by Kylie Delfino, Registered Holistic Nutritionist, Ottawa Integrative Cancer Centre
Why is it some clients make dietary changes and stick to them while others struggle to comply? This perplexing question motivated an initiative to track 148 cancer nutrition clients over a two year period, through a series of interviews to monitor behaviour change. We gained this insight: Those who made empowered food choices and implemented new nutritional behaviours in stages that they were comfortable with, made measurable and lasting dietary shifts, which transitioned into ingrained lifestyle habits.
People want the freedom to choose change; they do not want to be forced into change.
What inspires an individual to make empowered food choices? Through our analysis, we learned that if the individual can identify a WHY that is compelling enough for them to change their diet and in doing so they experience a REWARD they can measure, their initial nutritional behavioral changes have a better chance of transitioning into lasting nutritional habits.
When faced with a cancer diagnosis, most people’s WHY becomes apparent, and their motivation to make nutritional change is heightened. Yet our relationship to food is not always clear-cut. Many people will do their best to remove inflammatory and processed foods and adhere to a very strict anti-cancer whole food diet protocol for a select period of time, yet long term only a small percentage of people are able to sustain this style of diet.
From a behavioral psychology standpoint a cancer diagnosis, or any illness diagnosis for that matter, can cause shock and initiate a state of deprivation. Post diagnosis, many of the participants we interviewed described feelings of shock, anger, being wronged, let down by their body, robbed of their health, self-blame or guilt, and questioned what did I do to cause this? All of these emotions seem to culminate in a sense of deprivation and lack of control. When an individual is already in this state, to place them in further deprivation by removing foods from the diet—in some cases the foundational foods of the only way of eating they have known for decades—proved to be unproductive and demotivating in making nutritional change.
We learned that empowering the individual to make the choice of what first steps they are willing to take towards a whole food diet allows them to adapt new nutritional habits that are manageable to implement. Then, by helping them to measure the difference to their physical health and emotional state, they can gauge a REWARD based on their new dietary habits. This approach allows people to progress to even more positive nutrition habits over a longer period of time resulting in ingrained lifestyle habits not just short term bouts of anti-cancer ‘dieting’.
Food is so much more than sustenance and fuel; we all have emotional and cultural connections to food. We can have a positive connection to certain foods because they represent tradition, comfort, nurturing, celebration, reward or indulgence or, we can be repelled by certain foods because of their taste, texture or smell, because it does not digest well, or because we simply do not like the taste. For whatever reason, foods can comfort us or repel us, and this needs to be taken into consideration when helping people to reshape their nutritional habits. The removal of comforting foods leads to feelings of deprivation. The introduction of repelling foods will only be met with resistance. Each individual needs to understand how the why and the reward of making nutritional change will impact them personally.
In our experience, addressing an individual’s willingness to change nutritional behavior before suggesting a suitable dietary protocol proves to engage and empower the individual. When participants in our program were posed the question, What is your willingness to change nutrition behaviors?, a portion of the group chose to make immediate and dramatic dietary changes and this group initially reported feeling empowered and in control by doing so. Their initial willingness was high. However, by implementing many changes at once, after one-year, compliance with their new dietary changes was less than 5%. Too much change at once proved to be overwhelming.
The larger portion of the group reported feeling overwhelmed by having to make large and immediate changes in their diet and therefore opted for nutrition education classes and longer-term implementation. Both groups were asked what their biggest compliancy hurdles were to implementing new nutritional habits, and the most consistent responses were:
I don’t want to give up the foods I love: People reported being overwhelmed by having to give up too many foods at once, and not wanting to force dietary change on the rest of their family.
I don’t know which product to buy: Consumer confusion regarding what specific products to purchase can be a big hurdle. Take flax for example. It can be purchased in whole seeds, ground, combined with chia, flavored, raw and sprouted. It’s easy to see how confusing it can be for people to purchase the right product that their health professional has recommended.
I have never cooked it before: Having an apprehension to cook a new food or not cooking it correctly and being disappointed with the outcome can make the food unappealing and warrant no motivation to keep it in the diet.
I am confused: People are exposed to conflicting information on what foods support an anti-cancer diet.
Structuring the nutrition consultation process by having the clients identify what they feel their biggest compliance hurdles are and their biggest fears are around changing their diet, nutritionists are able to address each issue and agree on a starting point. This process allows the client to identify the WHY for dietary change and the REWARD from doing so, allowing them to feel comfortable and empowered by making their own choices.
Here is an example:
- Identify Fear: I don’t want to give up red meat.
- Empower without deprivation: Introduce plant-based complete proteins meals before lowering weekly servings of red meat.
- Identify possible compliancy hurdles: I don’t think grains will provide enough protein. I have no idea what to cook. Will I be hungry?
- Empowerment over fear and compliancy hurdles: Teach the client how to create complete plant protein meals by proper food combining. Provide recipes that include protein values. Explain why excess meat can be damaging to the body and how plant proteins nourish the body. Through this process, we can help people to establish the why and the reward.
- Behavioural progression: When the client is comfortable with eating complete plant protein meals, only then suggest swapping out some servings of red meat. This can help ensure the client feels no sense of deprivation; in fact it empowers the client to introduce the change on their terms and therefore own the behaviour.
Remember: People want the freedom to choose change; they do not want to be pressured into change.
There will always be a WHY for any behaviour … it’s just a matter of finding the WHY that is the most compelling and what reward the individual is seeking. As nutritional and health professionals is it our obligation to help our clients find their compelling why and help them measure the rewards, as this is the foundation of assisting them in making nutritional behavioural change and inspiring dietary compliance.
Kylie Delfino, RHN is the Founder of The Nourished Self Nutrition Clinic, Ottawa, Canada. As the Clinical Nutritionist of The Ottawa Integrative Cancer Clinic and developer of the Ottawa Regional Cancer Foundation Moving Towards a Whole Food Anti-Cancer Education Program, much of her work is dedicated to researching the positive impact of anti-cancer whole foods and the development nourishing recipes, digestive restoration nutritional programs and lifestyle empowerment strategies. Her passion for pure and nourishing foods lead to the development of an organic retail food line, called The Nourished Self Whole Food Organic Soups.