We all say we want to live a healthy life. So why is it so hard to do what we say? It's the central question that every wellness program tries to address.

The answer is that we don't really understand what it takes to change. Our culture makes us particularly vulnerable to believing that all it takes to adopt a healthy lifestyle is hard work, self-control and determination. It's the American way. Think again.

It's not that willpower has nothing to do with success in any endeavor - it just happens to be one of the least important ingredients required for success.

In fact, research suggests that willpower alone explains ultimate success in only 5% of cases. For 95% of people, to change a habit involves going through five stages of change, outlined by James Prochaska, et al. Here's a look at the five stages.


Stage 1: Deny

Most of us spend most of our lives, for most of the habits we want to change, in this stage. When we are in the denial stage we become very good at:

* Avoiding the discussion ("Stop nagging me.").

* Justifying our actions ("I have to [smoke/overeat/etc.] because ...").

* Agreeing to change, just not now ("I will, just leave me alone.").

* Comparing our habits to others who have poorer habits ("At least I don't ...").

* Blaming others or circumstances ("They make be because ...").

* Minimizing the impact of our habits ("But it's only ...").

* Telling ourselves that change is impossible and that trying again is fruitless.

* Casting doubt on the evidence of the positive effects of changing our habits.

When someone is in this stage, a call to action by his employer, spouse or even children is likely to fall on deaf ears because they are simply not ready to listen. Getting out of denial means letting the thought, "Perhaps I can change; I just don't know how" take root in our minds. It opens the door for us to think.


Stage 2: Think

In this stage, we actively consider whether or not we should change. We make no commitment, but open up to the possibility of change. We start to listen to and discuss ideas about change. We become interested in how other people have changed and think about the benefits of changing. We may also think about all the times we've tried to change in the past and failed. It's an important stage to go through because without first thinking about changing we certainly can't act on our intentions to change.


Stage 3: Prepare

Many people skip this stage and go from thinking about a change straight into taking action without preparing to be successful. Preparation includes getting an understanding of how we need to change our lives in order to be successful (such as a plan), and developing the skills (such as better time management) to ease the process of change.

For example, a person trying to quit smoking might need a plan to take a different route home from work, one that doesn't take her past the place she usually bought cigarettes. To lose weight, we need to change what is in our fridge and learn to make time for exercise.


Stage 4: Action

The action phase starts when we first start practicing a new health habit. For many of us, this is a short-lived phase. We commit to losing weight, but three days later we already have given up on our diet. We commit to exercising every day but after the second day, we give up on it and don't see the inside of a health club again for months. The action stage really just describes the first time we start practicing a new habit.


Stage 5: Win

The action stage is where all the benefits start to accrue, but the only stage that really counts, if we are interested in the benefits of good health, is the maintenance (or win) stage, where we keep up the good habits for weeks, months or the rest of our lives. Of course, we can always relapse from even the win stage - winning just means that we're not currently relapsing. Fortunately, the longer we stay in the win stage, the less likely we are to relapse and the easier it becomes to stay there.


Why does this matter?

Knowing which stage someone is in guides us to the types of things that will work best to get them to the next stage. What works for one stage is quite different from what works for other stages. Also, since most of us believe that success in changing habits depends on willpower, learning success is more about acquiring new skills is a welcome relief.

Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care and wellness. He can be reached at andrew@healthatwork.com. You can read more of his columns on EBN's website at ebn.benefitnews.com/ authors/316.html.

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