURAL DIFFERENCES

HEALTH STATUS

FEELING UNCOMFORTABLE

CULTURAL EXPECTATIONS

CULTURAL LIMITATIONS

SELF-CONSCIOUSNESS

FAMILY COMMITMENTS

LACK OF SELF-BELIEF

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UNDERSTANDING MOTIVATIONAL THEORIES AND CONCEPTS AND HOW THEY IMPACT BEHAVIOUR UNDERSTANDING MOTIVATION Motivation can be described as the ‘driving force’ and the reason behind an individual’s actions, behaviours and needs.

In other words, an individual’s needs and desires strongly impact their behaviour.

There are different forms of motivation including: and intrinsic motivation • Extrinsic motivation • Physiological Achievement motivation.

•

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EXTRINSIC VS INTRINSIC MOTIVATION Individuals will satisfy their needs through different means and are driven to succeed for varying reasons, both internally and externally. Everyone’s motivation is going to be different in life, depending on their physical and emotional wellbeing.

The table below explains the differences between intrinsic and extrinsic motivation:(12)

TYPE OF MOTIVATION

DESCRIPTION

REQUIREMENTS

Extrinsic motivation is based on receiving outside rewards. For example, a client who meets certain goals they are rewarded with shoes, money, trophies, or other tangible items.

SUPPORT FROM NUTRITIONAL ADVISORS: Extrinsic motivation can generally be created easily for clients by offering incentives for signing up for longer nutritional programs or rewards for accomplishing milestones, which are examples of extrinsic motivation.

EXTRINSIC MOTIVATION

By offering extrinsic motivation, nutritional advisors can potentially create motivation for new clients who would have never considered seeking nutritional support without it.

Nutritional advisors can also motivate clients to try new skills and, once they have mastered these skills, they will become intrinsically motivated.

• Praise • Money • Gifts • Compensation • Trophies/awards.

Overall, the goal is to have clients that are self-motivated.

This motivation does not require constant monitoring and has better long-term results. However, because self-motivation cannot be taught, it is important to use extrinsic motivation techniques until intrinsic motivation is accomplished.

INTRINSIC MOTIVATION

Intrinsic motivation is based on internal sources, in order to achieve a certain result. Being intrinsically motivated means clients stay committed to a nutritional program based on their own internal drive and not from outside pressure or rewards. In other words, intrinsically motivated clients are self-motivated and do not need any external motivation. Intrinsically motivated clients will more likely stay committed to nutritional support and/or recommendations in the long term.

SUPPORT FROM NUTRITIONAL ADVISORS: Intrinsic motivation is not something that can be taught and relies on the individual themselves. Nutritional advisors can encourage their clients to be intrinsically motivated, but in the end, the client will have to make the decision for themselves.

of accomplishment • Sense Curiosity • Pride • Interest • That “feel good” feeling / •enjoyment knowing that •theIndividuals activity is beneficial for their health.

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UNDERSTANDING SELF-MOTIVATION Self-motivation is an inner psychological drive to accomplish something. While there are many forms of external (or extrinsic) motivation, self-motivation is, as the name suggests, a motivation of oneself. Self-motivation may not be a new or emerging strategy of motivation; however, it is still vital and important to understand in order to encourage this practice with clients.

There are four main elements to self-motivation, these are outlined in the table below:

FOUR ELEMENTS THAT MAKE UP SELF-MOTIVATION 1

2

PERSONAL DRIVE

COMMITMENT

Personal drive is the desire that individuals will have to meet particular standards that they have set for themselves.

When clients take responsibility upon themselves to provide self-encouragement and motivation, they are not relying on any outside sources and have a higher chance of longterm success.

When individuals display commitment or dedication to a set of goals, they are showing resilience to any roadblocks or issues that may arise. Ensuring that the client is committed is vital to their success.

For example, when clients are not sure if they want to follow through with a nutritional plan or support from the beginning, it will be difficult to help them stay committed.

3

4

Initiative relates to the readiness of an individual to act by themselves, in order to meet specific goals.

INITIATIVE This is a great trait for clients to have when following support or recommendations from a nutritional advisor, as they will be willing to try new opportunities.

By having a more positive outlook on their situation, clients are displaying a willingness to continue the nutritional support program, despite any setbacks that they may face.

OPTIMISM When clients are optimistic, they are creating more confidence in themselves and their ability to achieve their goals.

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IDENTIFYING THE COMPONENTS OF MOTIVATION Motivation is not just about telling clients that they have done a “good job”. Nutritional advisors must also motivate their clients to participate, put forward their effort, and stay committed throughout their entire nutritional support program to gain success. When determining whether a client has adequate motivation, it is important to consider all the components that make up motivation.

The three main components of motivation are: Direction of effort Intensity of effort Persistence of behaviour.

• • •

01

01 DIRECTION OF EFFORT

The decision people make in where to put their effort

DIRECTION OF EFFORT

INTENSITY OF EFFORT The decision people make and how much effort.

02

01 03 PERSISTENSE IN BEHAVIOUR The decision people make in how long to put forth their effort

The ‘direction of effort’ of motivation relates to which situations the client is drawn to, what they are interested in, attracted to, and what they are seeking involvement in. Providing this motivation is achieved by offering inspiration and drawing interest to the client’s goals.

An example would be to detail the benefits and enjoyment clients will receive upon completing a nutritional program. When clients are inspired, they will be motivated in direction of effort.

INTENSITY OF EFFORT

The intensity of effort is built upon the direction of effort. When the direction of effort has been established, the intensity is then how much effort is put into an activity. There may be initial interest in an activity that leads to the direction of effort, but it can be useless if there is not enough intensity of effort utilised.

PERSISTENCE IN BEHAVIOUR

Finally, persistence in behaviour is the consistency with which clients will perform in their activities.

Creating motivation long term can be a difficult challenge, as many motivational strategies are only successful for a short while. It is important to learn about the client and their personality to maintain consistent motivation.

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MOTIVATIONAL THEORIES It is important for nutritional advisors to understand motivational theories to help their clients move through the stages of behavioural change, and to commit and adhere to their nutrition support interventions. A sound understanding of motivational theories will enable nutritional advisors to assist their clients through behaviour change for long term success with their nutrition and health-related goal(s).

Three main theoretical approaches to motivation exist, and these theories include: 1. Drive Theory 2. Incentive Theory 3. Evolutionary Theory.

NEED

GOAL

MOTIVATION CYCLE

DRIVE

INCENTIVE

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UNDERSTANDING THE ‘DRIVE THEORY’ Primary drive theory is based on the principle of the human need to maintain homeostasis, or physiological stability (related to basic survival and procreation). For instance, humans are inherently motivated to eat, because when they become hungry, hormones are released which drive hunger. This, in turn, drives the need to search for and consume food which results in homeostasis - reduced drive to eat because of feeling satiated (until hunger is signalled again).

DID YOU KNOW? This type of motivational concept is known as push theory, whereby an internal state drives behaviour. While drive theory is influential and widely used, it does not explain all motivation. For instance, it does not explain why people desire sweet foods after they have eaten a large meal when they should otherwise be satiated and have satisfied the physiological drive to eat to achieve homeostasis. Incentive theory better accounts for the drive to eat in this instance.

CASE STUDY: MARY Mary, a 40-year-old homemaker, mother of four children and seeking help to lose weight. Her diet consists mainly of processed foods, soft drink and treat foods, as she likes to snack.

Drive theory: A diet that consists mainly of processed carbohydrates, like chocolate, bread, pasta, and soft drink, will result in fluctuating blood sugar levels and the regular need to snack. Given that these foods tend to be energy dense and low in protein, this can result in weight gain, purely from the physiological ‘push’ to maintain fullness and address hunger as it occurs.

Addressing drive theory: In a situation like Mary’s, the best advice would be to reduce her intake of processed foods and soft drink and to increase her intake of whole foods and protein sources. This would result in better balanced blood sugar levels and reduced physiological ‘push’ to eat as regularly, while also reducing the overall amount of energy from foods, which could result in weight loss.

Secondary drive theory is related to social and identity factors which are less important for survival. This theory considers intrinsic motivation, which is based on internal sources, to achieve a certain result. Being intrinsically motivated means an individual shows commitment and adherence based on their own internal drive, and not outside pressure or rewards.

Intrinsic motivation can come from any of the following: of accomplishment • Sense Curiosity • Pride • Interest •

‘feel good’ feeling/enjoyment • That Knowing that the activity is good for overall health.

•

DID YOU KNOW? When an individual commits/takes part in an activity for pure satisfaction and the enjoyment of the activity itself, they are doing so because they are intrinsically motivated by the particular activity. An individual’s motivation for participating in the behaviour arises from the urge ‘within’, rather than out of a need to receive external rewards such as prizes, money, or acclaim.

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As a nutritional advisor, it is beneficial to understand that intrinsic motivation is not something that can be taught, as it relies on the individual client themselves. A nutritional advisor can, however, encourage their clients to be intrinsically motivated, but, in the end, the client will have to make the decision to commit for themselves. Intrinsically motivated people are self-motivated and do not need external motivation. They usually have more intensity during workouts than those who are reliant on external motivation. Intrinsically motivated people will more likely stay committed to nutritional programs or recommendations in the long term.

UNDERSTANDING THE ‘INCENTIVE THEORY’ Incentive theory is based on the principle that external stimuli can motivate behaviour. Incentives could include things like: foods • Sweet • Prizes/trophies/awards good grades • Getting Social approval • Praise • Gifts • Receiving a promotion • Advertising • Money/compensation.

• The incentive does not need to be internally driven (i.e., hunger) to produce a behaviour (i.e., eating sweet food). Therefore, an external stimulus, such as the smell of fresh cakes at a cafe, can be enough to override the internal drive (currently satiated) and drive motivation (consume the cakes even though satiated).

This motivational theory is known as pull theory, whereby an external stimulus can pull someone in a specific direction; therefore, this form of motivation is not explained by the principle of homeostasis. This theory can be useful in understanding how the built food environments influence behaviour toward eating and overeating. For instance, the availability of 24-hour drive-through fast food, combined with low prices, hyper-palatable foods, and close proximity are all external stimuli that motivate behaviour. If the environment were not designed like this, there would be less external stimulus to pursue these foods.

CASE STUDY: SIMON Simon, single 30-year-old tradesman, looking to lose weight. His diet consists of McDonalds for breakfast, Subway for lunch and takeaway for dinner most nights.

Incentive theory: Incentive theory tells us that it is the easy availability and palatability of fast food that is driving Simon’s behaviour.

Addressing incentive theory: Encouraging Simon to have breakfast at home, make a packed lunch and try driving a different route to and from work may help him reduce the ‘pull’ of fast food. This, in turn, may address his excess energy intake and could result in weight loss.

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Extrinsic motivation can be created in the form of rewards for clients hitting a goal. For example, the client could reward themselves with a new pair of shoes when a goal is reached. This type of reward acts as an incentive and will motivate the client to achieve their goals. It can also improve client satisfaction with the nutrition program and the service offered.

While extrinsic motivation has its merits, it is beneficial to remember that the end goal is ideally to encourage clients to be self-motivated. Clients that are self-motivated generally do not require constant monitoring and have better longterm results. However, because it can be difficult to teach clients to be self-motivated, a good strategy for a nutritional advisor is to use extrinsic motivation techniques until intrinsic motivation is accomplished.

DID YOU KNOW? There are arguments concerning ‘how’ and ‘for how long’ external motivators change behaviour. For instance, some research suggests that intrinsic motivation is diminished when extrinsic motivation is given (known as the ‘over justification effect’). If extrinsic incentives or rewards are used to encourage behaviours that an individual already finds they are intrinsically motivated by, the intrinsic motivation for that specific behaviour may decrease over time.

In cases such as this, this is where ‘extrinsic motivators’ can have an adverse effect - instead of serving as a motive for the desired behaviour or activity, it undermines a previously held intrinsic motivation. This can completely eradicate the intrinsic motivation and create a dependence on extrinsic rewards for continued performance.(13)

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UNDERSTANDING THE ‘EVOLUTIONARY THEORY’

The evolutionary theory of motivation is based on the principle that motivation is the product of natural selection, which promotes behaviours that increase success and survival.

Natural selection favours behaviours that increase reproductive success, such as: and dominance • Aggression • Bonding drive • Sex Seeking and eating food.

• These behaviours (and many others) likely helped human hunter-gatherer ancestors adapt to their environment and survive. For instance, aggression and dominance may have improved men’s chances of mating with females over competing males or may have improved success at hunting. Bonding is likely how women improved their success at raising children to adulthood, by ensuring protection from men and continuous food supply while caring for children.

It is within the evolutionary theory that social motives arise, such as the needs for:

• Achievement (independence) • Autonomy Exhibition • Order • Affiliation.

• These motives are driven by learning and socialisation and are dependent on the individual and the community within which they live. For instance, some people are motivated by the desire to please others (affiliation), whereas others are motivated by the desire to be recognised for something (achievement).

CASE STUDY: JOHN John is a 22-year-old student who lives in a share house. He would like to eat healthier but just does whatever his housemates do when it comes to eating (usually takeaway food).

Evolutionary theory: Evolutionary theory tells us that John is driven by the social need to fit in with his housemates’ culture (affiliation) and feels awkward if he does not conform to their eating practices.

Addressing evolutionary theory: Teaching John about healthier takeaway options and portion control would help him fit in without feeling different.

Ultimately helping John to become confident and independent will help him to be able to make healthier choices regardless of his housemates’ eating habits and influence.

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MASLOW’S HIERARCHY OF NEEDS Abraham Maslow (1908 - 1970) is an American psychologist best known for creating Maslow’s Hierarchy of Needs pyramid. Maslow’s ‘Hierarchy of Needs’ is a theory of motivation used in psychology and depicts a 5-tier pyramid of human needs, encompassing motives ranging from biological to individual to social. Maslow’s theory explained human motivation by arranging the satisfaction of needs in a hierarchical order. Maslow explained that motivation is not based on a satisfied need; it is only a dissatisfied need that motivates towards fulfilment.(14)

The tiers, from the bottom to the top, include: Food, water, shelter, and warmth • Physiological: Security: Safety, employment, and assets • Social: Family, friendships, intimacy and belonging • Esteem: Self-worth, accomplishment, • Self-actualisation: Inner fulfilment. and confidence •

Self-actualisation

Esteem Social

INNER FULFILMENT

SELF-WORTH, ACCOMPLISHMENT, CONFIDENCE

1.

DIRECTION OF EFFORT: FAMILY, FRIENDSHIP, The decision people make in where to put their effort INTIMACY, BELONGING

2.

SAFETY, EMPLOYMENT,

Security Physiological

PERSISTENSEASSETS IN BEHAVIOUR:

The decision people make in howlong to put forth their effort

FOOD, WATER, SHELTER, WARMTH

IMPORTANT NOTE It is important to note that over the years there have been a number of variations of this pyramid. Some modifications include ‘Self Transcendence’ as the top tier (striving for meaning and purpose beyond the self) or include ‘Cognitive’ and ‘Aesthetic’ needs between the tiers of ‘Self-actualisation’ and ‘Esteem’.

Maslow proposes that the lower tiers need to be fulfilled before the tiers further up can be tended to. For example, a homeless individual, who has a short supply of food daily, is less likely to be focused on their social security and feelings of belonging, as their primary concern on a day-to-day basis is to find adequate food to prolong survival. As such, once physiological needs are met, security needs can be tended to; once security needs are met, social needs can be tended to, and so on with the remainder of the hierarchy.(15) VAST FITNESS ACADEMY | NAT11046005: ANALYSE AND APPLY PRINCIPLES OF PSYCHOLOGY AND BEHAVIOUR MANAGEMENT | VERSION 1 - 11.11.2022

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PHYSIOLOGICAL: FOOD, WATER, SHELTER, AND WARMTH The bottom tier of the pyramid is inclusive of all physiological needs a human requires, such as: adequate supply of food • AnAccess to safe drinking water • Appropriate • Warmth. shelter • These needs are basic needs for human survival. If an individual does not have access to these physiological needs, all their motives and behaviour will be directed at gaining adequate access for survival. Once adequate food, water, shelter, and warmth have been secured, these individuals can shift their motives to the next pyramid tier: security.

FOOD.

WATER.

SHELTER.

SECURITY: SAFETY, EMPLOYMENT AND, ASSETS The next tier relates to an individual’s security, both financially and physically. The ‘security’ tier refers to the safety of an individual (free from danger in their home living environment, in their suburb, in their religion), regular and secure employment and the ability to purchase and retain basic assets (such as mode of transport, clothing and cooking utensils).

SOCIAL: FAMILY, FRIENDSHIPS, INTIMACY, AND BELONGING Once an individual has their security and physiological needs met, they can tend to their social needs. Their social needs are the third tier of the pyramid including all social relationships and feelings of intimacy and belonging. Social relations are inclusive of: Family Friends Colleagues Acquaintances.

• • • •

Attaining and maintaining healthy relationships that offer support, love, intimacy, and belonging is crucial in fulfilling an individual’s social needs. Having no social relations can negatively affect an individual’s health and wellbeing, and individuals are therefore motivated to find and secure lasting relationships.

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ESTEEM: SELF-WORTH, ACCOMPLISHMENT, AND CONFIDENCE The next tier of the pyramid represents an individual’s esteem and refers to their self-worth, self-efficacy and confidence.

Only once all the tiers below ‘esteem’ are fulfilled can an individual focus on their self-esteem. Self-esteem can be defined as confidence in their own worth or abilities.

This tier refers to individuals feeling:

SELF-ESTEEM

• Appreciated • Supported • Important • Respected.

SELF-EFFICACY

SELFCONFIDENCE

UNDERSTANDING SELF-WORTH Self-worth is how much value individuals put on themselves and how they rate themselves. This can either be positive or negative.

HIGH SELF-WORTH Having high self-worth means individuals have a positive outlook on themselves.

This creates: Confidence Self-acceptance Positive thinking.

• • •

LOW SELF-WORTH Having low self-worth means individuals have a negative outlook on themselves.

This creates: Lack of confidence Jealousy Worry about what others think of them Negative thinking.

• • • •

UNDERSTANDING SELF-EFFICACY Self-efficacy is the confidence clients will have over their ability to keep themselves motivated and achieve their goals.

Self-efficacy can directly affect how long a client will stay committed to their nutritional plan, or recommendations made by the nutritional advisor.

ELEMENTS OF SELF-EFFICACY PRO-SOCIALITY

Pro-sociality is behaviour that is in line with society’s development. In this scenario, the behaviour is committing to an exercise program in a safe environment. Pro-sociality is the opposite of moral disengagement.

MORAL DISENGAGEMENT

Moral disengagement is behaviour that shows individuals believe that they do not have to act within certain moral obligations. An example would be clients who make excuses for their actions, avoid taking responsibility and puts blame on others for being unable to complete their goals.

OVEREFFICACIOUSNESS

In some cases, mainly when learning a new skill, clients can become overly confident in their abilities and create over-efficaciousness. When clients are overly confident in their physical abilities when learning new exercises or participating in new fitness programs, studies have shown that this has an adverse effect and clients become less motivated throughout the program.

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SELF-ACTUALISATION: INNER FULFILLMENT The final tier (or top tier) of the pyramid, which only a small percentage of people may reach, is self-actualisation. Selfactualisation is a need that essentially equates to an individual achieving their full potential.

Self-actualisation can only occur when all other pyramid levels have been fulfilled. This tier may see individuals acquiring new skills, taking on new challenges or acting in a certain way, to achieve their life goals.

HOW TO APPLY THE MASLOW HIERARCHY OF NEEDS TO NUTRITION COUNSELLING (16) Maslow’s theory proposes that people are motivated by five levels of need, and it emphasises that certain basic needs should be met before others can be considered. The nutritional advisor must meet their clients right where they are at. Maslow’s Theory of Needs can assist in helping the nutritional advisor assess the situation and choose the most appropriate nutrition recommendations.

Below are examples of how the theory can be applied in a nutritional setting: A homeless person needs to find adequate food and shelter for survival. They will be at the first level in the pyramid (psychological). The motivation of a homeless person for food is to have enough to eat. A nutritional advisor can help the homeless person by getting them access to a daily, energy-dense meal at a food bank.

A single person employed in a low-paid job will seek food security. They will be at level two or three in the pyramid (security and social). They will be motivated to have enough acceptable food on an ongoing basis.

This person’s motivation will be for affordable, everyday foods. They may be interested in low-cost foods that are energy-dense and nutritious and may be motivated to plan for weekly meals.

A happily married homeowner in a well-paid job will be at level three or four in the pyramid (social and esteem).

They will be motivated to improve their current diet. They will have enough acceptable food, and their food supply will be secure. They may be interested in improving their nutrition and exploring new foods and cuisines.

A well-educated person with a successful career and disposable income may be at level five in the pyramid (self-actualisation). They will be motivated to improve health beyond basic nutrition. For example, they would be interested in foods like organic produce, grass-fed beef, or super-foods to improve health and well-being. At this level, gustatory and aesthetic considerations may also guide motivation for food.

The examples are not exhaustive and illustrate the different motivations for food, depending on the needs of the individual. The examples demonstrate that if a person at level two in the pyramid receives nutritional advice about affordable, nutritionally dense meals and snacks, they will be motivated to follow the meal plan and reach their goals.

However, if the meal plan includes expensive organic foods, they may feel unmotivated to follow the plan. The meal plan will seem irrelevant to them, even unobtainable, and the client may not continue with consultations.

So, matching nutritional advice with a client’s current nutritional needs is important. Once clients have addressed their current nutritional needs, the nutritional advisor can assist them in striving for higher levels in the hierarchy and realise their nutritional potential.

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THE AROUSAL THEORY OF MOTIVATION The Arousal Theory of Motivation is another motivational theory that nutritional advisors can become familiar with to support their clients. Arousal in the context of psychology means the state of being physiologically alert, awake, and attentive. A part of the brain called the ‘Reticular Activating System’ (RAS), located in the brain stem and projecting to many other areas, is the primary site of arousal control (see image below).

The RAS and an individual’s arousal levels are influenced by many factors, such as: and stress • Emotions Food that is consumed • Neurotransmitters.

• The neurotransmitters norepinephrine, serotonin, dopamine, and acetylcholine all influence the functioning of the RAS. Higher levels of these neurotransmitters can lead to higher states of arousal and attention to different stimuli.

DID YOU KNOW? The RAS is like a ‘pacemaker’ for arousal.

When the RAS slows down, it may be difficult to concentrate, or lethargy and sleepiness may increase. When the RAS speeds up, energy levels, alertness and readiness to respond to the environment may increase.

Projections into cerebral cortex

Visual impulses

Auditory impulses Reticular formation Ascending sensory tracts (pain, touch, temperature)

Descending motor signals to spinal cord

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Arousal can also be defined as the bodily sensation of feeling energised. Arousal levels can differ depending on a number of factors, and there can be both an optimal and sub-optimal state of arousal to a given situation or stimulus.

An optimal level of arousal should result in a readiness to perform an activity and may be accompanied by an increased heart rate, breathing and perspiration (sweating). With the right level of arousal, an individual can be active, animated, alert and motivated; however, where arousal is not high enough feelings of sluggishness, sleepiness and low motivation may result. Alternatively, where arousal levels are too high, performance may also be negatively impacted.

Each individual has a unique arousal level that works for them, and when their arousal levels drop below optimal, they will tend to seek some type of stimulation to elevate them. For example, if an individual’s levels drop below optimal, they may engage in risk-taking behaviour, seek out social contact or exercise to elevate them. Conversely, if an individual’s arousal level is too high, they may seek to reduce it by resting or sleeping, with low motivation levels for stimulating behaviours or activities.

AROUSAL AND TASK PERFORMANCE The Arousal Theory of Motivation, commonly referred to as Yerkes-Dodson Law, asserts that arousal levels can influence performance. The law states that performance will improve with increased arousal levels, up to an optimal arousal level. Beyond this optimal level, performance begins to be negatively impacted, and this is especially the case when performing complex tasks.

For example, students taking exams require an optimal level of arousal for good performance by improving alertness, focus and attention. However, where arousal levels are too high, ‘test anxiety’ can cause nervousness and an inability to concentrate properly, while low levels may also negatively impact performance.

DID YOU KNOW? Test anxiety is a common term used for a combination of physiological over-arousal, tension, and somatic symptoms, along with worry, dread, fear of failure, and catastrophising, that occur before or during test situations.

The graph below shows the Yerkes-Dodson Law and depicts how the relationship between performance and level of arousal has an inverted U-shape:

PERFORMANCE

Strong Optimal arousal

Fatigue sleepiness Strong stress, anxiety, impared performance

Weak Low

Arousal

High

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THE SCIENCE OF HOW FOOD AND NUTRIENTS IMPACT BEHAVIOUR AND EMOTIONS

There are many activities that an individual can turn to for assistance in mood regulation; alcohol, exercise, tobacco, social interaction, caffeine, medication, and food, to name but a few. The way an individual chooses to improve their mood is essentially their ‘drug of choice’.

While the above strategies can work in various ways and to various degrees for different individuals, many individuals turn specifically to food to regulate their moods. Unfortunately, however, the food of choice to improve mood are highly palatable foods which are often high in sugar (particularly sucrose) and processed fats, such as fast food, lollies and chips.(17) Foods like these are chosen as they instantly elevate blood sugar and serotonin levels, thus providing an immediate improvement in energy and mood.(18) Individuals remember the way they feel when they consume these high energy foods and the instant improvement in mood and happiness. Consequently, this may create a habit of turning to food for a mood boost. This repetitive behaviour of food intake leads to the activation of brain reward pathways that eventually override other signals of satiety (fullness) and hunger.(19) This is known as ‘emotional eating’, which can be detrimental to an individual’s health in the longer term.

A number of healthy foods can impact mood secondary to their nutritional profile. Therefore, it is important to have a sound understanding of which healthful foods are useful in mood regulation, both in the short and longer-term.

The nutrients (macronutrients and micronutrients) which are known to impact an individual’s mood include(20)(21): fat (especially omega-3 essential fatty acids) • Dietary Tryptophan • Water (amino acid) • Vitamin B9 (Folate) • Vitamin B12 (Cobalamin) • Vitamin D • Dietary fibre.

• *The above nutrients and their interactions with human behaviour are explored on the following pages:

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DIETARY FAT AND ITS INFLUENCE ON BEHAVIOUR Fat, in particular polyunsaturated fatty acids (PUFA), have long been known to play a part in cognitive function and overall mood. There are high levels of PUFAs in the neuronal cell membranes found in the central nervous system; however, some of these PUFAs (omega-3 and omega-6) cannot be synthesised in the body and must, therefore, be obtained from the diet.(22) Omega-3 fats, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are among the most studied PUFAs

Research shows a positive link between their consumption and a significant improvement in brain health and mood, and a decrease in depressive symptoms, as well as other benefits such as:(23)(21) cognitive performance • Improved Brain and retinal development • Improved aging • Memory formation and neuroprotection.

•

Omega-3 is found in the following foods: fish (e.g., salmon) • Oily Seafood • Walnuts • Flaxseeds • EPA/DHA capsules.

•

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TRYPTOPHAN AND ITS EFFECTS ON BEHAVIOUR Tryptophan is an essential amino acid necessary for children’s growth and nitrogen balance in adults. Serotonin is synthesised from tryptophan, so changes in the levels of tryptophan cause changes in brain serotonin levels. (serotonin is a neurotransmitter associated with happiness). Research has found that a deficiency in tryptophan can rapidly decrease feelings of happiness and overall mood.(24)(25)

Tryptophan is found in the following foods: oysters, octopus, and squid •• Clams, Banana •• Pineapple Plum •• Turkey Nuts (cashews, walnuts, peanuts) (sesame, pumpkin, sunflower) •• Seeds Soybeans •• Cheese Red meat •• Poultry Beans and lentils • Eggs.

Trypphan

o C11H12N202

O

OH HN

NH2

FOLATE AND HOW IT AFFECTS BEHAVIOUR Folate has positive effects on memory performance, including speed of processing information, recalling information, recognition, and verbal ability. While folate is not suspected of having a direct effect on mood, it can have secondary positive effects on mood as a result of improved memory performance.

Folate is found in the following foods:

•• Liver Beans and lentils •• Spinach Asparagus •• Avocado Beetroots.

Folate deficiency is one of the most common vitamin deficiencies in Australia, which can potentially lead to developing a condition called ‘folate deficiency anaemia’.(26)

The main symptoms of a folate deficiency include:(20) fatigue •• Extreme Weakness of breath •• Shortness Headaches skin •• Pale Feeling sore inside the mouth • Gastrointestinal symptoms.

Individuals that are at risk of a folate deficiency include:(20) women •• Pregnant The elderly that drink excessive amounts of alcohol or have alcohol use disorders •• Individuals Individuals who take certain medications with the MTHFR polymorphism (genetic impaired ability to convert folate to its active form) •• People People with malabsorptive disorders.

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THE EFFECTS OF HYDRATION ON BEHAVIOUR Water is essential as a part of a healthy diet. It makes up approximately 60% of an adult’s total body weight and is essential for survival.

H2O

The amount of water required on a day-to-day basis will be different for each individual and is dependent on various factors such as: levels • Activity Climate • Medical conditions • Food intake • Age • Weight • Gender.

• Daily consumption of adequate water is paramount to the overall health and well-being of an individual, both physically and mentally. A decrease in water in the body will affect various systems and functions, including the brain, kidneys, and cells. As little as a 1-2% loss of your body weight in water can result in physical and mental performance decline.(27)

In addition to this, a lack of water also impacts various other functions in the body, such as: regulation • Temperature Electrolyte imbalances • Decreased movement/aches and pains in joints • Blood pressure regulation.

•

SIDE EFFECTS OF MILD TO CHRONIC DEHYDRATION(28) LACK OF ENERGY

HEAT CRAMPS/HEAT STROKE

BRAIN SWELLING

DRY MOUTH

FATIGUE/TIREDNESS

DECREASED URINATION

INCREASED THIRST

ORGAN FAILURE

DRY SKIN

DIZZINESS

A DECREASE IN BLOOD PRESSURE

HEADACHES

YELLOW URINE

SEIZURES

POOR CONCENTRATION

DID YOU KNOW? The human body cannot survive after a few days without any water! The duration of survival without water is dependent on activity levels, climate, medical conditions, food intake, age, weight, and gender.

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VITAMIN B12 AND ITS EFFECTS ON BEHAVIOUR B vitamins are known for their energy-enhancing effects on individuals. Vitamin B12, otherwise known as cobalamin, can have direct effects on mood, with a clear association existing between vitamin B12 deficiency and depression.(29) (22) Vitamin B12 also has positive effects on memory performance including speed of processing, recalling information, recognition, and verbal ability.(30)

Vitamin B12 is found in the following foods:

• Eggs milk, cheese, yoghurt • Dairy: Meat • Fish, shellfish • Poultry.

•

VITAMIN D AND ITS EFFECTS ON BEHAVIOUR Vitamin D is a fat-soluble vitamin that uses sunlight for synthesis. Its deficiency in the human body has been found to potentially play a role in mood disorders such as depression and seasonal affective disorder (SAD). Research suggests high doses of vitamin D supplementation may improve mild depressive symptoms.(31)

Vitamin D is found in the following foods: fish (e.g., salmon) • Oily • Eggs • Cheese • Offal.

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HOW FIBRE CAN HAVE AN EFFECT ON BEHAVIOUR

Fibre is something the body needs but never actually digests. Fibre plays numerous roles in general health and wellbeing, including regulating bowel motions, blood glucose uptake and increasing satiety.

Inadequate fibre in the diet may result in a faster sugar uptake into the bloodstream, providing the body with a rush of energy followed by a lull. This energy lull can often trigger individuals to seek food with a quick energy hit, such as a high carbohydrate snack/meal, to improve their mood and energy levels.

The table below provides a list of common foods that are rich in fibre, along with their suggested serving sizes:

FOODS RICH IN FIBRE

SUGGESTED SERVING

SPLIT PEAS

1 cup = 20.2g

LENTILS

1 cup = 7.3g

BLACK BEANS

1 cup = 10.9g

LIMA BEANS

1 cup = 10.9g

ARTICHOKES

Medium vegetable = 11.4g

PEAS

1 cup = 8.8g

BROCCOLI

1 cup = 5.9g

BRUSSEL SPROUTS

1 cup = 7.3g

BERRIES

1 cup = up to 8g

AVOCADOS

½ each 2.8g

In general, it is recommended to ensure adequate consumption of whole food such as fruit, vegetables, nuts, and foods high in omega-3 fatty acids (such as fish and walnuts); swap poor quality foods for more nutrient-rich options, and limit intake of processed foods and trans fats.

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MOOD STABILISING NEUROTRANSMITTERS The brain is composed of millions of nerves called ‘neurons’. A neuron is a specialised cell that conducts nerve signals.

To conduct a signal, a neurotransmitter is passed between two neurons so that the signal may continue its journey to or from the brain. A neurotransmitter is a chemical in the nervous system that acts as a messenger to help transmit nerve impulses between brain cells and neurons.(32)

There are four main neurotransmitters that are very closely linked to mood:

• Serotonin • Dopamine • GABA • Norepinephrine.

The image below shows a typical nerve or neuron and a close-up of a synapse (the location between two neurons where neurotransmitters are used).

Receptor Reuptake pump Mitochondrion

Neurotransmitter

Vesicles Synaptic cleft Axon Axon

UNDERSTANDING SEROTONIN Serotonin is a neurotransmitter that promotes emotions/feelings of wellbeing and happiness. Positive feelings are important for an individual’s overall mental health, especially for those with psychological disturbances or a mental health decline. Being in a more positive mindset and feeling more positive emotions will increase the individual’s confidence and ability to carry out nutritional recommendations.

Serotonin is synthesised in the body from tryptophan, an essential amino acid. Tryptophan is abundant in:

• Fish • Eggs • Chicken beans, legumes • Nuts, Turkey • Other meats.

• Around 90% of serotonin is located in the gastrointestinal tract (GI Tract), where it acts to regulate intestinal movements; however, it is probably best known for its effects in the brain as it is the main neurotransmitter affected by antidepressant medications like selective serotonin reuptake inhibitors (SSRIs).

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An individual who is deficient in serotonin may experience any of the following symptoms:(33)

• Anxiousness mood • Depressed • Aggression • Irritability • Insomnia energy • Low • Low self-esteem

libido • Decreased Poor appetite • Poor memory • Constipation • Weight gain • Carbohydrate cravings • Digestive problems.

•

Nutritional advisors can promote adequate serotonin levels by evaluating an individual’s diet. The diet should be nutritionally balanced with ample hydration. As tryptophan (amino acid) is required to synthesise serotonin, it is important to ensure an adequate intake of tryptophan in the diet.

FUN FACT Tryptophan (essential amino acid) creates vitamin B3 (niacin) which is essential in creating the neurotransmitter serotonin.

UNDERSTANDING DOPAMINE Dopamine is one of the most powerful neurotransmitters as it directly activates reward and pleasure centres within the body, affecting mood and food intake.(34) When highly palatable foods are consumed, such as chocolate, sodas, fast food , lollies and potato chips, dopamine is released in response. Dopamine activates the reward and pleasure centres of the brain, therefore providing a positive connection between the food consumed and the resulting mood. Over time, individuals will prefer foods that activate these reward centres in the brain. Eventually, this behaviour of dopamine activation will override the signals of hunger and satiety leading to overeating and weight gain.

Dopamine neurons receive information from a number of regions in the brain including:(34) hypothalamus and brainstem regions (involved in autonomic responses) • The The (involved in memory) • The hippocampus amygdala (involved emotional reactivity) • The thalamus (involved ininarousal) • Prefrontal cortex (involved in emotional reactivity).

•

FUN FACT Dopamine synthesis is stimulated by a surplus of food and hyperpalatable foods such as sodas and fast foods, and the effects of dopamine synthesis can become addictive, thus leading to overeating and obesity.(34)

A dopamine deficiency may result in depression, mood swings, food cravings and poor attention. Dopamine levels can become deficient due to poor nutrition, chronic stress, inadequate sleep, and medications. As a nutritional advisor, it is important to ensure clients enjoy a nutritionally balanced diet and incorporate exercise, good sleep hygiene and adequate relaxation into their daily life.

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UNDERSTANDING GAMMA-AMINOBUTYRIC ACID (GABA) Gamma-aminobutyric acid (more commonly referred to as GABA) is a central nervous system neurotransmitter whose primary role is inhibiting (preventing) excitatory activity in the nervous system. In other words, GABA’s function is to reduce nerve transmission in the brain, thus calming nervous activity.

While GABA is primarily found in the brain, it also active in various locations in the body including the following:

• Pancreas • Stomach • Intestines • Kidneys • Bladder • Lungs • Liver.

GABA has calming effects on the body and plays a role in motor control and vision. It is important in the regulation of insulin and glucagon. It acts on the pancreas to prevent glucagon from being secreted when insulin is released during digestion.

Gaba o

C4H9N02

O

H2N

OH

A deficiency in GABA may result in:

• Depression • Anxiety attacks • Panic Insomnia • An increased risk for dependence on drugs or alcohol.

• UNDERSTANDING NOREPINEPHRINE Norepinephrine is a neurotransmitter of major importance in regulating cognition, motivation, and intellect, all of which are fundamental in social relationships and mental health. Individuals with low levels of norepinephrine are more susceptible to mental health disorders, such as depression and anxiety.(35) Protein causes norepinephrine to be released into the brain, increasing norepinephrine levels.

Foods that are linked to the release of norepinephrine include protein-rich foods such as:

• Meat • Eggs • Chicken • Nuts • Seeds • Beans • Dairy products.

As a nutritional advisor, it is important to ensure a client is reaching their minimum daily estimated protein requirements.

Reaching their protein requirements will help ensure the appropriate release of norepinephrine into the brain, which may assist with improved mood and mood regulation.

Norepinephrine o C8H11N03

OH

HO HO

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NH2

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UNDERSTANDING THE EFFECTS OF NUTRIENT DEFICIENCIES ON A HEALTHY FUNCTIONING BODY Nutrients which are not consumed in adequate amounts may cause a deficiency in the body and may result in various consequences, including (but not limited to):

• Depression • Anxiety • Fatigue • Insomnia

• Obesity • Moodiness • Cravings.

Everyone is unique in their requirements, influencing factors and signs and symptoms of deficiencies. Nutritional advisors need to be aware of all the potential effects of some common nutritional deficiencies. Knowing these effects can act as a guide on how to identify nutrient deficiencies, how best to improve the diet, and how to determine when a referral to a GP is necessary.

Examples of common deficiencies and their consequences are explored below:(36)

NUTRIENT

CONSEQUENCE OF DEFICIENCY

confusion • Mental • Irritability.

VITAMIN B6 Anaemia • (PYRIDOXINE) • Moodiness.

Weakness FOLATE/FOLIC ACID • Depression.

• VITAMIN B12 Pernicious anaemia.

• (CYANOCOBALAMIN) • Anxiety.

• Lethargy.

VITAMIN C • Fatigue.

• Psychological changes. of appetite • Loss Anaemia PHOSPHOROUS • Anxiety.

• changes • Personality MAGNESIUM Altered anxiety-like behaviour.

• apathy • Mental SODIUM Fatigue.

• weakness • Muscle CHLORIDE Lethargy.

• • Lethargy IRON • Decreased motivation. symptoms • Neuro-psychiatric ZINC Loss of appetite.

• abnormalities • Neurological COPPER Fatigue and weakness.

•

VITAMIN B1 (THIAMIN)

memory • Poor • Sleep disturbance.

• Low energy/tiredness.

• Extreme fatigue.

• Depression.

• Depression.

• Sugar cravings.

• Fatigue • Irritability. or lack of emotion • Apathy Fatigue.

• • Confusion • Irritability.

• Loss of appetite.

• Insomnia • Fatigue. cognitive function • Decreased Depression.

• • Problems with memory and learning.

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RECOGNISING OTHER PSYCHOLOGICAL THEORIES THAT UNDERPIN DIETARY AND EXERCISE PATTERNS UNDERSTANDING THE MOTIVATION OF HUNGER AND EATING As a nutritional advisor, it is important to understand that hunger and the motivation to eat are far more complex than simply ‘feeling hungry’. Hunger is a complex and in-depth motivational system, whereby many biological and environmental factors need to be taken into consideration.

With research constantly evolving, scientists are beginning to understand this complex system, and can identify some key biological factors which will affect hunger regulation:

BIOLOGICAL FACTORS regulation • Brain Glucose digestive regulation • Hormoneandregulation.

•

ENVIRONMENTAL FACTORS availability and related cues • Food Learnt preferences and habits • Stress and eating.

• [The above factors are discussed in more detail on the following pages.]

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BIOLOGICAL FACTORS AND THEIR RELEVANCE TO HUNGER REGULATION Walter Canon originally hypothesised that a ‘grumbling stomach’ (scientifically referred to as stomach contractions) caused an individual to experience hunger. This was a simple theory which was eventually discredited following another study whereby individuals with no stomachs (stomachs had been removed for medical reasons) still felt hunger despite the inability to have stomach contractions. This, therefore, indicated to scientists that individuals can continue to experience hunger without any stomach contractions, and therefore it was inaccurate to say that stomach contractions cause hunger.

Following this, there are now much more complex theories of what exactly causes hunger. These theories include: regulation • Brain and digestive regulation • Glucose Hormonal regulation.

•

BRAIN REGULATION One of the theories for the ‘motivation of hunger’ refers to brain regulation, particularly in two specific centres of the hypothalamus. The hypothalamus is a tiny structure located at the base of the brain (see image below) involved in the regulation of many biological processes. The two centres of interest within the hypothalamus include the Lateral Hypothalamus (LH) and the Ventromedial Nucleus of the Hypothalamus (VNH).

In a study of animals, scientists found that when the LH was lesioned, the animals had a decreased interest in eating.

In contrast, when the VNH was lesioned, the animals ate in excess, almost as though they had lost their regulation of satiation (fullness) and consequently gained weight rapidly.

Hypothalamus Pituitary gland

While the above explanation may seem simple, several decades later, and with an abundance of additional research, scientists now believe that it is not so much the LH and VNH which act as simple on and off switches for hunger, but rather that hunger is controlled by another part of the hypothalamus known as the arcuate nucleus. The arcuate nucleus contains two groups of important neurons: one group which is sensitive to incoming hunger signals, and the other group which is sensitive to satiation.

In contrast to studying the influence of various anatomical areas of the hypothalamus, contemporary theories rather relate hunger cues to the neural circuits which pass through the hypothalamus. These neural circuits rely on neurotransmitters, with serotonin, Neuropeptide Y, GABA, and ghrelin gaining much attention in hunger regulation.

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GLUCOSE AND DIGESTIVE REGULATION Hunger can depend on glucose and digestive regulation. Glucose is a simple sugar that the body can use as an immediate energy source. Much of the food which an individual consumes is converted to glucose. Based on the observation that individuals tend to feel full when blood glucose levels rise and less full when blood glucose levels fall, Jean Mayer proposed that hunger was based on the rise and fall of blood glucose levels. This hypothesis is known as the Glucostatic Theory.

In addition, the digestive system, particularly the stomach, is also involved with hunger cues. After food is consumed, cells in the stomach send signals to the brain which decrease the desire for further eating, and certain nerves carry satiety messages, based on how nutrient dense the food is.

HORMONAL REGULATION Hunger can also be affected by the hormones in an individual’s bloodstream. Insulin, one of the hormones affecting hunger, is released into the bloodstream in response to increased blood glucose levels. Insulin is secreted by the pancreas and assists the glucose in moving from the bloodstream into the cells of the body. Insulin levels increase when food is consumed and decrease as blood glucose levels drop. An inadequate supply of insulin is linked to the onset or uncontrolled management of diabetes mellitus, and insulin secretion is sensitive to the fluctuations of body fat stores.

As such, insulin has been hypothesised to have a fundamental role in regulating hunger.

The hormones ghrelin, and cholecystokinin (CCK) are also directly linked to stimulating hunger cues. When food has not been consumed for a period of time, the stomach secretes ghrelin. Ghrelin is a hormone that causes stomach contractions (a grumbling stomach) and induces hunger. Once the food is consumed, the intestines then release CCK, which carries satiety signals to the brain and consequently decreases those hunger cues.

Finally, leptin is another hormone that is thought to be linked to the motivation of hunger and eating. Leptin is a hormone which is produced by fat cells throughout the body and released into the bloodstream. Higher levels of fat stores result in higher production and release of leptin. As leptin levels rise, hunger decreases; therefore, an obese individual is less likely to feel hungry than a slim individual, secondary to their fat stores affecting the production of leptin. However, one of the theories for obesity refers to obese individuals developing leptin resistance, whereby the body becomes resistant to the information provided by leptin.

While there are a number of additional hormones in the human body that may be affecting hunger cues, insulin, ghrelin, CCK, and leptin appear to be the major ones extensively studied.

LEPTIN Adipose cells

GHRELIN Brain

Stomach

Intestines Liver

INCRETIN Muscle

Pancreas

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ENVIRONMENTAL FACTORS AND THEIR RELEVANCE TO HUNGER REGULATION While hunger is a biological response of the human body, it is not only biological factors which trigger hunger cues in an individual. There are some theories which look at how individuals eat not only in response to hunger signals , but rather for pleasure. As such, there are a number of environmental factors which play a role in initiating hunger and appetites.

Some of these environmental factors include: Food availability and related cues Learnt preferences and habits Stress.

• • •

FOOD AVAILABILITY AND RELATED CUES Nutritional advisors should be aware that there are a few variables which will impact the amount and type of food consumed, including: Palatability Quantity available Variety.

• • •

These variables act to influence food choices and are outlined in the table below:

PALATABILITY

Palatability refers to the pleasure obtained from consuming food and varies according to immediate water, nutritional and energy requirements. The palatability of foods will have a significant impact on an individual, as well as the amount of food the individual will consume. The more palatable a food is, the more of it will be consumed. Each individual has a different palate, and what may be very palatable to some, may not be palatable at all for others.

QUANTITY AVAILABLE

The amount of food available will often determine the amount of food an individual will consume.

For example, an individual who is served a larger portion is likely to consume the entire portion despite feeling full, whereas if that same individual is served slightly less, they are likely to consume their portion and gain satiation, but not necessarily desire more food.

VARIETY

The variety of food available will affect the amount an individual is likely to consume. The more variety available, the greater the amount consumed. Individuals tend to get sensory-specific satiety, a decrease in pleasure from eating food when it is consumed on a regular basis. Individuals with a smaller variety of food are less likely to consume as much, because of sensory-specific satiety; whereas, if that same group of individuals attended a buffet with a large variety of food, they would be far more likely to consume food in excess.

In addition, there are a number of cues which can stimulate hunger. For example, seeing images of delicious food, hearing the sizzling, frying of food, or smelling the odour of certain foods can all trigger an individual’s hunger. Even a simple written description of a food item may be enough to stimulate hunger cues.

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LEARNT PREFERENCES AND HABITS While some taste preferences are innate (natural), such as babies preferring sweeter foods at birth, learnt preferences develop over time through various influences. What one individual prefers to eat is predominantly based on what they have been taught, brought up with, and what they have experienced throughout the course of their life.

Where an individual was brought up and what they learnt will determine their own taste preferences and habits.

Preferences for different types of food will differ depending on the individual’s cultural, religious, ethnic and geographical limitations. For example, those living in France are generally more open to eating snails and frogs’ legs; Inuits (people of northern Canada and parts of Greenland and Alaska) may be more partial to eating maggots; Southeast Asian individuals are more likely to eat grasshoppers; Muslims are likely to avoid pork.

As a nutritional advisor, this information is important to understand, since cultural and personal preferences vary widely, where one suggestion for a way of eating or type of food may suit some clients, it may not suit others. For this reason, it is important to use a collaborative approach to each client that respects their individual needs when developing recommendations.

STRESS AND EATING It is widely understood and acknowledged that stress can induce eating in a large percentage of individuals. Stress, a negative emotion, is often counteracted by individuals consuming foods which they believe will bring on positive emotions (e.g., happiness, satisfaction) and make them feel calmer. Examples of these foods are usually energy-dense foods such as chocolate, cake, chips, ice cream and other discretionary items. Unfortunately, the positive emotions felt initially by consuming these foods are not long-lasting and are often quickly replaced with more negative emotions (e.g., guilt, shame, feelings of no self-control).

Interestingly, researchers have found that stress-induced eating is quite common among long term dieters. The mechanism behind stress-induced eating is thought to be related to the action of cortisol (stress hormone) on the hormones insulin and leptin, and the neurotransmitter neuropeptide Y (NPY), which upregulate the desire to eat (see image).

PSYCHOLOGICAL STRESS THREAT RESPONSE

COGNITIVE RESTRAINT

INSULIN LEPTIN

HIGH CORTISOL

NPY

REWARD PATHWAYS

COOKIES

VISCERAL FAT

ACCUMULATION

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UNDERSTANDING EATING, BODYWEIGHT AND OBESITY Just as hunger is regulated by both biological and psychological factors, so too is obesity. Obesity is a disease which, in 2017-2018, 67% (or two thirds) of Australians are classed as overweight or obese.(37) Obesity can be diagnosed for individuals who have a Body Mass Index (BMI) of 30 or above. Obesity increases an individual’s risk of total mortality and their vulnerability to disease.(38)(39)

Obese individuals are at greater risk of the following:(38)(39) cardiovascular disease (CVD) • Developing Hypertension (high blood pressure) • Hypercholesterolaemia (high cholesterol levels) • Arthritis • Respiratory conditions • Muscular and skeletal pains • Certain cancers • Vital organ function decline • Diabetes mellitus • Asthma • Depression • Liver disease.

• How an individual becomes obese is related to biological and psychological factors. As explored earlier, there are a number of factors affecting an individual’s appetite and hunger. A disruption in one of these parameters, such as hormone regulation, can make it difficult for a person to maintain a healthy body weight.

In addition to what has been previously discussed, genetic predisposition, excessive eating coupled with inadequate exercise and the concept of the set point theory can also help to explain why individuals may gain weight and struggle to remove excess weight.

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GENETIC PREDISPOSITION Some individuals may be genetically predisposed to obesity while other individuals are not. Some individuals appear to eat all they wish without gaining any weight whatsoever, whereas other individuals must work a lot harder and watch their diet strictly, to avoid unwanted weight gain.

Researchers have found that some people develop a gene vulnerability to obesity, making them more prone to obesity.

For the same reasons mentioned above, understanding this will enable the nutritional advisor to better assist their clients.

EXCESSIVE EATING AND INADEQUATE EXERCISE One of the simplest explanations for weight gain and obesity is excessive eating coupled with inadequate exercise. This refers to when an individual consumes more energy on a day-to-day basis than they expend. The amount of energy an individual requires daily is related to physical activity levels and their resting metabolic rate.

When more energy is consumed than are being expended, weight gain will occur as a result. Even if an individual is consuming unprocessed foods, if what is being consumed exceeds what is being expended, weight gain will occur.

By undertaking a proper assessment of a client’s energy requirements and current energy intake, nutritional advisors can help tailor client eating patterns and dietary intake to help achieve one of three outcomes: loss • Weight maintenance • Weight Weight • gain.

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THE CONCEPT OF ‘SET POINT THEORY’ Set Point Theory proposes that the body monitors fat cell levels to keep them (and weight) fairly stable. It is found that individuals who lose weight over time are likely to put the weight back on, and those who work to put it on may struggle to keep that weight on. For example, when the body drops weight below its set point, it will compensate for this by increasing hunger levels and decreasing metabolism.(40)

Weight gain Diet & exercise to reduce weight Increased appetite/ slowing of metabolism Hormone levels/ signally change to keep weight on

Following on from the Set Point Theory, researchers have proposed an alternative theory called ‘Settling Point Theory’.

The Settling Point Theory proposes that weight tends to drift around the level at which the constellation of factors determining food consumption and energy expenditure achieve an equilibrium. This theory suggests that an individual’s weight will remain stable, providing there are no changes to the factors which affect weight.(40) Where the Set Point Theory suggests that an obese person’s set point will always remain at that particular weight, the Settling Point Theory suggests that with various long-term lifestyle modifications (such as diet and exercise), an obese individual’s set point will slowly drift down without active resistance.

DICTIONARY SET POINT THEORY

The Set Point Theory proposes that the body monitors fat cell levels to keep them (and weight) fairly stable.

SETTLING POINT THEORY

The Settling Point Theory proposes that weight tends to drift around the level at which the constellation of factors that determine food consumption and energy expenditure achieve an equilibrium.

Understanding Set Point Theory allows the nutritional advisor to help clients understand how weight and weight maintenance may work for them in the long term. With this information, it may be possible to help clients achieve slow, steady and sustainable weight loss while being realistic about what is achievable for a client long term.

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IDENTIFYING STRATEGIES AND TECHNIQUES FOR POSITIVE BEHAVIOURAL CHANGE AND CLIENT ADHERENCE There are several strategies which a nutritional advisor can use to assist a client to achieve positive behavioural change and adherence. The chosen technique will be individually specific depending on what the client’s desired outcome in behavioural change is.

Common strategies used in behavioural change are outlined in the table below:

NUTRIENT

SUGGESTED SERVING

REALISTIC CLIENT EXPECTATIONS

Assisting clients to set realistic and sustainable goals to ensure ongoing motivation and positive change.

COPING TECHNIQUES

Discuss various coping techniques which the client may implement when feeling stressed or unmotivated, such as speaking with a friend, walking on the beach, or writing down why they are making these changes.

STRESS MANAGEMENT

Individuals will cope with stress in many ways. It is important to understand the client’s stress management style and help make changes if their current style may prove to have negative effects on their goals.

REMOVAL OF DEFENCE MECHANISMS

Clients may be in denial about their current health status. As a nutritional advisor, it can be beneficial to kindly educate the client regarding the consequences if no changes were made and the benefits of when dietary changes are made. This can assist clients to go from the denial thought pattern to acceptance, and possibly ‘contemplation’.

Contemplation is part of the Stages of Change Model, previously discussed in this resource.

SOCIAL SUPPORT SYSTEMS

Encourage the client to use positive support systems, which will provide encouragement and motivation to continue with healthful behavioural changes.

POSITIVE REINFORCEMENT

Continuously provide positive reinforcement to the client by reminding them of what they have already achieved, that they are doing so well, they have great willpower, great self-control, are well educated, or mention anything that will create a nurturing, motivating and inspiring environment.

PLEASURE AND PAIN ASSOCIATIONS

Helping the client to identify how their goals and dietary changes can lead to long term pleasure, even if they are currently feeling short term pain.

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STRATEGIES AND TECHNIQUES FOR OVERCOMING NEGATIVE SELF-TALK Even if they are doing well and achieving set goals, individuals may struggle with internal negative communication, which can be disruptive and unmotivating. For these individuals, it can be helpful to assist with education regarding commonly used techniques and strategies. These can be utilised to assist in the overcoming of negative self-talk and communication.

Example of strategies that a nutritional advisor can utilise to assist a client in overcoming negative self-talk can include (but is not limited to):

• Mindfulness • Self-love

• Kindness • Acceptance of common humanity.

The table below discusses the above strategies in more detail: Allowing an individual to put themselves first and to love and accept who they are as a person.

This can be a challenging task for some individuals.

Nutritional advisors can encourage their clients to practise self-love with the following simple strategies:

SELF-LOVE

time out for ‘alone time’ • Taking Doing activities bring internal joy • Practising positivewhichself-talk • Speaking daily mantras • Treating the body with care (i.e., nutrition, exercise, rest) • Meditation.

•

It is important for an individual to be kind to themselves. This follows on closely with self-love.

Nutritional advisors can help their clients to be kind to themselves by encouraging them to utilise the following strategies:

KINDNESS

MINDFULNESS

causing self-harm • Not Treating body with respect (by trying to only speak positively about it) • Listeningtheto the • the body signals)body and acting upon its demands (e.g., taking a break or going to bed as time for rest and recovery • Taking Nourishing the body with a nutrient-dense diet.

• Mindfulness can be applied to many scenarios, such as being mindful of the internal self-talk going on or practising mindful eating. Being mindful of both internal and external cues is the act of being aware and present in a particular moment and accepting the associated feelings, thoughts, and bodily sensations.

Mindfulness is often used as a technique in nutrition counselling and psychology. Nutritional advisors can utilise mindfulness with clients to overcome negative self-talk.

ACCEPTANCE OF COMMON HUMANITY

The word ‘common’ refers to something which is shared, and ‘humanity’ refers to the human species. Common humanity, therefore, relates to the shared values, emotions, and failures within the human species.

Understanding and accepting that everyone (e.g., family member, friend, or an individual themselves) is bound to make mistakes, as they are ‘only human,’ is all part of accepting common humanity. Nutritional advisors can educate and encourage their clients to incorporate this strategy as an effective tool to overcome negative self-talk.

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SUPPORTING CLIENTS BY UTILISING AROUSAL CONTROL TECHNIQUES As a nutritional advisor, it is important to understand the ‘Arousal Theory of Motivation’ (discussed earlier in this resource) to effectively support clients to achieve their health/nutritional goals. It is important to understand this theory and have the knowledge of techniques to combat high arousal levels in clients, where it becomes detrimental to their health and mental state.

There are several techniques that can be utilised with clients to assist and support them in controlling unwanted feelings and arousal levels, and examples include: management • Anxiety Progressive relaxation • Stress management • Visualisation • Positive self-talk • Craving control.

•

ANXIETY MANAGEMENT Anxiety is the body’s response to fear. It is normal and helpful in some situations, motivating the body to act. It is the body’s mechanism to keep itself safe, triggering the ‘fight or flight’ response when faced with danger.(41) Anxiety is the most common mental health condition in Australia. Statistics released in 2022 reported 43.7% of Australians (over two in five, or 8.6 million people) experience a mental health disorder in their lifetime and of these, 3.3 million people had an anxiety disorder.(42) Prolonged or severe anxiety can be unhealthy. An anxiety disorder occurs when an individual’s anxiety levels significantly impact their life. There is no single identifiable cause for anxiety disorders. Family history, personality, physical health, ongoing stress, and substance use can all contribute to its development.(43)

In cases when the client is experiencing elevated levels of anxiety, coping strategies that a nutritional advisor can encourage include: a step back and relax. Practise yoga routines, meditate, go for a walk, or talk to someone.

• Taking Eating healthy meals and snacks, it is important not to skip meals.

• Minimising or eliminating or caffeine, as these can trigger panic attacks.

• Getting more rest; when thealcohol body is stressed, it needs more time to recover.

• Taking deep breaths.

• Counting to 10 and back again.

• Trying to make humour out of the situation.

• Keeping a positive outlook.

• Talking to friends or family and finding support •

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PROGRESSIVE RELAXATION Muscle tension can be the result of stress and anxiety. A technique known as progressive relaxation can help to reduce or eliminate anxiety. This technique involves the intentional tensing and relaxing of different muscle groups, starting from the feet and working up to the face, and is explained below.(44)

A nutritional advisor can explain this technique to clients to assist them with their anxiety management. The nutritional advisor would encourage the client to: a quiet space away from distraction • Find Wear loose clothing, and remove footwear • Sit or comfortable, lie in a comfortable position.

• The client would then work through the following muscle groups. For each muscle group listed, the client would breathe in and tense all the muscles in the specified muscle group for approximately 5 seconds. The client would then breathe normally and keep muscled relaxed for ten seconds.

1.

2.

3.

4.

5.

6.

7.

8.

Right hand and forearm. Make a fist with your right hand.

Right upper arm. Bring your right forearm up to your shoulder to “make a muscle”.

Left hand and forearm.

Left upper arm.

Forehead. Raise your eyebrows as high as they will go, as though you were surprised by something.

Eyes and cheeks. Squeeze your eyes tight shut.

Mouth and jaw. Open your mouth as wide as you can, as you might when you‘re yawning.

Neck! Be careful as you tense these muscles. Face forward and then pull your head back slowly, as though you are looking up to the ceiling.

9. Shoulders. Tense the muscles in your shoulders as you bring your shoulders up towards your ears.

10. Shoulder blades/Back. Push your shoulder blades back, trying to almost touch them together, so that your chest is pushed forward.

11. Chest and stomach. Breathe in deeply, filling up your lungs and chest with air.

12. Hips and buttocks. Squeeze your buttock muscles 13. Right upper leg. Tighten your right thigh.

14. Right lower leg! Do this slowly and carefully to avoid cramps. Pull your toes towards you to stretch the calf muscle.

15. Right foot. Curl your toes downwards.

16. Left upper leg. Repeat as for right upper leg.

17. Left lower leg. Repeat as for right lower leg.

18. Left foot. Repeat as for right foot.

You may wish to download and give a copy of the progressive muscle relaxation process to your clients. Click here to access the guide.

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STRESS MANAGEMENT One of the best ways to manage stress is to develop positive coping mechanisms. Some people turn to food, drugs, or alcohol for their stress management, which can be detrimental to their health and wellbeing.

There are many ways to help manage stress, and, as a nutritional advisor, it is important to know that everyone will handle stress differently, even in the same situation.

There are a number of different ways to encourage clients and help them manage stress, some of which are listed below: for a walk • Going Going to • Exercisingthe gym • Meditation • Playing with a family pet • Writing a journal • Painting • Going to church or praying • Sleeping • Talking to a close friend or family member • Gardening • Seeking help from a general practitioner (GP) or another medical practitioner such as a counsellor, a psychologist, • or a psychiatrist.

PERSONAL PRODUCTIVITY SKILLS PHYSICAL ACTIVITIES (SPORTS) PRESENT MOMENT AWARENESS LEADING A BALANCED LIFE

MANAGING STRESS

CONFLICT RESOLUTION SKILLS JOURNALING (DIARY) MEDITATION

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VISUALISATION Visualisation (also referred to as mental imagery) can be a powerful technique which nutritional advisors can use with their clients. It can help individuals enhance their conscious mind, increase self-awareness, and achieve a more relaxed state of mind.

This is not to be confused with daydreaming, as visualisation is an intentional action. This is a healthy way of bringing positive energy into the heart, body, mind, and overall spirit. Through visualisation, individuals will be opening up themselves and their capacity for creativity and achievement.

For example, a nutritional advisor may encourage a client to visualise themselves confidently ordering a healthy item off a restaurant menu, enjoying the food and company, and feeling proud of themselves. This visualisation may help the client in a real-life situation to order a healthier item, knowing they will enjoy it and feel good about it later too.

The following steps may help individuals with visualisation: a quiet, comfortable spot away from distractions such as people, pets, or technology.

• Find Remove that may be restrictive such as tight clothing, belts, large jewellery, or socks.

• Get into aanything comfortable position, relax and close the eyes.

• Slow breathing down and pay close attention to what it sounds like.

• Let go of any tension the body and visualise it as it leaves the body.

• Relax the entire body throughout and mind, in readiness to visualise themselves as they wish to be: • client is feeling constricted in life, they may visualise themself as a bird flying free across an ocean with • Ifnotheworries in the world.

If the client feels as though they are not physically fit enough, they may visualise themself lifting a heavy • weight or winning a competition. the client feels as though they are not good enough and feeling down, they may visualise themself • Ifstanding on top of a mountain as being a ‘vast and powerful force’.

If a client to lose weight, they may visualise themself in a new pair of jeans or swimming piece.

• If a client wants easily tempted by treat foods, they may visualise themself declining the treat foods and enjoying • a healthierisalternative instead.

• Ifday.a client is training for a sports event, they may visualise themself crossing the finish line on the competition As a nutritional advisor, it is important to know that clients will have their own reasons and style for visualising; something that may work for one person may not work for someone else, which is not a problem.

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ENCOURAGING POSITIVE SELF-TALK Encouraging positive self-talk as a nutritional advisor can be an effective tool for helping clients who present with low self-esteem, who regularly speak poorly of themselves or just want to feel better about themselves.

DICTIONARY SELF-TALK

Self-talk is defined as an individual’s inner voice speaking to them. While not often considered or acknowledged, the reality is that most individuals will have a constant commentary running through their head. Self-talk can be either positive or negative.(45) Reach Out Australia have numerous resources available in the form of articles, tools and apps that can help encourage positivity. Visit reachout.com to explore topics that may be helpful for your clients.

For example, most individuals will look in the mirror when they get dressed in the morning, essentially waiting for internal positive reinforcement that they look good enough to go out in public or have made the right clothing choice for the day. If the individual is satisfied, then they will continue with their day. However, if the individual receives negative self-talk, this may result in compensatory behaviours such as changing clothes and re-assessing.

Positive self-talk is essential for an individual’s mental health, and some individuals may have to learn how to speak positively to themseves. Learning positive self-talk may be a matter of turning any negative thought into a positive one, finding daily mantras or simply judging themselves as they would someone else.

The table below provides some examples of positive self-talk that a nutritional advisor can encourage, which can be extremely influential with their clients: ‘I AM POWERFUL’

‘I AM BEAUTIFUL’

‘I AM CALM AND RELAXED’

‘I AM A VAST AND POWERFUL FORCE’

‘I CHOOSE TO BE HEALTHY AND HAPPY’

‘I WILL BE GENTLE ON MYSELF’

‘I WILL TAKE MYSELF LESS SERIOUSLY’

‘I WILL ACHIEVE ANYTHING I PUT MY MIND TO’

‘I AM IN CONTROL OF MY LIFE’

‘I HAVE SO MUCH TO OFFER PEOPLE’

‘I AM GOING TO REACH MY GOALS’

‘I WILL TAKE THINGS ONE STEP AT A TIME’

‘I AM IN CONTROL OF MY CHOICES’

‘I AM STRONG AND HEALTHY’

How to create

POSITIVE SELF-TALK

I can’t

I can

I am late for work

Get rid of internal negative chatter

I get nervous at parties

Don’t be harsh on yourself when you face a setback

But I like going

Look at your social gaffes positively

I better call the office

I am so stupid

Everyone makes mistakes

Build your self-esteen

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CRAVING CONTROL TECHNIQUE (‘RIDING THE WAVE’) The craving control technique, often referred to as ‘riding the wave’, assists individuals in their response to cravings.

Riding the wave refers to an individual being exposed to a particular stimulus (such as food) which promotes arousal (craving). The individual is to acknowledge how their desire for the stimulus rises and then falls, much like the swell of a wave rising and falling.

It is important for individuals to acknowledge that cravings subside and are not constant, just as a wave subsides again and is not always risen. This simple activity of ‘riding the wave’ can be especially useful to help nutritional advisors build a client’s mental strength or resolve to abstain from specific foods that may have been the cause of bingeing or emotional eating.

There are four main steps when using this technique. These steps are discussed in the steps below as well as the image on the following page:

STEP 1 STEP 2

STEP 3

STEP 4

FOCUS Focusing on where the craving is experienced (where there is increased arousal). For example with food, it may be the mouth (salivating), the stomach (due to hormone release) and in the brain (due to the anticipation of receiving a reward).

ACKNOWLEDGE Acknowledge and observe the feeling that the particular craving experience brings about.

For example, acknowledging that giving in to the craving would result in short term pleasure, the pleasurable taste of the craved food and the sense of reward or relaxation that giving into the food would have. Also acknowledging the longer term feelings that giving in to the craving would have such as guilt, annoyance and failure. These feelings should not be the focus of the technique since failure may occur in the early stages of practising the technique, and should be used as a learning experience, not focused on negatively. This step represents the rise of the wave, just the rise of a craving. The focus is to not give in to the rise of the wave but to rather ride the wave out.

REPEAT FOCUS Focus again on how the craving is experienced and how it changes as the craving rises and begins to fall. This will include a reduction in the power of the craving and the sensations that drove it initially. This step shows that, just like a wave, the cravings will rise and then subside, and then may rise again. It is up to the individual to ride the wave as the cravings swell, acknowledge the cravings and associated emotions, feel the cravings start to subside and then ride the wave again should another craving rise again.

RELEASE Using controlled breathing throughout the technique can be helpful in releasing the craving.

Otherwise, simply observing how the craving passes and how the body feels afterward can be focused on to help build mental strength and confidence for the next time the technique is used. Despite the rises in the waves, the waves will always subside, just as cravings will always subside. Using techniques to assist the individual in not giving in to the craving will help build mental strength and confidence for when the next rise in the wave occurs again.

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RIDE THE WAVE - CRAVING CONTROL TECHNIQUE Acknowledge how you experience the craving.

2.

4.

1.

Release the tension as you release each deep breath.

3.

Focus on the area where you experience the craving.

Repeat focusing with each part of your body that experiences the craving.

HOW NUTRITIONAL ADVISORS CAN IMPLEMENT ‘RIDING THE WAVE’ A nutritional advisor can assist a client to implement this technique by accompanying them to a supermarket, or by getting the client to close their eyes and visualise the scenario below.

CASE STUDY A client walks down the confectionery aisle of the supermarket and looks at the various types of confectionery available. At some point, a particular food (usually a favourite or regularly consumed type of confectionery) will produce a craving to pick up the item, place it in a basket/trolley, buy and consume the item.

In order to ride the wave, instead, the client looks at the stimulating food item in the supermarket and observes the craving they are feeling. They allow themselves to detach and observe how the craving develops and rises like a wave, until it passes and the craving falls away.

It is important that a nutritional advisor remind the client that this technique takes time to learn since self-control is like a muscle - the more often it is practised, the easier it becomes to perform the behaviour (abstaining).

The client must also be reminded that ‘failing’ at the technique is not a failure in the scheme of behaviour change and should be seen as a learning opportunity instead. A nutritional advisor can also encourage the client to practise this technique on a full stomach, which is good advice for grocery shopping in general.

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ENCOURAGING NEW YEAR RESOLUTIONS WITH CLIENTS It is often around New Year that individuals begin to think about creating healthy eating habits and adopting a healthier lifestyle. The start of the year can be a popular time to try to actively change lifestyle habits, as individuals are more motivated by the fact the entire year is ahead of them.

Regardless of what resolution is committed to, the goal which a nutritional advisor will see as the most important is to improve the client’s health in the coming year.

Resolutions generally come in two forms: 1. Change a habit currently perceived as negative, such as decreasing or eliminating alcohol, sugar, or tobacco from the diet 2. Create a new positive habit to improve overall health. Examples of this may be to consume more vegetables, drink more water or meet daily minimum protein requirements.

Behavioural changes can impact on a person’s ability to follow through with their goals. Despite the best intentions and an initial burst of enthusiasm, clients may soon encounter barriers which have the potential to keep them from achieving their resolutions.

These barriers can come in many shapes and forms, such as: commitments • Work Health • Lack ofissues • Lack of self-esteem • motivation.

It is therefore important to remember why these original goals were set and ensure that they are achievable and realistic for each individual’s situation. The SMART method can assist with setting effective goals (discussed later in this unit).

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FUNCTIONAL BEHAVIOURAL ANALYSIS (FBA) DICTIONARY FUNCTIONAL BEHAVIOUR ANALYSIS (FBA)

Functional Behaviour Analysis (FBA) can be defined as the analysis of the function of behaviour. The purpose of FBA is to identify antecedents or consequences that maintain behaviour, with a view to introducing adjustments that will produce an alternate behaviour or set of behaviours.(46)

As a nutritional advisor, it is possible to assist and support clients in changing their behaviours or breaking unhealthy habits through a process of functional behaviour analysis (FBA). FBA examines the specific behaviour and then identifies the triggers and the reinforcers that cause and maintain the behaviour. FBA concentrates on the individual and the context of the behaviour rather than offering a diagnosis.

When the behaviour occurs, there will constantly be two presenting features, these features include:(46) form of the behaviour is the specific behaviour of the client; what they are doing.

• The The function of the behaviour is the trigger for the behaviour; this can be a cognitive or environmental trigger. For • a cognitive trigger, an emotion may cause the behaviour. For example, feeling sad may be the trigger for binge eating. An example of an environmental trigger is walking past a bakery every day, which triggers cravings for a cake, even when not hungry.

OCCURING BEHAVIOUR FORM

FUNCTION

The ‘form’ of a behaviour is what is demonstrated by the client and typically observed by a nutritional advisor.

The ‘function’ of a behaviour is less easily identified that the ‘form’.

Of the two features, it is the ‘form’ that is easiest to identify.

This is the underpinning reason for the ‘form’ of the behaviour.

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The rationale of FBA is to identify the antecedents, unwanted behaviour, and consequences (known as the ‘ABC method’) that control the outcome/behaviour. Using this method can enable nutritional advisors to assist their clients in identifying and managing unwanted behaviours to support their goals.

A

B

ANTECEDENTS (STIMULI/ TRIGGERS)

BEHAVIOURS (UNWANTED RESPONSE)

Antecedents are the triggers that precede the event that leads to an unwanted behaviour. These can be internal and are associated with feelings, or external and are associate with smells, visuals, habitual routines. These include things like:

smell of coffee (external) • The past the fish and chip shop (external) • Walking Afternoon sunsets after work (external) • Stress (internal) • Sadness (internal) • Rumbling stomach (internal).

•

Behaviours are the unwanted response to the antecedent trigger. They usually result in the consumption of some rewarding food or drink. Again, resulting behaviours can be varied and may include food or non-food behaviours such as:

coffee • Drinking Eating hot chips (usually energy-dense foods) • Drinking alcohol • Biting nails • Drug use • Overeating energy-dense foods •

Consequences are the changes that occur because of the behaviour.

These are usually a mix of reward and punishment, including:

C

CONSEQUENCES (CHANGES THAT OCCUR)

• Enjoyment • Guilt • Self-loathing.

• Regret

Consequences are often initially positive (short-term consequence) as they serve to sooth a negative trigger. However, the result is a negative emotion once the client realises that the impact of the unwanted behaviour is actually negative rather than positive (long term consequence).

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This approach is an effective practice for evaluating difficult or challenging behaviour in which nutritional advisors can utilise to support their clients in changing unwanted behaviours or unhealthy habits. As a guide, this can be achieved by following the steps below:

STEP 1 STEP 2

STEP 3

ANTECEDENTS Assist the client in becoming aware of the antecedents by helping them to identify triggers (both internal and external) and with the aim to limit or control triggers by increasing new cues or triggers.

BEHAVIOURS Next, a nutritional advisor can assist the client in exploring their own behaviours to specific triggers (which in relation to eating include the reasons for eating, distractions, mindfulness etc.).

New replacement behaviours need to be identified that are more healthful or in-line with client goals. These should be decided on by the client in collaboration with the nutritional advisor and can be food (however, often best avoided) or non-food based.

For instance, monetary incentives, new clothes or activities, a treat meal can all act as positive reinforcers for maintaining new behaviours or reducing old habits.

CONSEQUENCES Perhaps the most influential factor is step three, in which a nutritional advisor can assist clients in becoming aware of the consequences of their behaviour, especially negative emotions relating to their behaviour.

Negative emotions can be used to reinforce abstaining from the unwanted behaviour that does not fit with their goal(s).

CASE STUDY: JESSICA Jessica is 35 years old, single and an emotional eater. She is overweight and wants to lose 10kg but struggles as she loves chocolate. When she talks about eating, she mentions feelings of loneliness and self-loathing, and feels helpless to lose weight, no matter how hard she tries.

In Jessica’s case, her antecedent triggers are her negative emotions (loneliness), which she tries to remedy with sweet foods which produce a rewarding response in the brain, taking away a negative stimulus.

ANTECEDENT Emotional (Feeling lonely)

BEHAVIOUR Eating chocolate

CONSEQUENCE Short term: Feeling happy/satisfied.

Long term: Self-loathing/helplessness.

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UNDERSTANDING AND ENCOURAGING MINDFUL EATING Mindful eating focuses on the way food is eaten as opposed to the type of food that is eaten. This approach brings awareness to eating habits, which help an individual to eat in response to their appetite as opposed to mindless eating (to eat in response to the pleasure of food and avoid judgement and feelings of guilt).

DID YOU KNOW? The ‘Mindful Eating Approach’ (MEA) is a simple health approach which aims to improve the relationship individuals have with food. This approach does not focus on a diet, nor provide meal plans; it is based on the enjoyment of food and encouraging eating for health.

MINDFUL EATING VS MINDLESS EATING Mindful eating is a simple life practice that can be utilised by individuals of all ages, cultures and genders. This approach focuses on an individual’s attention to the present moment, which assists in disconnecting regular, unsatisfying, harmful habits and behaviours. This approach assists individuals in the way they perceive food, and changes the way they respond to food, both physically and emotionally.

Mindless eating is the opposite. It can be defined as consuming food without paying attention to what or how much is being eaten. Most people will fall into the trap of consuming foods without actually being hungry.

A common example of mindless eating is nibbling on something while watching television. The individual’s attention is not on the food being consumed but instead on the program on TV. Therefore, they are at risk of consuming excessive amounts of food without realising it.

There are a number of occasions that increase the risk of mindless eating, such as: simply because it is a ‘mealtime’ as opposed to being hungry • Eating Emotional • Eating sugareating dense or caffeinated foods to assist in waking up or staying awake • Eating at certain events and occasions out of habit • Time restrictions and therefore having to eat quickly • Confusing thirst for hunger and eating in response to thirst signals.

•

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TECHNIQUES FOR MINDFUL EATING There are several strategies which can be utilised to help bring an individual into the present moment of eating.

Some mindful eating strategies include: a food and emotion journal • Keeping Chewing • Putting thefoodknifeadequately and fork down between mouthfuls • Abstaining from distractions the TV or social media during mealtimes • Encouraging clients to listen tosuchtheirasbody’s signals and eat accordingly.

• A nutritional advisor can help a client by going through these techniques to assist them to practise mindful eating.

The following mindful eating techniques have been put together by Eating Disorders Victoria: 1. Eating small or moderate amounts of food every 2-3 hours.

2. Before eating, ask a few basic questions such as: Am I hungry? Am I thirsty? If so, what type of food/ drink do I want? What type of food/drink will my body benefit from the most?

3. Set a nice place to eat and arrange food nicely on the plate. Do not eat standing or walking.

4. Being in the present (take 3 deep breaths) before beginning to eat.

5. Eat slowly, paying attention to the smell, taste, sound, texture and look of the food.

6. Put utensils or food down between mouthfuls.

7. Every few minutes check in with the body’s hunger signals.

8. Stop eating just before feeling full and wait 10-20 minutes before eating more food if hunger is still present.

9. Enjoy the whole meal. If individuals don’t enjoy eating, they will never be satisfied.

Don’t rush

Consider the source

Enjoy the experience

MINDFUL EATING Drink water

Love what you eat

Sit at a table

Question what you eat

Avoid distractions

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MINDFUL EATING PRACTICE When consulting with a client, a nutritional advisor can use the method/activity below to help clients understand the practice of mindful eating. Nutritional advisors may like to go through this exercise with their clients while they are in a face-to-face setting, or alternatively may send the client home with this activity to do in their own time.

Nutritional advisors in some instances, however, may need to encourage the client to practise this activity a few times, as the first time may be a bit unusual for them if they are new to practising mindful eating. Each step of this activity can initially be written down or spoken out loud and over time it will become a subconscious thought process.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 STEP 7 STEP 8

SELECT THE FOOD Choose a bite size portion of a particular food. This may be anything from blueberries or nuts, to a forkful of beef or an egg.

EXAMINE THE FOOD Look at the food closely taking, in particular notes about the shape, colour and texture of the food. You may notice that the food has a gradient of colour, has a rough texture or is in an oval shape.

SMELL THE FOOD Smell the food. Does it have a smell? What can you smell? Do you know of other foods which smell similar? Is this smell pleasing to you? Is this smell how it usually smells? Have you ever noticed the smell of this particular food before?

PLACE THE FOOD ON YOUR TONGUE (DO NOT CHEW) Simply place part of the food on your tongue and be aware of what happens. Does it have a strong flavour? Do you like the flavour? Are your salivary glands producing excess saliva? Is it heavy on your tongue?

BITE THE FOOD Take a bite of the food and become aware of the change of flavour and the texture in your mouth. Did the food have a different flavour on the inside as opposed to the outside? What texture is the food? Do you like that texture?

CHEW THE FOOD Begin chewing the food and take note of the sounds in your mouth and the change of texture of the food. Does the food change texture? What is the mouthfeel? What noises can you hear from your mouth?

SWALLOW THE FOOD Send the food to the back of your throat and swallow it. Can you feel it travel down your oesophagus? Do you need to do a few swallows to get it all down?

SAY THE NAME OF THE FOOD Silently, or aloud, say the name of the food you just consumed.

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MONITORING BEHAVIOUR CHANGE AND PROGRESS

Monitoring behaviour change is an essential part of any consultation. This can play a fundamental part in maintaining motivation, identifying what is and is not working, and overcoming barriers to change.

Monitoring behaviour change can be highly beneficial to help maintain motivation in clients. When clients see the positive effects of their dietary and lifestyle change, they are far more likely to continue with the change.

Monitoring change and progress indicates to the nutritional advisor what is working and what may need to be refined.

Monitoring change also shows nutritional advisors and fellow health professionals the client’s current health status, thus providing key information on how to best assist the client on an individualised basis.

It is the responsibility of the nutritional advisor to monitor the change or progress appropriately and store the data correctly.

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IDENTIFYING METHODS FOR MONITORING BEHAVIOUR CHANGE Monitoring behaviour change in clients is important so that a nutritional advisor can observe what behaviour changes are being made, and which behaviour changes are being resisted. This information will help provide a better service to the client, as recommendations can be adapted based on behaviour changes, thus allowing a nutritional advisor to foresee and anticipate changes to better meet the client’s ever-changing needs. Monitoring change relates to observing and recording information about the client.

Behaviour change is monitored for a number of reasons, including: problems are identified, and necessary changes can be made to avoid them becoming larger problems.

• Smaller a nutritional advisor to provide appropriate support as required (e.g., counselling, referral to appropriate • Allows health professional, dietary changes can be amended). quality service can be provided, as the nutritional advisor has a comprehensive understanding of the • Better client’s progress.

• Both clients and nutritional advisors can work together to resolve issues to ensure ongoing nutritional success.

There are many different behaviours which may be monitored; however, not all behaviours need to be monitored.

A nutritional advisor would only monitor behaviours specific to a client that may impact their ability to carry out nutritional recommendations.

The table below outlines some behaviours which may be monitored:

CHANGING BEHAVIOUR PATTERNS

NEGATIVE SELF TALK

ANXIETY/DEPRESSION

NEGATIVE BODY PERCEPTION.

PROVOCATIVE OR THREATENING BEHAVIOUR

LACK OF MOTIVATION

FORCEFUL REFUSAL TO COOPERATE

INTENT TO HARM SELF OR OTHERS

REJECTION OF SIGNIFICANT OTHERS

APATHY

SERIOUS AND CHRONIC COMPLAINTS

LOSS OF INTEREST OR WITHDRAWAL

There are several different ways that a nutritional advisor can monitor their client’s behaviour. This can include: monitoring • Formal Informal • Reflectivemonitoring monitoring.

• The type of method to monitor behaviour would depend on the client. As a health professional, it is always encouraged and required that all discussions, be they informal or formal, with the client or with other personnel, be documented appropriately and in a professional manner.

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FORMAL METHODS FOR MONITORING BEHAVIOUR Formal methods of monitoring behaviour are structured and organised.

A formal method would include reviewing and reflecting on a number of different information sources, such as: provided by other health professionals • Assessments Relevant tests results and associated recommendations • Referral letters completed, from other health • Past and current case notes professionals • Letters from other health professionals and key individuals • Medical reports from various organisations and health professionals • Formal interviews with other health professionals (e.g., psychologists) • Reports from other health professionals • Concerns and information provided by close friends and family.

•

INFORMAL METHODS FOR MONITORING BEHAVIOUR Informal methods are less structured and organised than formal methods and are associated with casual interactions and observations.

Informal methods of monitoring behaviour may include: informally with friends or family of the client (only with the approval from the client) • Talking Discussions professionals • Observationswithmadeotherbothhealth in and out of the workplace.

•

UTILISING REFLECTIVE MONITORING In addition to formal and informal methods of monitoring behaviour change, sometimes reflective monitoring can be key to a thorough understanding of a client’s situation and how best to provide support.

Reflective monitoring refers to reflecting on a client’s case alone or with another understanding individual such as a colleague or supervisor. Reflecting on a case when the client is not physically present can help gain a deeper understanding of the situation, and thoughts and ideas may be provoked which were not originally there. This, in turn, may help a nutritional advisor provide better support and care to their clients.

Reflective monitoring is a practice that all health professionals are encouraged to get into the habit of doing regularly.

Taking the time to reflect on a client’s situation may help to: that the recommendations made were sound and will benefit the client.

• Ensure Provide additional recommendations to the client to better support their situation.

• Gain a deeper of the client’s situation so that a better service can be provided.

• Gain insight asunderstanding parts of the client’s situation may not have been addressed as well as they could have • been, and identifyto what ways to improve practice for next time. the strong points of the consultation, as this may be helpful for future consultations.

• Identify Identify weak of the consultation so that improvements can be made.

• Look into and areas ensure a comprehensive understanding of the client’s medical history and take the time to learn • medical areas/terms which may not be familiar.

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SPECIFIC INFORMATION TO MONITOR A CLIENT’S PROGRESS When it comes to monitoring a client’s progress, it is essential to monitor information where changes are most likely to be seen, whether they be positive or negative. It is important to monitor both positive and potentially negative changes, as the negative changes will provide insight into where adjustments to the current recommendations may need to be made.

In most scenarios, the easiest way to identify what should be monitored will stem from the client’s goals and what they are aiming to achieve. For example, if a client’s goal is weight loss, it is a good idea to monitor weight, as well as circumference measurements. If a client is aiming to lose body fat and gain lean muscle mass, skin folds would be the major indication of change and therefore would be the basis of monitoring progress.

It is encouraged that, in addition to the specific goal the client is trying to achieve, more parameters are followed. This is encouraged for a number of reasons: if the client is making positive lifestyle changes, they are likely to see positive changes in more than one area in their health; clients will find it motivating to see more positive progress notes; if the client doesn’t see positive changes in some parameters, the other parameters will help to keep the client motivated.

There are several different parameters which can be monitored, including but not limited to: body weight • Total Body percentage • Body fatmuscle mass percentage • Hydration status • Circumference measurements • Skinfolds • Pathology results (e.g., cholesterol, sugar, iron) • Blood pressure • Dress/pant size • Energy levels • Craving frequency • Bowel motions (e.g., consistency, frequency) • Satiety ratings • Physical capabilities.

•

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HOW TO MONITOR PROGRESS (COLLECTING DATA)

When it comes to monitoring a client’s progress, a multitude of methods can be employed. The chosen method for monitoring will depend on what is being monitored.

In most scenarios, the data that will be monitored will be quantifiable, meaning it will have a number associated with it. In that respect, both parties can watch this number rise and fall as changes are implemented. Non-quantifiable data which can also be tracked, may include before and after pictures of the individual, to show the changes in their body shape and size.

In some scenarios, it can be helpful and motivational for this data to be placed in a graph to show the client the trajectory of their results. Placing the data on the graph will create a visual effect which is exceptionally beneficial for those who are visual learners.

Below are some examples of ways to graph various datasets: Lipids

Urine Chart

HDL

1 Target

3 4 5

Dehydration

Left vertical axis title

2

LDL

TOTAL CHOLESTEROL

TRIGLYCERIDES

200

150

100

50

6 7 8

Severe Dehydration

0

1/1/2010

7/1/2010

1/1/2011

7/1/2011

1/1/2012

7/1/2012

Dates

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RECOGNISING AND APPLYING PRINCIPLES OF COMMUNICATION AND COUNSELLING TECHNIQUES IDENTIFYING EFFECTIVE COMMUNICATION Communication is the process of exchanging information between a sender and a receiver. Effective communication relies on the ability of the sender to explain their meaning and the interpretation of the message by the receiver.

Communication is key to the success of any relationship. As a nutritional advisor, it is important to develop the ability to communicate effectively with clients.

Communication can be verbal, non-verbal, or written. Examples of each have been provided in the table below:

VERBAL COMMUNICATION

NON-VERBAL COMMUNICATION

WRITTEN COMMUNICATION

Talking

Shaking Hands

Text Messages

Talking is the major form of communication through consultations with clients. It is generally the preferred method of conveying information from one individual to another and allows for immediate clarification and response.

Handshaking is seen as a sign of respect and courtesy in Australia. While males mostly conduct the handshake, many females use this method of communication when greeting or bidding farewell to a client.

Text messages are frequently used to remind clients about their appointment times. Some clinics allow clients to text back while others request a phone call if the appointment time needs amending.

Using Sounds or Words to Express Thoughts and Feelings

Clapping

Journals, Brochures, or Internet Websites

Throughout the consultation, both the professional and the client may make various sounds to show active listening and agreement.

While not used frequently during a consultation, clapping may indicate excitement or pleasure. For example, a client may reach their goal weight and clap with excitement.

Media sources, such as journals, brochures, and websites, are frequently used to help advertise a nutritional advisor›s clinic, expertise, and products. These can be accessed by a wide variety of audiences.

Saying YES In Agreement

Eye Contact

Email

Throughout the consultation, each party may show their understanding or agreement by simply verbalising ‘yes’.

Maintaining eye contact through verbal communication is a sign of respect and shows the client that the professional is actively listening and not being distracted. When eye contact is not given, it may appear that the individual is disinterested, bored or uncomfortable with the topic at hand.

Emails can be used throughout clinical practice to communicate with clients, fellow health professionals and the wider community through email updates.

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Saying NO In Disagreement

Hugging

Memo

Throughout the consultation each party may show their lack of understanding or disagreement by simply verbalising ‘no’.

While not frequently used throughout consultations, hugs are a method of intimate communication which may be a greeting, a well wish or farewell.

A memo (short for memorandum) is a note or document used to record information. Where letters are generally used to communicate with external recipients, a memo could be used for internal purposes in a business.

Emphasis

Facial Expressions

Letter or Proposal

When communicating, emphasis can be placed on certain words to highlight various parts of the message.

Facial expressions can often communicate more than words themselves. Facial expressions will show immediate emotions throughout the consultation such as frustration, confusion, happiness, or agreement.

A written letter is often used to communicate information of a client from one health professional to another. This is a common courtesy to assist the fellow health professional to provide optimal care and advice for the client.

Tone

Patting on the Back

The tone of voice which is used can provide a lot of information regarding the emotions (e.g., happy, sad, frustrated, angry), and feelings about the topic (e.g., disapproval, apprehensive).

Patting on the back can be used for both a congratulatory message and a sympathy message depending on the situation.

Tempo

Posture

It is important to control the tempo (speed) of speech for effective communication. Speaking too quickly can be difficult to understand, while talking too slowly can be distracting for the client.

An individual’s posture while communicating can say a lot about their interest levels. For example, an individual slouched back in their chair would not look as professional or as engaged as an individual who is sitting upright listening intently.

Gestures Gestures can be used to assist with non-verbal communication, usually using the head or the hand. For example, an individual may cock their head to one side to show they do not fully understand something or may put their hand up, palm facing forward, to interject or pause the conversation.

Sign Language A very popular form of nonverbal communication is sign language.

This mode of communication is predominantly used by deaf individuals and allows individuals to fully communicate using their hands to sign words.

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RECOGNISING COMMUNICATION STRATEGIES There are several strategies which can be utilised when communicating with a client.

Outlined below are some common tips for effective communication between a nutritional advisor and a client: the message simple and meaningful.

• Keep the client’s behaviour or the situation based on the way they may see it.

• Describe the feedback. Assessing if the feedback is appropriate right now, or if this information is too • Prioritise overwhelming for the client at this moment. encourage, and positively reinforce the intended message.

• Inspire, the client the same as the nutritional advisor would want to be treated themselves. Consider how the • Treat information may be coming across and adjust the tone, the intensity of information and reiteration as required. examples to reiterate information.

• Use Avoid when consulting, as this can appear rude and give the client the impression they are not being • listeneddistractions to properly.

HALF EMPTY

HALF FULL

NO, HALF FULL

NO, HALF EMPTY

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COMMON COUNSELLING TECHNIQUES There are several different counselling techniques which can be utilised by a nutritional advisor to help during consultations. Various techniques will assist with different aspects, such as communication, clarification, encouragement, empowerment, and specific behavioural modification.

Common counselling techniques can include (but are not limited to): listening • Active Body language • Questioning techniques (open and closed questions) • Paraphrasing techniques • Summarising • Note-taking • Encouraging client’s self-responsibility • Empowering clients to make their own decisions • Behaviour modifications specific to the client.

•

ACTIVE LISTENING Active listening refers to physically listening to what the client is saying and responding appropriately. Active listening may be simply listening and nodding; or it may be listening by asking a few questions and seeking further information; or it may be the paraphrasing what the client has said. This shows the client they have not only been listened to but understood as well.

BODY LANGUAGE As discussed previously in this unit, body language is important for communicating with clients, as it can portray so much information. For example, crossed arms may signal disagreement, fidgeting may signal boredom or loss of interest, eye contact can signal active listening, slouched posture can indicate fatigue, nodding can indicate understanding or agreement, and shrugging can indicate being unsure of something. Nutritional advisors can not only portray various messages through body language, but can also pick up nonverbal messages from clients.

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QUESTIONING TECHNIQUES Asking clients for further information can show a desire or need to know more information. It can also indicate an interest in the conversation, which is useful, especially for rapport building. Asking the right questions at the right time is an important skill for all health professionals. Asking the right types of questions will not only allow the right information to be obtained but will also assist in the development of mutual trust and understanding.

There are two types of questions: open and closed. The type of question utilised will depend on the information required.

The table below explains the differences between the two types of questions:

OPEN-ENDED QUESTIONS

CLOSE-ENDED QUESTIONS

Open-ended questions that cannot be answered with just ‘yes’ or ‘no’; they are used to elicit detailed information and encourage the client to speak. These types of questions are important, especially for clients who do not speak very much or provide much detail.

Asking open-ended questions where the client cannot simply answer ‘yes’ or ‘no’ will allow the nutritional advisor to obtain a much greater amount of useful information.

Closed questions can be answered with either a single word - ‘yes’ or ‘no’ - or a short phrase. These questions are used to gather specific information and get the client back on track if they stray off topic.

Examples of open-ended questions include: ‘What do you normally eat for breakfast during the week?’

‘What are the reasons motivating you to lose weight?’

‘How would you describe your emotion when you find yourself binge eating?’

Examples of closed questions include: ‘Is that a common experience?’

‘How old were you when you first started reacting to milk-based products?’

‘Have you ever tried quinoa flakes?’

• • •

• • •

PARAPHRASING TECHNIQUES Paraphrasing is used to achieve greater clarity. Paraphrasing is essentially rephrasing what an individual has said using different words to ensure proper understanding. Paraphrasing usually occurs following an explanation as opposed to a simple question.

CASE STUDY - EXAMPLE 1 Client: ‘I feel very unmotivated when I look at the scales because I feel like I am working so hard but am not getting results fast enough. I think we should consider decreasing calories or increasing my exercise to allow for a faster weight loss’.

Nutritional advisor: ‘You would prefer to be losing weight faster, and to do so, you would like to decrease calories or increase exercise further. Do you think faster weight loss will help with overall motivation?’

CASE STUDY - EXAMPLE 2 Client: ‘I am really struggling to get my family on board with the food side of things as it is quite different from what we are used to eating on a day-to-day basis.’

Nutritional advisor: ‘Your family is not enjoying the food as much as they used to. Do you think if we adapted your current recipes by simply giving them a healthier twist, it would help to get your family on board?’

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As the nutritional advisor is essentially asking for clarification, it allows the client the opportunity to either agree or disagree with the nutritional advisor’s interpretation of what has been said.

SUMMARISING Summarising, while similar to paraphrasing, is a summary rather than a clarification.

A summary is often given at the end of a consultation to summarise the following: has been spoken about,.

• what the client will be working on. and • what when • the next consultation will be.

The summary can be given by either the nutritional advisor or the client. Its purpose is to ensure that both individuals are on the same page regarding what is happening and the plan.

NUTRITIONAL ADVISOR ‘To confirm, this week, you will be working on your fat intake, paying special attention to the types of oils you are cooking with, the introduction of fish to the diet and the inclusion of nuts and seeds in your baking and salads. We have you booked in for the 10th of next month at 2pm. If you have any questions between now and then, you have my email address and phone number to make contact. Does that all sound okay with you? Do you have any questions to ask before we finish?’

NOTE TAKING Note taking during a consultation can be beneficial for a number of reasons:

the nutritional advisor to remember what has been said.

• Helps Assists • requiredthe. nutritional advisor in remembering what questions to ask and identifying where further information is assist in staying on topic and not getting distracted.

• May with keeping busy, especially if the nutritional advisor feels awkward with too much eye contact or • Assists nothing to do with their hands.

BEHAVIOUR MODIFICATIONS SPECIFIC TO THE CLIENT As each client is so individual, it is important to ensure that behaviour modifications are specific to each client. What may work for one client may not work for another.

In the initial consultation, it is important to:

to what the client is saying, ask for feedback, • Listen Encourage them to be a part of the decision-making and recommendations, • Assess barriers to change and how to overcome them.

•

In the follow up consultation, it is important to:

the client to identify what did and did not work.

• Ask Explore to overcome the client’s barrier to change.

• Formulatesolutions a new or modified course of action with the client.

•

By doing this, it will allow behaviour modifications to be more specific to a particular client, as opposed to a one-sizefits-all approach.

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ENCOURAGE A CLIENT’S SELF-RESPONSIBILITY DICTIONARY SELF-RESPONSIBILITY Self-responsibility refers to being able to take responsibility of emotional conflicts without blaming or projecting these feelings upon another person by making it their fault.

When it comes to making behaviour changes, it is solely up to the client to take responsibility. While a nutritional advisor can encourage and educate, and family and friends can provide ongoing support, it is still the client who must make the changes and maintain them. It is therefore essential to encourage clients to obtain and maintain self-responsibility when it comes to making behaviour changes.

As a nutritional advisor there are many benefits to educating and creating awareness of self-responsibility with clients.

Examples of the various benefits include (but are not limited to):

client becomes self-reflective and believes that all the things which happen to them are entirely the result of • The their own actions up to that point in time. client decides to take ownership of their circumstances instead of blaming external forces (such as other • The people, luck/unluck, coincidences). self-responsible client has the capability to see beyond the immediate situation/circumstances, and instead, • Aconsiders ‘the big picture’.

Clients who demonstrate self-responsibility often go out of their way to keep improving by filling in any blanks in • their knowledge or abilities. By doing so, they expand their thoughts, allowing their ‘mental picture’ to become as

•

complete as they require.

A self-responsible client is more inclined to treat themselves with self-respect, self-efficacy, and act with integrity.

The nutritional advisor can provide encouragement and motivation by offering frequent consultations. They can educate the client and assist with goal setting, setting rewards and identifying barriers to change. They can also discuss the pros and cons of change and the consequences of no change in achieving goals.

EMPOWERING CLIENTS TO MAKE THEIR OWN DECISIONS Like with anything, when an individual takes responsibility for their own actions, they are far more likely to succeed with it. As a nutritional advisor, it is essential to empower clients to make their own decisions and not to rely on their family, friends, spouse or even the advisor to make certain decisions for them. Remind the client that making their own decision will allow them to identify what they do and do not think is achievable, enjoyable, and realistic. As a result, they will be far more likely to carry through with the recommendation themselves than if someone else decided for them.

GIVING AND RECEIVING FEEDBACK Feedback methods refer to the way feedback is presented. Feedback can be positive, negative, or constructive, and, when delivered well, can positively impact the individual. Feedback is provided from the client to the nutritional advisor, and from the nutritional advisor to the client. There is a constant feedback process, which is providing information to either party about how the other individual is taking on board and processing the provided information.

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When seeking feedback, there are several different methods which can be utilised to ask for information, such as:

• Surveys • Interviews • Emails calls • Phone Face to • face.

Positive feedback can be reinforced to an individual through positive statements, such as: have lost so much weight - well done!

• You You really stuck to your goals this past month - you must be so proud!

• You have are looking • You have amazinggreat!willpower!

• You have done an excellent job!

•

Negative or constructive feedback, on the other hand, may need to be delivered more subtly so that the individual does not take the feedback poorly. Often, positive feedback is provided before the negative/ constructive feedback, and then more positive feedback is provided again at the end. This technique can often be referred to as the ‘sandwich technique’ whereby the negative/constructive feedback is softened with positive feedback both before and after.

THE FEEDBACK SANDWICH

POSITIVE FEEDBACK

CONSTRUCTIVE FEEDBACK

POSITIVE FEEDBACK

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The table below outlines how the sandwich technique works, whereby the positive feedback is delivered as the two slices of bread, and the negative/constructive feedback is delivered as the ‘filling’.

THE ORDER OF THE INGREDIENTS

WHAT TO DELIVER

HOW TO DELIVER IT (WHAT TO SAY)

THE FIRST LAYER OF THE BREAD

Point out something positive that the client is doing around their performance.

‘You have been putting in a massive effort this past month to achieve the goals we have set together for you’.

THE ‘FILLING’ OF THE SANDWICH

Let the client know about their performance and what they can or should work on. This feedback needs to be delivered carefully so as not to upset or demotivate the client.

‘I need you to stick to your healthy eating plan and exercise regime over the holidays as I know it can be a tough time of year to stay motivated. Remember we went through this at the same time last year also?’.

THE OTHER LAYER OF THE BREAD

It is important to provide the ‘cushion’ to the negative feedback.

Re-enforce the client’s positive behaviour and encourage them to stay motivated. Even though the ‘filling’ of the sandwich was the real message, the receiver will get that message loud and clear, but the negative impact of it will be diluted with the ‘bread’ or the positives of the sandwich.

‘I am sure that you will achieve your goals as you are almost there and have already lost 3kg. You have been able to adapt to these changes extremely fast. Well done, you should be proud of yourself’.

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APPLYING THE PRINCIPLES OF GOAL SETTING TO SUPPORT BEHAVIOUR CHANGE An important element of adopting motivational theories and encouraging behaviour change is creating effective goals with clients. When goals are not within a timeline and are too vague, clients will lack motivation and drive to reach these goals. Successful goal setting provides clients realistic expectations to encourage intensity and commitment.

IMPORTANT NOTE The term ‘with the client’ has been used rather than ‘for the client’, as a goal developing process should be established ‘with’ the client using a client-centred approach by actively engaging the client in the goal-setting process. Working with clients rather than delegating or developing goals ‘for’ the client can be a more successful approach to client engagement and adherence.

There are different approaches that a nutritional advisor can take to create goals that encourage client adherence and commitment. The most common approaches to goal setting include: goals • SMART Short, medium, goals • Outcome, process,andandlong-term performance goals.

• It is important to remember, however, not to be limited to only the approaches listed above as there are many different approaches that can be applied. The approach to take will depend on the client themself, their individual attributes, personality, and motivation.

Ac

Pl n o i t

an

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CREATING SMART GOALS When assisting clients in setting goals, it is beneficial to set SMART goals. SMART goals are Specific, Measurable, Attainable/Achievable, Relevant/Realistic and Timebound.(47)

Specific Measurable Achievable Realistic

Timely

What do you want to do?

When exactly do you want to accomplish it?

S M A R T How will you know when youve reached it?

Is it in your power to accomplish it?

Can you realistically achieve it?

Setting goals using the SMART principle enables clients to be completely sure of what needs to be done to reach their long-term goals. Furthermore, clients can create short-, medium- and long-term goals using the SMART method.

A SMART GOAL/S MAY BE: ‘To lose 5kg of weight within the next 4 months’.

For a client to lose weight, they may have multiple strategies, such as decreasing processed foods, increasing vegetable intake, exercising more and practising mindful eating. This client may, therefore, have set goals around each of these areas. Regarding vegetable consumption, their client’s SMART goal may look like something like: ‘Within the next 4 weeks, to be consuming 5 serves of vegetables (1 serve = 1 cup raw vegetables or ½ cup cooked vegetables) at least 5 days of every week, with at least 3 different types of vegetables each day’.

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The table below examines SMART goals a little further, using the example of increasing vegetable intake to assist in weight loss.

It is important to understand exactly what the client wants to achieve. Nutritional advisors can better structure the nutritional program to meet their client’s expectations when goals are specific.

S

SPECIFIC

For example, to assist the client to formulate specific objectives and goals, the nutritional advisor can ask the following questions: What exactly do you want to accomplish?

How do you want to accomplish this?

Who do you want to accomplish this with?

What limitations do you have?

Why specifically do you want to reach this goal?

• • • • •

FOR EXAMPLE: If the aim is to increase vegetable intake to assist in weight loss, the goal must specify how many serves of vegetables need to be consumed each day to reach the desired result. So, instead of simply saying ‘increase vegetable intake’, a specific goal would be to increase vegetable intake to 5 serves per day every day of the week.

M

MEASURABLE

Measurable goals mean determining what the vision for meeting the goal may look like and the ability to provide evidence that clients are meeting their goals or breaking the goal down into measurable elements.

Measurable goals can be beneficial in refining what exactly it is that a client wants to achieve.

Defining the physical proof (or evidence) of a client’s goal or objective makes it clearer, and easier for them to reach.

FOR EXAMPLE: The number of serves of vegetables consumed can be counted, and therefore it is measurable.

A weight loss goal could be measured using the measurements from scales, or circumference measurements.

Can a client’s goal be reached? A nutrition advisor will need to assist their client in determining if the goal is a realistic expectation. This client will need to consider the time and effort that will be required in order to meet their goal.

A

ATTAINABLE/ ACHIEVABLE

Another factor that needs to be considered for ‘attainable goals’ is if the goal is going to conflict with other priorities in life. If there are not enough resources or the goal conflicts with other priorities, this can set a client up for failure. It does not mean that the goal cannot be reached; however, the timeframe and the planning may need to be adjusted to make it realistic.

FOR EXAMPLE: Is it achievable to consume 5 serves of vegetables per day every day of the week? For some this may be very easy while for others this may not be achievable secondary to food security, allergies, major dislikes, or time restraints. When creating a goal, it is important that the goal can be achieved to ensure the client does not become disheartened part way through.

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R

RELEVANT/ REALISTIC

T

TIMELY/ TIME-BOUND

Is this goal relevant to a client? Is it realistic? This can be determined by asking a client the following questions: Why do you want to accomplish this goal?

What is the primary objective of reaching this goal?

Will meeting this goal provide you with what you are looking for?

• • •

FOR EXAMPLE: Consuming the 5 serves of vegetables per day is realistic for an average individual. However, setting a goal to lose 10kg in 2 weeks is not as realistic. The goal must be achievable without causing harm. A personal goal should be relevant and realistic to avoid disappointment and unnecessary setbacks.

It is natural for people to procrastinate when there is no deadline set. If a client’s goal is to lose 10kg, is that in 12 weeks or 6 months? Clients need to be set up for success by being encouraged to create achievable time-bound goals. If deadlines are not set, some goals may never actually be achieved which can be disheartening for a client. By providing a timeframe of when to accomplish goals, a client will be more likely to increase their motivation in order to meet these goals.

As a Nutrition Counsellor, keeping the timeline realistic and flexible is important in order to keep their client’s morale high. Being too strict or rigorous on the timely aspect of goal setting can sometimes have adverse effects on clients and cause unwanted stress.

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IDENTIFYING A CLIENT’S SHORT, MEDIUM AND LONGTERM GOALS SMART goals can be used to set up the main goal. For example, the goal for a body builder is to lose 10% of body fat in 12 weeks. This goal is specific- it specifies exactly what will be done, measurable -body fat can be tracked, it is achievable and relevant for a body builder, and it has a time frame of 12 weeks. This is the overall goal, or the long-term goal. When the long-term goal is set up, the goal can be broken down into smaller goals. This is where the short- and medium- term goals can be used.

The length of time of these three different levels generally depends on the length of time of the overall program or intended support program with the client. For example, if a nutritional plan or program is set with the client for 12 weeks, then the long-term goals should be the entire length of the intended plan, while medium-length goals could be threeweek goals and short-term goals could be weekly or daily goals. It is important to note that long-, medium- and shortterm goals should still be set up using the SMART acronym.

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The table below outlines short, medium and long-term goals in more detail, as well as provides examples of each level of goal setting: Short-term goals should correspond with achieving medium-term goals, and from there, medium-term goals correspond with long-term goals. Breaking up long-term goals in this way will assist in making the goals more attainable.

SHORT-TERM GOALS

In other words, each goal set out for a client should be a single action, either prioritised for that day or week, and that supports a monthly or quarterly goal.

EXAMPLES:

only whole food-based products for a minimum of 4 days each week.

• ToTo consume consume at least 2.2L water on days where exercise is completed, and at least •2L of water on rest days. in 10 minutes a day for ‘relaxation’ • Scheduling • Aiming to eat recommended servings of vegetables per day.

Medium-term goals are stepping stones to achieving long-term goals. Medium-term goals should be met due to the consistency of short-term goals. In other words, medium-term goals assist in bridging the gap between short-term goals (i.e. daily activities) and the longterm overall visions of clients.

MEDIUMTERM GOALS

EXAMPLES:

to a healthy eating regime for 4 weeks • Sticking 3L of water per day consistently over 6 weeks • Drinking weight loss of 13kg within the next 9 months • ToTo achieve 5km without stopping in the next 3 months • To run have of 4 cups of vegetables every day • To swap amilkminimum over to dark chocolate for the next 2 months • To be active inchocolate some form daily for at least 20 minutes.

• Long-term goals are the desired end result. Long-term goals are reached by consistency with medium-term goals.

Long-term goals may seem initially out of reach. However, breaking long-term goals down into achievable short and medium-term goals can assist with keeping clients motivated.

Completing these smaller goals can give clients a sense of achievement and allow them to track their progress towards their ultimate target.

LONG-TERM GOALS

Even if the long-term goal is not achieved or is altered over time, setting short and mediumterm goals provides opportunities for a client to experience success along the way.

EXAMPLES:

achieve weight loss of 25kg within the next 18 months.

• ToMaking eating a part of everyday life for its many health benefits • Drinkinghealthy water every as a part of a new lifestyle habit • Maintain weight loss day, goal weight has been achieved • To complete a 10km runafterwithout • Reduce alcohol down to no morewalking/stopping than 10 standard drinks per week as per •Australian guidelines VAST FITNESS ACADEMY | NAT11046005: ANALYSE AND APPLY PRINCIPLES OF PSYCHOLOGY AND BEHAVIOUR MANAGEMENT | VERSION 1 - 11.11.2022

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OUTCOME, PROCESS AND PERFORMANCE GOALS Goal setting is an extremely important activity to conduct when working with clients. This ensures that both the client and the nutritional advisor understand what is desired, and that clients have realistic expectations. Any unrealistic expectations can be discussed and modified during the consultation. In addition to the previous types of goal setting discussed earlier, there are another three types of goals that can be discussed and encouraged with clients; these include: Process goals Performance goals Outcome goals.

• • •

PROCESS

• Technoque or strategy PERFORMANCE

• Specific standard OUTCOME

• End Result The table below provides more details on the difference between each type of goal: Process goals relate to the strategy or routine used to achieve performance goals and ultimately, outcome goals. These goals focus on a client’s individual actions that are not dependent on or related to the performance or actions of others.

PROCESS GOALS

PERFORMANCE GOALS

EXAMPLES:

takeaway consumption from 5 times each week to 1 time each week.

• Reduce Ensure lunch dinners consist of a 120g protein source, minimum of 2 cups •vegetables and noandmore than 25% carbohydrate-rich food. active 5 days each week for a minimum of 30 minutes (2 days strength and 3 •daysBecardio).

Performance goals define the standard to be achieved. These are the performance levels that clients need to be able to achieve if they are to reach their desired outcome. Clients have a better ability to control the results of these goals as opposed to outcome goals.

EXAMPLES: Finish a 5km event in under 40 minutes.

OUTCOME GOALS

Outcome goals define the desired end result and can provide clients direction and a sense of purpose. Outcome goals depend on not only a client’s performance or ability to commit to a plan but also the actions of others.

EXAMPLES: Reduce fat mass by 10kg and increase lean muscle mass by 2kg over the next 4 months.

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To describe the interaction between the three types of goals, the following equation can be used:

PROCESS + PERFORMANCE = OUTCOMES Focusing on achieving the process and performance goals, should hopefully lead to the achievement of outcomes goals.

To summarise the connection between process, performance and outcome goals, it is helpful to understand that they are categorised by how much control clients have over each goal. A client generally has the most control over ‘process goals’ and the least control when it comes to ‘outcome goals’.

When supporting clients and assisting them in setting goals, nutrition advisors can encourage their clients to visualise and set the desired outcome, but more importantly, encourage them to focus on the process and performance goals along the way.

Focusing on the process and performance goals with clients enable clients to improve and adopt healthier lifestyles more efficiently while encouraging them to enjoy the steps involved in the process, rather than solely focusing on one main goal at the end. By encouraging clients to set a foundation with process and performance goals, the outcome goals are more likely to be achieved by themselves.

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MODIFYING STRATEGIES AS REQUIRED, BASED ON CLIENT FEEDBACK RECOGNISING THE NEED TO MODIFY NUTRITIONAL SUPPORT STRATEGIES/INTERVENTIONS As nutritional advisors begin to see clients regularly, it will be essential to tailor interventions and strategies to ensure that there is progress towards goals. It must be remembered that each client and their situation is unique and, as such, what works to achieve one client’s goal may not work for another. Therefore, it is essential to get regular feedback about how the client is progressing with a strategy, whether it is working, being enjoyed or what could be done to tweak or modify it.

Gaining feedback from a client not only identifies if a strategy or intervention needs modifying; it also provides another level of service and added value for the client, since most clients require ongoing support to be successful (therefore they have engaged the services of a nutritional advisor).

The table below provides examples of factors that a nutritional advisor can monitor to help identify whether their client is producing, or failing to produce, desired results:

WHERE STRATEGIES ARE PRODUCING DESIRED RESULTS, THERE MAY BE LITTLE TO DO EXCEPT FOR CHECKING IN ON THINGS LIKE:

WHERE STRATEGIES ARE FAILING TO PRODUCE THE DESIRED RESULT, IT WILL BE IMPORTANT TO GET FEEDBACK ON MANY ITEMS, SUCH AS:

intake • Dietary and strategies for adherence • Enablers Positive dietary changes • Positive behavioural • Progression (i.e., weight,changes circumference measures, •increased muscle mass, clothes fitting looser).

intake • Dietary and obstacles • Barriers Negative changes • Negative dietary behavioural changes • Perceived reasons for lack • Managing expectations. of progress •

It is essential to provide praise for any positive changes, even weight maintenance (where weight loss is the goal), as praise can increase adherence and motivation to continue.

Acknowledging and investigating reasons for failure to make progress and investigating them further will enable the nutritional advisor and client to troubleshoot and adjust strategies to produce better results.

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RECOGNISING NON-ADHERENT CLIENTS It is important also to be aware that clients may not always be completely honest. Although people have good intentions, seeing a health professional places an expectation on some clients that they must behave in a certain way, to please the professional. This can result in the client offering misleading information about dietary intake, motivation, habits, behaviours, or exercise, to prevent disappointing their nutritional advisor. This is very common and some clients do this knowingly (they are knowingly non-adherent) whereas others do this unknowingly (unknowingly non-adherent).

Someone who is ‘knowingly non-adherent’ may be struggling with motivation, life stress, breaking habits, dislike of current strategies or some other cause for their non-adherence and may hide the behaviour.

Someone who is ‘unknowingly non-adherent’ believes they are doing everything right but may forget about what they have eaten; They are unaware of behaviours that sabotage progress. In both cases, nutritional advisors need to tactfully investigate the reasons for progress failure and work with clients to create new strategies that re-enables progress.

Ensuring that client rapport is a focus and building an environment of openness can help to reduce the likelihood of nonadherence. The case study below provides an example of gaining feedback and modifying support strategies for a client.

CASE STUDY: SHEILA Sheila is a 45-year-old medical receptionist who has lost 30kg in the last year with the help of a nutritional advisor and is now 10kg from her goal weight. Her weight loss has stalled in the last month due to social commitments (friends visiting for a month) and Sheila’s motivation is waning because of her lack of progress.

WHAT SHOULD A NUTRITIONAL ADVISOR DO? The table below outlines three factors that nutritional advisors could do in this scenario:

PRAISE RECOGNISE

Sheila has lost 30kg and is weight stable. Do not let her forget this: it is a huge achievement.

Sheila has been weight stable for a month, which is an achievement, so praise and ensure she is not minimising this achievement.

Work with Sheila to identify the cause of stalled progress by: Checking dietary intake Identify barriers and obstacles (social commitments) Identify negative dietary changes (restaurant and takeaway meals) Identify negative behavioural changes (reduced motivation) Recognise perceived reasons for failure to progress (social eating and low motivation) Manage expectations: This is an unusual time (more social over this period), it is not going to be this way forever, weight is stable and new strategies will help manage this period.

•• • STRATEGISE • ••

WHAT COULD BE MODIFIED? Sheila is motivated to lose weight but seeing no progress is demotivating. Managing Sheila’s expectations is important in this situation - food and social eating should be enjoyed and not seen as a negative, especially as it is not planned to continue long term. Weight maintenance is an excellent result in this situation and should be celebrated. However, if Sheila is determined to continue, educating her on healthier options for eating out may help reduce her energy intake (such as reducing alcohol intake, eating a salad or soup to start, entree instead of main, sharing a meal, skipping dessert, eating to satiety, leaving some food on the plate or increasing water intake before and during eating).

Changing her non-social eating patterns (such as breakfast at home, lunches at work) and exercise may also help to increase progress.

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UNDERSTANDING ETHICAL, SAFE AND LEGAL USE OF NUTRITION AND PSYCHOLOGY CLIENT CONFIDENTIALITY Across the range of support that a nutritional advisor provides to their client, they will also be provided with a client’s personal and confidential information; this type of information can include (but is not limited to): Contact information Lifestyle patterns and habits Family histories Detailed medical information.

• • • •

In Australia, professionals are bound by the Privacy Act 1988, which regulates the handling of personal information.

The Act is underpinned by thirteen Australian Privacy Principles (APP) which govern the collection, processing, storage, protection, and dissemination of personal information relating to individuals.

This means that all information is considered confidential and is not to be discussed with anyone, except for other health professionals who are currently treating or are being referred to treat the client, and only with the client’s consent obtained.

When discussing the general nature of the consultation and seeking advice from other health professionals, care must be taken to ensure that the client’s contact details, such as their name, address, and phone number, are not disclosed.

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STORING AND DOCUMENTING CLIENT INFORMATION Storing information regarding behavioural changes and progress must be done in the same manner of storing any type of confidential information. All information that is confidential must be stored in a safe and secure location where only individuals involved with the client’s primary care have access. All hard copies of consultation notes and information must be locked away to all unauthorised personnel, and all soft (electronic) copies must be secured with a password.

There are several elements which should be documented through the client support process. Initial client records, screening surveys and documents, such as assessment results, should be retained within the client’s record. These documents serve two primary purposes: firstly, they form a record for tracking the client’s progress against their nutritional goals, and secondly, they form a legal record of advice provided.

Whether electronic or hard copy, it is important that each client have an individual record consisting of the following documents at a minimum: questionnaires and assessment results • Pre-screen Initial consultation • The client’s nutritionnotes plan • Progress records including monitoring assessment records.

• When considering how these documents are retained, it is important to remember the requirements of the Australian Privacy Act (1988) governing their retention and management. The information provided by the client, and that which was gathered during the support process, remain confidential. This means that reasonable measures must be taken to secure the information and ensure it is not accessible by others.

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DUTY OF CARE FOR NUTRITIONAL ADVISORS Duty of care is written legally into the Workplace Health and Safety Act 1995. It is a moral duty to anticipate possible hazards and causes of injury and do everything reasonably practicable to prevent/remove/minimise these causes.

Like any professional field where advice is provided to a client in relation to health and wellbeing, there are legal and ethical considerations which need to be considered. Incorrect nutritional advice provided to a client can have direct and serious implications for both their physical and mental health, and accordingly, it is of utmost importance to understand the role and scope of practice as a nutritional advisor.

Consequences to the client when nutritional advisors are practising outside of their scope may include, but are not limited to: impact on pre-existing health conditions • Negative or dangerous nutrient imbalances, interactions, toxicities, and deficiencies • Sub-optimal Negative interactions between nutrients and drugs.

•

As a result of this, the nutritional advisors are at risk of: legal proceedings for caused harm on a client, which could incur considerable financial costs and lost • Potential time • Potential loss of professional reputation.

It is important to have a sound understanding of the duty of care and responsible practice requirements inherent as a health professional. In Australia, the provision of health and fitness information is generally not governed under a single legislation, act or code, but may rather be governed under codes of conduct for membership groups, peak bodies, or industry authorities. However, any individual providing professional advice to clients in relation to health and wellbeing will hold a duty of care, which can be defined as “the legal obligation of professionals to safeguard others from harm while they are in their care, using their services, or exposed to their activities.”(48) Under this concept, a nutritional advisor who has provided incorrect nutritional advice, supplied or recommended products that have a negative impact on a client’s health, or indirectly contributed to a client’s injury or illness through incorrect, outdated or inappropriate nutritional support services, may be in breach of their duty of care.

Nutritional Advisors are reminded to refer back to their Scope of Practice (SoP) (Nutrition Council Australia, 2018) for important information and requirements regarding duty of care.

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CONTINUOUS PROFESSIONAL DEVELOPMENT Continuing professional education refers to maintaining and improving skills, knowledge, and experience to develop professional practice through formal education, self-directed learning, professional activities, and work-based learning.

The Scope of Practice policy document, developed by Nutrition Council Australia (NCA), states that nutritional advisors should take responsibility for their professional development, so they can perform their duties within the boundaries prescribed by national, professional, legal and local codes of conduct and practice.

INFORMED CLIENT CONSENT Under common law, there is a legal obligation to obtain client consent - that is, that the client agrees to services that are intended for them. Clients have the right to decide on what care is appropriate for them if they have the capacity to make that decision. A client without capacity should be supported to be involved as much as is possible in decisions about their care.

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UNDERSTANDING A CLIENT’S RIGHTS AND RESPONSIBILITIES Clients have certain rights and responsibilities, which a nutritional advisor should ensure are always enforced to produce a positive working relationship. If the individual’s rights are not respected, they will not get the outcome or service they wanted, while if they do not meet their responsibilities, it will be more challenging to work with them.

The client is entitled to:

respectfully by nutritional advisors and all other employees.

• BeHaveaddressed their human respected.

• Be included in anyrights decision-making processes about them.

• Have any relevant information provided in a format they can understand (e.g., read aloud, in Braille, broken into • small chunks). their concerns listened to.

• Have any risks to their health and safety reduced as far as reasonably possible.

• Have Have their recorded information remain private and confidential without good reason for breaking confidentiality.

•

The client is responsible for:

respectful towards the nutritional advisor and other employees.

• Being Becoming involved in the process (e.g., making decisions, providing information, reading relevant materials, • raising concerns and needs).

• Taking sensible measures to reduce the risk to their health and safety.

IMPORTANT NOTE As many clients may suffer from mental illnesses, nutritional advisor may have to make reasonable exceptions to some responsibilities.

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UNDERSTANDING THE REFERRAL PROCESS AS A NUTRITIONAL ADVISOR SCOPE OF PRACTICE It is important to remember that not all people who make a booking are within a nutritional advisor’s scope of practice.

It is of paramount importance that nutritional advisors can identify individuals outside their scope of practice and refer on to an appropriate health professional. Practices outside a nutritional advisor’s scope of practice can breach ethics and legalities and be unsafe for the client too.

Nutritional Advisors are reminded to refer back to their scope of practice (SoP) (Nutrition Council Australia, 2018) for important information and requirements regarding duty of care.

In terms of nutritional counselling, nutritional advisors are certified upon completion of the Certificate IV in Nutrition to work with adults aged 16 years and above. Nutritional advisors are therefore unable to work with clients under this age (0-15 years of age). Nutrition advisors are not counsellors or psychologists and can only work with clients within the context of nutrition counselling.

NUTRITIONAL ADVISORS CAN WORK WITH ‘HEALTHY CLIENTS’ IDENTIFIED USING THE INDUSTRY ENDORSED RISK STRATIFICATION SCREENING TOOL AND CAN WORK WITH THE FOLLOWING ADULTS:

• • • • • • • •

Healthy clients with no mental health conditions Clients requiring nutritional counselling for weight loss Clients with low self-confidence and low self-esteem Clients using negative self-talk Clients with a lack of energy Clients who have withdrawn from social settings Clients with a loss of motivation to exercise Clients with mild broken/disrupted sleep patterns.

NUTRITIONAL ADVISORS CANNOT WORK WITH ADULTS WITH THE FOLLOWING MENTAL HEALTH CONDITIONS OR PROBLEMS: with mental health conditions for which •theyIndividuals are required to take medication; (anxiety, depression, bipolar, schizophrenia, borderline personality disorder, autism, ADHD) unless a GP gives medical clearance Individuals with eating disorders Individuals with suicidal thoughts Individuals who are over-exercising or thought to have an exercise addiction Individuals who self-harm Individuals with insomnia Individuals with substance abuse issues.

• • • • • •

Furthermore, nutritional advisors are required to regularly review their client’s changing circumstances and refer on to the appropriate medical professional should a client move from being an appropriate client (falling within the ‘healthy adult’ definition) to inappropriate (where they possess any of the above-mentioned mental conditions or problems).

IMPORTANT NOTE Please refer to the sections on ‘Duty of Care’ and ‘Understanding when to refer’ to ensure that the nutritional advisor understands their responsibilities toward their client’s care.

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UNDERSTANDING WHEN TO REFER TO AN APPROPRIATE HEALTH PROFESSIONAL It is a nutritional advisor’s role to identify when a client would best be referred to a more suitable health professional. It is important to understand the scope of practice within which a Nutritional advisor can practise and when to refer on.

Nutritional advisors are reminded to always refer to their scope of practice (SoP) for important information and requirements when it comes to referring clients.

As a nutritional advisor is trained to see individuals who are considered healthy and without acute or chronic diseases, it is important to be able to identify if an individual is suffering some form of disease or condition and therefore requires a referral. If an individual is referred on, once they have consulted and received medical clearance from their doctor, physician or whomever they are required to see, the client is welcome to continue consulting with the nutritional advisor.

Some individuals are not aware of their current health status and may not be aware that they are at an increased risk of various diseases. It is the responsibility of the nutritional advisor to identify any concerning states and refer on as required.

If a client presents with mild signs or symptoms, a nutritional advisor can continue to support the client; however, if moderate or severe signs and symptoms are indicated, it is important that a nutritional advisor gains the outside support from a GP for medical clearance before continuing care. If indicated, a referral may be required to another health professional, such as a psychologist.

The table below identifies mild, moderate, and severe signs and symptoms for various mental health conditions.

MILD CONDITIONS

MODERATE CONDITIONS

SEVERE CONDITIONS

A nutritional advisor can support their client and work through ways to combat these mild signs and symptoms.

A nutritional advisor should refer clients to a GP if they show any signs of the following symptoms. If medical clearance is gained and the client is cleared by a GP, the nutritional advisor can continue to support the nutritional needs of the client.

If a client persists with any of the following signs/symptoms, a nutritional advisor will need to refer their client to an appropriate health care professional (i.e., GP, APD or psychologist). A nutritional advisor cannot continue to support the following conditions.

Low self-confidence

Anxiety.

Severe depression

Negative self-talk

Withdrawal from food.

Severe mental health disorders (bipolar, borderline personality disorder, schizophrenia)

Withdrawal from social settings

Severe fatigue.

Ongoing withdrawal from food and eating

Lack of energy

Ongoing broken/disrupted sleeping patterns

Self-harm

Loss of motivation to exercise

Severe Insomnia

Broken/disrupted sleeping patterns (mild)

Severe exercise addiction Severe health conditions (autism, ADHD)

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IDENTIFYING NEGATIVE BEHAVIOURS AND THE NEED FOR REFERRAL

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Identifying negative behaviour can be challenging. It is important to have a solid knowledge about specific behaviours of concern. Not all negative behaviour changes are a reason for concern; however, some could ultimately damage an individual’s reputation, family, and credibility and possibly lead to irreversible damage to either themselves, others, or objects.

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Below is a table outlining a number of behaviours which can be of concern, especially if not identified, monitored, and intervened with as required.(49)

BEHAVIOURS

EXAMPLES

SELF-HARM

A person may hit, scratch, or cause self-harm in a number of ways. It may not be overly noticeable as the individual may try to hide this behaviour and keep the harmed parts of their body covered.

HARMING OTHERS

A person may cause harm to others in a number of ways such as physical abuse (e.g., hitting, scratching, biting, punching), sexual abuse or verbal abuse (e.g., yelling, belittling, bullying).

BREAKING THINGS

An individual may experience a rage of anger or frustration, and as a result, cause damage to items such as throwing, breaking, and smashing items on purpose.

REFUSING TO DO THINGS

A person may start to refuse to do an activity that they once enjoyed doing, such as refusing to eat certain foods, take their medications or socialise.

DOING THINGS THAT OTHERS DO NOT APPROVE OF OR LIKE

A person may do things which can make others around them uncomfortable, such as screaming, yelling offensive language, or running around without appropriate clothing, all with very little concern for their surroundings.

HIDING THEMSELVES AWAY

A person may become socially isolated, refusing to be social or cancelling meetings or catch-ups with friends/family. This is a different behaviour to someone wanting privacy or time alone with their family or friend. This is repeated behaviour without reluctance.

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If any of the above behaviours are recognised in a client, it is essential that this information is discussed with the client and a referral is made to an appropriate health professional such as a psychologist, counsellor, general practitioner (GP) or other professional as deemed most appropriate by the nutritional advisor. It is important to remember that if a client is harming, or has the intent to harm themselves or others, their confidentiality can be breached as an appropriate referral is made with haste.

A nutritional advisor may like to discuss the matter with the client and ask for permission from the client to write/provide a referral; however, in some instances, the client may refuse, in which case the nutritional advisor is still obligated, for the safety of the client and/or others, to make a referral. Therefore, it can sometimes be easier to simply let the client know that a referral is being made in the best interest of themselves and others.

Upon conversation with the client, it may be found that they are currently not 100% invested in making positive changes, and may, therefore, benefit from a small break while they take the time to take care of other areas in their life.

In this situation, a nutritional advisor should remind the client of all the progress they have made, how they are moving towards their goals and look forward to working with them again in the future. Genuinely wish them all the best and consider following them up with an email a month or two down the line to check their progress and to remind them that their nutritional advisor is still there to help them reach their goals.

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IDENTIFYING APPROPRIATE HEALTH PROFESSIONALS FOR REFERRALS It is essential that a nutritional advisor practices within their scope of practice and refers to an appropriate health professional as required. A nutritional advisor can identify when an individual needs an ongoing referral based on information provided in their Risk Stratification Screening Tool.

If nothing is flagged in this screening tool, a nutritional advisor may continue the care of the client; However, if something is flagged, it is vital that a referral is made to an appropriate health professional such as: An Accredited Practicing Dietitian A general practitioner (GP) A psychologist.

• • •

It is also important to remember that over the course of supporting a client, their situation and mental health can change due to several factors. Nutritional advisors should be sensitive to their client’s changing needs and always consider a referral if changes occur that would change their initial Risk Stratification score.

WHEN TO REFER TO AN ACCREDITED PRACTISING DIETITIAN An Accredited Practising Dietitian (APD) has undertaken a course of study that included substantial theory and supervised and assessed professional practice in clinical nutrition, medical nutrition therapy and food service management.(50) A nutritional advisor would refer the client on to an (APD) when the client is outside their scope of practice, and their issues are diet related.

Some common examples of health conditions that require referral to an APD for nutritional support include: disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) • Eating mellitus (pre-diabetes, type 1, type 2 and gestational diabetes) • Diabetes Coeliac disease • Cancer (current diagnosis and/or receiving treatment for cancer) • Renal disease • Bariatric surgery (including gastric sleeve, gastric bypass, lap band) • Chronic gastrointestinal tract issues such as diverticulitis, bowel obstructions, bowel resections, irritable bowel • syndrome (IBS), inflammatory bowel disease (IBD) including ulcerative colitis and Crohn’s disease disease (hypothyroidism or hyperthyroidism) • Thyroid Prescribed for blood pressure, cardiovascular disease, and high cholesterol, such as ACE inhibitors, • beta blockers,medications warfarin, or statins.

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WHEN TO REFER TO A DOCTOR (GP) A general practitioner (GP) is a doctor who is also qualified in general medical practice. GP’s are often the first point of contact for someone, of any age, who feels sick or has a health concern. They treat a wide range of medical conditions and health issues.(51) A nutritional advisor would refer the client on to their local GP when the client is outside their scope of practice, and their issues are related to medical health.

Common examples of when a nutritional advisor would refer to a GP include:

clearance required for nutritional advisor • Medical • Hypertension • Hypercholesterolemia • Dyslipidaemia blood glucose levels • Uncontrolled mellitus • Diabetes Medication changes • Food intolerance/allergy referrals (e.g., coeliac testing, lactose intolerance testing).

•

WHEN TO REFER TO A PSYCHOLOGIST The role of a clinical psychologist is to assess, diagnose, and treat the psychological problems and the behavioural dysfunctions resulting from, or related to physical and mental health. In addition, they play a significant role in the promotion of healthy behaviour, preventing diseases and improving patients’ quality of life. A nutritional advisor would refer the client on to a psychologist when the client is outside their scope of practice for applying principles of psychology, and their issues are related to mental health.(5)

Common examples of when a nutritional advisor would refer to a clinical psychologist include:

• Depression • Anxiety disorders • Eating An indication of self-harm • Insomnia or severe • Bipolar disorder fatigue • Alcohol/substance abuse or addictions • Indications of verbal, physical or sexual abuse • Post-traumatic stress disorder • Strained relationships.

•

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RECOGNISING TRAITS OF MAJOR MENTAL HEALTH DISORDERS AND THE NEED TO REFER TO A MEDICAL PROFESSIONAL As a nutritional advisor, while not in the direct area of expertise, it is still important to be aware of the various mental health conditions, their signs, symptoms, and treatments, and have the ability to make justified reasoning for referring on when required.

Mental health conditions that a nutritional advisor will need to have awareness of, and refer on to an appropriate health professional for psychological intervention are: and its various types • Depression Bipolar Disorder • Schizophrenia • Autism Spectrum Disorder • Obsessive Compulsive Disorder • Attention Deficit Hyperactivity Disorder (ADHD) • Eating Disorders.

•

It is important to remember that the mental health of clients is not the responsibility of a nutritional advisor; however, it is essential for the nutritional advisor to remain compassionate and helpful to ensure the best care is provided to the client. In due course, it may be helpful to build a rapport with various psychologists and counsellors around the local area, so that referrals can be made comfortably, to assist with a client’s mental state.

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UNDERSTANDING DEPRESSION Depression, while not always visible to an outsider, can be crippling for an individual who suffers with it. Many Australians live with depression and/or anxiety, which affects their overall wellbeing, personal relationships, careers, and productivity.(52)

There are various types of depression with symptoms ranging from mild to significantly debilitating. Some of these depressive conditions include: Depression • MajorMelancholia • Psychotic depression • and postnatal depression • Antenatal • Seasonal affective disorder (SAD).

MAJOR DEPRESSION Major depression is sometimes called major depressive disorder (MDD), clinical depression, unipolar depression, severe depression or simply depression. It involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms. Symptoms of depression can be experienced on any given day and can generally linger for extended periods of time. Symptoms of depression can also interfere and cause havoc with all areas of an individual’s life, including work, personal achievements, and relationships (social and intimate).(52) Depression can be further described as mild, moderate, or severe; melancholic or psychotic.(52)

MELANCHOLIA Melancholia is a term used to define a severe form of depression, in which many of the symptoms of depression are also presented physically. One of the major noticeable changes is that the individual starts to move more slowly. Individuals are also more likely to develop a depressed mood or state of mind that is generally classed by a complete loss of pleasure in every situation (or almost every situation).(52)

PSYCHOTIC DEPRESSION Sometimes, individuals who suffer from a depressive disorder can lose touch with ‘real life’ and quite often, experience forms of psychosis. This can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others), such as believing they are bad or evil, or that they are being watched or followed.(52) The individual can also become paranoid, where they feel as though everyone around them is against them or that they are the root cause of illness or bad events occurring around them.

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ANTENATAL AND POSTNATAL DEPRESSION Women are at an increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period).(52) The causes of depression at this time can be complex and are often the result of a combination of factors. In the days immediately following birth, many females experience the ‘baby blues’ which is a common condition related to hormonal changes and affects up to 80% of women. The ‘baby blues’, or general stress adjusting to pregnancy or a new baby, are common experiences, but are different from depression.

Depression is longer lasting and can affect not only the mother but her relationship with her baby, the child’s development, the mother’s relationship with her partner and with other members of the family.

Almost 10% of women will experience depression during pregnancy. This increases to 16% in the first three months after having a baby. Up to 25% of new fathers suffer from paternal postpartum depression.(53)

The table below outlines some common myths and facts associated with depression: (54)

DEPRESSION MYTHS Depression is not a real illness

FACTS While some people believe that depression is nothing more than sadness, it is a complex mental health disorder which can be caused by a range of factors.

Treating depression may involve a range of intervention strategies such as exercise prescription, nutritional changes, counselling, and medications.

Depression is cured with antidepressants

For example, exercise prescription will assist in the natural release of ‘happy’ hormones; antidepressant medications may alter brain chemistry and control symptoms; nutritional intervention may assist with better cognitive function and reducing hormonal imbalances, and psychological treatments, such as counselling, can assist with developing coping strategies. Quite often, a combination of treatments is used.

People with depression should just ‘snap out of it’

Depression is not a choice. Depression is a medical condition which affects the chemistry, structure, and function of the brain, and often requires professional treatment.

Depression is caused by something sad happening

Events that cause sadness or grief may increase the risk of depression, but depression is not necessarily caused by negative incidents. Depression can involve unexplained low moods or feelings of hopelessness, which may last for extended periods of time and occur even when things are seemingly going well.

People with depression will be on medication for the rest of their lives

For some, management of depression may involve long term use of antidepressants. However, the use of other psychological, nutritional, and physical treatments may enable some to reduce reliance on medications.

Depression only affects women

Women may be more likely to express their feelings and seek help; however, depression can affect men as well. Compared to women, men with depression are more likely to commit suicide.(54)

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UNDERSTANDING BIPOLAR DISORDER Bipolar disorder is a mental health condition where individuals experience significant changes in mood and energy.

Individuals suffering from bipolar disorder can fluctuate between depressive episodes (e.g., feeling of hopelessness, low mood, extreme sadness) to manic episodes (e.g., rapid speech, racing thoughts, agitation, little need for sleep). These changes in mood can last for a week or more and can have significant impacts on the way the individual interacts and forms connections and relationships with others.(55)

Below is a table which outlines some common myths and facts about bipolar disorder.(55)

BIPOLAR MYTHS

FACTS

Bipolar disorder is just mania

Individuals suffering from bipolar disorder experience depression and hypomania as well as mania.

There is only one type of bipolar disorder

There are a number of different types of bipolar disorders, each characterised by different experiences, levels of mood disturbance and duration, including: Bipolar I: Manic and depressive episodes, Bipolar II: Major depressive episodes, and hypomanic episodes which are less extreme than bipolar I. Cyclothymic Disorder: Hypomanic and depressive symptoms are experienced for two or more years, which are less severe than bipolar I/II, and Other specified bipolar disorders: Bipolar-like mood disturbances which may be less severe or of shorter duration, and do not fit in other categories.

• •

Bipolar disorder is uncommon

People who have bipolar disorder are just moody

• •

Approximately, one in fifty, or 1.8% of Australians will experience bipolar disorder each year.

The mood disturbances experienced by people with bipolar disorder are different from everyday mood swings. The highs and lows are extreme and can last for significant lengths of time.

These disturbances may require medical intervention and can be very debilitating for the person affected.

People with bipolar disorder are manic all the time

Depressive episodes are more common than manic episodes for most people with bipolar. This can sometimes lead to bipolar being misdiagnosed as depression.

Mania (or manic syndrome) is enjoyable, productive, or fun

During episodes of mania, people may feel very energetic and able to go without sleep for extended periods of time. Individuals may do things out of the ordinary such as making big decisions about their career, relationships, or assets, given how they are feeling at that current time, which can be damaging long term. Mania can result in feelings of irritability, restlessness, lack of control, fear, and distress too.

Medication is the only treatment for bipolar disorder

Many people diagnosed with bipolar disorder is treated with medication. However, psychological therapies can also be beneficial.

These include: Cognitive behavioural therapy (CBT), Family-focused therapy Interpersonal and social rhythm therapy.

•• •

Other strategies such as meditation and reflection, sleep management and education can also assist with self-management.

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UNDERSTANDING SCHIZOPHRENIA Schizophrenia is another mental health disorder which affects the functioning of the human mind. Individuals suffering from schizophrenia may experience symptoms such as delusions and hallucinations and may also suffer from longer periods of reduced expression, motivation, and functioning. It is suggested that genetics, the environment in which an individual was brought up, substance abuse and trauma can all increase the likelihood of developing schizophrenia. It is estimated that approximately one in 100 individuals will experience schizophrenia.(56)

The table below outlines some common myths and facts about schizophrenia.(56)

SCHIZOPHRENIA MYTHS

FACTS

Schizophrenia is a split personality

Schizophrenia results in separation from reality but is not related to having multiple personalities.

Schizophrenia is contagious

Schizophrenia cannot be contracted by contact with someone who has it.

People with schizophrenia are violent

A small number of people with schizophrenia may become violent when experiencing hallucinations or delusions; however, this is comparatively rare.

People with schizophrenia can just wish it away

Schizophrenia is a mental health disorder that requires professional intervention, generally including both physical and psychological treatments.

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UNDERSTANDING AUTISM SPECTRUM DISORDER Autism spectrum disorder is a developmental condition which affects the way individuals relate to their environment and interact with other people.(57) Individuals may experience challenges with social communication and interaction, and repetitive behaviours. They may also have unusual sensory interests and sensitivities, including limited varieties of food.

Often children with autism have a very bland palate, showing preference to white coloured foods such as potatoes, bananas, porridge, yoghurt, and chips. They tend to struggle with a variety of textures and strong flavours, and as a result, can suffer from nutritional deficiencies and failure to thrive (FTT). It is within the scope of a nutritional advisor to consult with adults on the spectrum, provided they are not taking prescribed medication for this condition and/or do not have major food aversions or difficulties. Those taking prescribed medication must obtain a medical clearance from their GP, prior to working with a nutritional advisor. For those with strict food aversions and difficulties, referral to an appropriate APD and psychologist for ongoing support is needed.

An estimated one in 100 people have autism, with almost four times as many boys than girls being affected.(57)

The table below provides insight into common myths relating to Autism:

AUTISM MYTHS

FACTS

People with autism do not want friends

People with autism can struggle with social skills, which may cause them to appear shy, unfriendly, or disinterested. This can make it difficult to interact with others and build friendships.

People with autism cannot feel or express emotion

Autism can affect the way people communicate and express emotions, but this does not mean they do not feel or experience them.

People with autism cannot understand the emotions of others

Autism can affect a person’s ability to perceive and interpret communicated messages, so they may not detect emotion expressed only through nonverbal channels. However, this does not mean they are incapable of showing compassion and empathy for others.

People with autism are intellectually disabled

People with autism often have unique strengths and differences, with many possessing exceptional skills in specific fields such as maths or music.

People who display qualities typical of autism are just odd and will grow out of it

Autism is a condition that affects brain development, and for many people with autism, the condition will be lifelong.

People with autism will have autism forever

While autism is generally a lifelong condition, various interventions can assist in reducing symptoms and improving skills. Recent research shows that intensive intervention in the early stages can enable children to make enough improvement to ‘test out’ of the autism diagnosis.

Autism is just a brain disorder

Autism can also result in other issues such as allergies, food sensitivities and gastrointestinal disorders.

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UNDERSTANDING OBSESSIVE COMPULSIVE DISORDER Obsessive compulsive disorder (OCD) is an anxiety disorder that affects around 2% of the adult population in Australia.(58) People with OCD experience recurring, uncontrollable thoughts and behaviours, known as obsessions and compulsions.(59) Obsessions can include exaggerated worries or concerns, such as fear of harm or contamination, preoccupations with symmetry or order, distress over leaving electrical items on, or other intrusive thoughts and images.

Compulsions can be thoughts or behaviours that are repeated, often according to specific patterns or rules. Compulsive actions are usually taken to combat the fear or anxiety that results from obsessions. However, these compulsions only provide temporary relief and obsessions soon continue, which creates a cycle of obsessive-compulsive behaviour.(56) For example, an individual may be fearful of leaving the oven on (obsession), and will therefore, check the oven to alleviate the stress (compulsion). With OCD, individuals may need to repetitively check to ensure the oven is off (compulsion), which can begin to affect their daily routine.

Both obsessions and compulsions can become incredibly time-consuming and significantly disrupt daily life for a person with OCD. It is important for a nutritional advisor to refer clients with OCD for appropriate care.

The table below outlines common myths and facts around OCD. (59)

OCD MYTHS

FACTS

People with OCD are just ‘neat freaks’ or ‘germaphobes’

Obsessions and compulsions about orderliness and cleanliness are common; however, there are many other ways people can experience OCD. The reasons for these behaviours are more serious than a simple desire to keep things neat and tidy and are often rather compelled by irrational fears of what may happen if things are not done.

People with OCD do not realise they are acting irrationally

Generally, most people with OCD know that what they are thinking and doing is irrational; however, they do these compulsions to prevent associated consequences.

People with OCD are often humorously portrayed in the popular media; however, for those with the condition, it is no joke. OCD can be extremely disruptive and significantly impact a person’s everyday life and activities.

OCD is ‘funny’ In addition, around 40% of people with OCD also experience depression at some point, and more than 60% have suicidal thoughts, with almost 25% reporting having attempted suicide.

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UNDERSTANDING ATTENTION DEFICIT HYPERACTIVITY DISORDER The term attention deficit hyperactivity disorder (ADHD) describes a neurodevelopmental disorder which is evidenced by a recognised and persistent pattern of behaviour. ADHD begins at birth and can affect both sexes, and all age groups.

Most people consider ADHD to be only hyperactivity; however, this is only one element of the condition which may not be relevant to everyone, and which can often subside in adulthood.

People with ADHD can experience challenges with maintaining attention and focus, managing emotions, losing or misplacing things, impulsive actions, and outbursts of intense emotion or frustration.(60) There are a lot of misconceptions about attention deficit hyperactivity disorder (ADHD). This can make it difficult to know what is true and how best to support the individual; therefore, it is important to ensure that clients with ADHD are referred to their GP for appropriate care.

The table below outlines the common myths and facts associated with ADHD.(61)

ADHD MYTHS

FACTS

ADHD is not a real medical condition

The National Institutes of Health, the Centres for Disease Control and Prevention and the American Psychiatric Association all recognise ADHD as a medical condition. Research shows that it runs in families, meaning it might also be genetic.

ADHD is the result of bad parenting

ADHD is a medically recognised condition whereby the brain is affected in an individual, thus making them more prone to restlessness, hyperactivity, and other behaviours.

Only boys have ADHD

While boys are more than twice as likely to develop ADHD, girls still get ADHD. The ways boys and girls present with symptoms can be quite different, where boys may appear more hyperactive and girls more ‘daydreamy.’

Kids with ADHD will outgrow it

ADHD is recognised to be a lifelong condition; however, as individuals age, they may learn to better manage their symptoms.

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UNDERSTANDING EATING DISORDERS Eating disorders are serious mental illnesses which involve unhealthy preoccupation with eating, exercise, body weight and body shape. Three of the most prevalent eating disorders in Australia are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED).(62) Each one is discussed in more detail below. It is essential that nutritional advisors refer clients they suspect to have an eating disorder to their GP or a suitable health professional for diagnosis and treatment.

ANOREXIA NERVOSA (AN) Anorexia nervosa is a mental health condition that can have a significant impact on physical and mental health. This eating disorder is characterised by low body weight, distorted perception of body weight and shape, and excessive fear of gaining weight.

There are two subtypes of AN:

which involves severe restrictions on food intake • Restricting, Binging/Purging, also involves food intake restrictions, but with the addition of binge eating episodes, • followed by purgingwhich to compensate for food consumption.

(63)

Common warning signs of AN are:

weight loss • Rapid self-esteem • Low Preoccupation food or related activities • Obsessive caloriewithcounting • Changes in food preferences or rules for consumption • Avoiding food or mealtimes • Extreme fear of weight gain • Sensitivity to comments about weight or body shape, eating or exercise • Excessive exercise activity • Anxiety, depression, and mood swings • Unnecessary use of laxatives, diuretics, or appetite suppressants.

•

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BULIMIA NERVOSA Bulimia nervosa (BN) is a mental health condition characterised by repeated binge-eating episodes followed by compensatory behaviours, such as purging. Binge eating involves consuming a large amount of food in a short space of time. During these episodes, the person may feel a sense of loss of control and experience feelings of guilt and shame.

This leads to compensatory purging behaviours such as inducing vomiting, fasting, or over-exercising. They may also misuse laxatives, enemas, or diuretics.

BN can often start with dieting for weight loss. Restrictions and deprivation of food intake, along with insufficient nutrition, can lead to a starvation reaction, prompting overwhelming and uncontrollable urges to eat. The cycle of binging and compensation can become more intense over time.

While it is common for anorexia nervosa to be recognised by extreme weight loss, people with bulimia nervosa usually maintain an average weight, which means it is not always easily detected. (64)

Common warning signs of BN are:

irritability, or depression • Anxiety, food and mealtimes • Avoiding Changes weight • Frequentlyinvisiting the bathroom after mealtimes • Unexplained disappearance • Excessive expenditure on foodof food • Obsessive dieting behaviour • Over-exercising.

•

BINGE EATING DISORDER Binge eating refers to an ‘unrestrained and often excessive indulgence in food’. For some people, this food indulgence is an occasional indiscretion that has no impact on daily life. For others, it is an actual problem and has a major impact on physical and mental wellbeing. So, it is important to note that not everyone who experiences binge eating episodes has a mental health condition known as binge eating disorder (BED).(65) The two key features of binge eating disorder are eating in a short time period, an amount of food that is larger than most people would eat in similar circumstances. And, whilst eating, there is a feeling of losing control (feeling like you cannot stop eating). The difference to bulimia nervosa is that for BED there is no compensatory purging behaviour.

In 2013 the American Psychiatric Association released a specific eating disorder diagnosis for binge eating disorder in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5).(66)

The main diagnostic criteria in the DSM-5 for binge eating disorder are:(66) 1. Recurrent and persistent episodes of binge eating 2. The binge eating episodes are associated with at least three of the following: Eating more rapidly than normal.

Eating until feeling uncomfortably full.

Eating large amounts of food when not feeling physically hungry.

Eating alone and feeling embarrassed by how much one is eating.

Feeling disgusted with oneself or guilty after eating.

3. Marked distress regarding binge eating 4. Absence of regular compensatory behaviours (e.g. purging)

• • • • •

Binge eating disorder is the most common eating disorder in Australia. Approximately one million Australians live with an eating disorder, and of these people, 47% have a binge eating disorder.(67) It is a serious mental health condition and affects people of all ages. If a nutritional advisor suspects someone may have a binge eating disorder, it is important to refer to a GP or an eating disorder psychologist for screening and diagnosis.

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The table below outlines some common myths and facts regarding eating disorders. (68)

EATING DISORDER MYTHS

FACTS

Eating disorders are a personal choice

Eating disorders are serious mental health illnesses with potentially life-threatening consequences. People with eating disorders experience distorted thoughts and emotions which trigger unhealthy behaviours around eating and exercise.

Eating disorders are a cry for attention

Rather than attempting to attract attention, people with eating disorders often go to great lengths to conceal their behaviour.

Families, in particular parents, are to blame for eating disorders

There is no single cause that has been identified, but rather there is a range of psychological, social, biological, and other external factors which can contribute to the development of an eating disorder.

Dieting is a normal part of life

While moderate changes to diet and exercise can be beneficial to physical health. Extreme or unhealthy dieting can significantly increase the risk of developing an eating disorder. Dieting is also associated with other mental health issues including depression and anxiety.

Eating disorders only affect women

Eating disorders can affect individuals of all ages, genders, and socioeconomic groups. Research has found that approximately 25% of people experiencing AN or BN are male. In adolescents, the lifetime prevalence of AN has been found to be the same between males and females.(68)

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