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  • Assessing Readiness to Comply with Diet

    Hello BBM team!

    I hope you all are well.

    I was wondering if there are clients for whom you would change your initial management, particularly in terms of nutrition, based on your assessment of their readiness to comply to indicated interventions?

    For example, say a 30 y/o male with a BMI of 34, WC of 44", no history of food tracking, and limited history of exercise comes to you for coaching.

    Certainly, reducing fat mass and waist circumference are priorities for this individual, but if they don't have any experience in managing their training and nutrition, is there a period of time where you might first focus on building those habits?

    I'm imagining that for some people, learning to track their calories, prep their meals, exercise frequently, and sleep better all at once might be overwhelming (although individual variations in motivation to do any/all of these things certainly may vary).

    I hope my question makes sense, and I very much appreciate your time and all that you do.

  • #2
    Sooghs,

    Thanks for the post and interesting timing, as this is something Austin and I have been talking about a lot recently.

    It sounds like the question mainly revolves around making a single health/behavioral change (SHBC) or multiple health/behavioral changes (MHBC) and if we'd expect one strategy to do better than another compliance and outcome wise.

    We've been looking into the research on this and the field appears to be fairly new. After reading a number of studies (including 3 separate large meta analyses) on the topic, here is my current take on this:

    1) If we define outcomes solely by improvements in health status, MHBC seem to do a little better than SHBC, but more research is necessary.
    2) If we define outcomes solely by compliance to the intervention, SHBC and MHBC seem to do about the same without significant differences in compliance rates.
    3) If we look at other health promotion campaigns, e.g. smoking cessation, we routinely see MHBC as the standard of care with medium to large effect sizes in important outcomes like mortality.
    4) I don't think there's any data suggesting SHBC outperforms MHBC in any particular demographic, recommendation subset, or scenario- to the point where I think the claim, "Make small changes one at a time to improve compliance" is bro-science. This is not to say SHBC cannot work, as all things have the potential to work via complex mechanisms (see placebo effect, recall bias, etc.), but it IS suggesting that recommending SHBC in situations where multiple changes should be made is unethical (by withholding care).

    Just my 0.02.
    Barbell Medicine "With you from bench to bedside"
    ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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    • #3
      Fantastic response, thank you so much Jordan. This is exactly what I was looking for.

      Basically, I’m in a position where I’m responsible for onboarding clients who are completely new to establishing healthful habits.

      My employer is on a “SHBC kick” at the moment, and is excited about the idea of making the “smallest possible change” to improve health outcomes.

      However, in the example I provided above, I couldn’t imagine just not addressing that person’s indicated weight loss for the sake of appealing to simplicity (now why does that sound familiar?)

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      • #4
        Originally posted by sooghs View Post
        Fantastic response, thank you so much Jordan. This is exactly what I was looking for.

        Basically, I’m in a position where I’m responsible for onboarding clients who are completely new to establishing healthful habits.

        My employer is on a “SHBC kick” at the moment, and is excited about the idea of making the “smallest possible change” to improve health outcomes.

        However, in the example I provided above, I couldn’t imagine just not addressing that person’s indicated weight loss for the sake of appealing to simplicity (now why does that sound familiar?)
        Right. What are you gonna do, not counsel?
        Barbell Medicine "With you from bench to bedside"
        ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

        Comment

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