Can mobile apps help people lose 

weight...and keep it off?

Many of us may be well accustomed to using health and fitness mobile apps that have the sole purpose of counting calories and measuring activity levels, to help us lose weight. With the majority of people now using Androids and iPhones, downloading apps to our mobile phones is easy and hugely popular. As a result, tracking what we consume on a daily basis has never been so simple. 

However, how effective are these calorie counting apps? Can technology really aid us in reaching our ideal weight, or is it just a fad, a fashion accessory that will be forgotten with the next diet fix?  Furthermore, as with all successful weight loss, does it come down to our own behaviour and self motivation to bring about healthy changes to our life?

A recent study from the Northwestern University Feinberg School of Medicine, identified as the first of its kind, sought to examine the relationship between technology and the impact it had on weight. The study will be published in the Archives of Internal Medicine. 

The Study and Findings

The Northwestern technology research incorporated behaviour change techniques, including self monitoring, goal setting, feedback and social support.

The research examined a cohort of sixty nine overweight and obese men who were an average age of fifty eight. All participants were offered health education classes on nutrition, exercise and behaviour change; every two weeks during the first six months and once monthly for the remainder of the year. 

Each participant received personalised weekly calorie and activity goals to help them lose weight and all participants were encouraged to attend nutrition and health classes. The participants were divided into two groups. One half recorded their activity and diet on paper, whilst the other half used the Northwestern technology mobile device, to transmit their data to a behaviour coach, who monitored and provided feedback twice a month. 

From the evidence, it was found that those who used the mobile device and attended eighty percent of the nutrition classes lost fifteen pounds and maintained this for one year. The weight loss for those who used the mobile app but who did not attend any classes lost almost nine pounds. The group who attended classes but did not use the mobile app, did not loose any weight. 

The lead investigator of the study and Professor at the University, Bonnie Spring, found the results to be positive and argued that mobile devises could have a significant role to play in making people more health aware; "The app is important because it helps people regulate their behaviour, which is really hard to do....Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment." 

However, Spring also emphasised that weight loss only occurred when people attended health education classes and engaged in regular exercise. The app alone would not be effective.

"The 'widget' is critical but it is not magical by itself," Spring added. "People need all the tools at their disposal." 

Should we all be downloading apps?

Diets usually fail because we end up eliminating certain food groups – and in the long term this is not sustainable. The difference between “diet fads” and calorie counting mobile apps, is that the latter can help set achievable and realistic goals, whilst simultaneously tracking our calorie intake and activity levels. 

It is often the case that we do not realise how many calories certain foods contain, and so, we are ignorant to all the hidden fats/sugars.  Thus, these quick and easy food tracking devices empower us to make sensible and more informed decisions that govern our health and weight. 

A frequent user of a calorie counting mobile app, Koorosh Ashrafi, PhD Research Scientist at BTG International group company, says; “I’ve lost 10 kilos over the past 6 months, and you learn balance is the key.  I’ve lived quite a sedentary lifestyle because of the pressure of work and studying, and I was still consuming the same amount of calories as 10 years ago when I was training as a rugby player.  Although I am a firm believer of everything in moderation, having a device at the tip of your fingertips, really does educate you about food and its content”

Nelly Araujo, Development Administrator at RSPH, and previous user of the mobile app says; “The goal setting was a motivational tool for me, but I found doing the mobile exercise with my partner, is what also drove me to make healthy changes – because we could support and encourage each other”

Bringing about behaviour changes in our life is no easy task.  We have to want to do it and it helps if we have the right tools at our disposal along with a good support network.

Spring believes that one of the big challenges in treating obesity is the need to provide behavioural treatment in a healthcare system where professionals don’t often have the time and training to support people with unhealthy diets or mental problems.

The RSPH is a strong advocator of the benefits of making healthier behavioural changes, but acknowledges that for many this can be challenging. The RSPH Level 2 Awards in Understanding Behaviour Change, is a qualification aimed at helping learners, health trainers and anyone working within the community to engage with individuals to develop strategies to undergo behaviour change and to offer brief advice and interventions to support individuals in improving their health and wellbeing.  Please click here for further information on the qualification, or contact Gina Mohajer.   

Understanding Behaviour Change: 

Happening at all levels

On the 29^th November 2012, the Royal Society for Public Health (RSPH) held a seminar on behaviour change. Led by Graham Rushbrook Development Advisor for RSPH, there was a chance to learn about the RSPH’s new Understanding Behaviour Change qualification, as well as to hear Kent Community NHS Health Trust’s experience of using the qualification. Participants then engaged in discussion about their experiences of obstacles to behaviour change for their clients.

The RSPH Understanding Behaviour Change qualification focuses on how best to support individuals in adopting positive behaviour change. At the heart of effective behaviour change is effective communication and relationship building. Within a one-to-one setting, the needs of the client are at the centre of all interactions, and the focus is on the holistic support of clients – not limiting support to narrow health requirements. As Graham highlighted, behaviour change “is done with, not to people”.

If individuals are to choose to change their lifestyles, any fear or ambivalence first needs to be addressed. It is also essential that an individual’s right not to change their behaviour is respected, and that the context and circumstances that may affect development of a plan to change lifestyle or health behaviour information is understood. The qualification also covers the importance of presenting information appropriately and accurately based on the needs of the individual, and teaches how to develop an effective lifestyle or behaviour change implementation plan and how to evaluate the impact of advice given.

Anne Ford, Head of Self Management and Prevention at Kent Community NHS Health Trust, spoke about her experience of using the RSPH’s behaviour change qualification to enable Health Trainers to support people with chronic health conditions. She highlighted that the effectiveness of behaviour change techniques lies in their client-centred nature and underlined the potentially valuable role of Health Trainers in supporting individuals in self management. The assessment of the Kent Community NHS Health Trust self-management and prevention plan has shown that through behaviour change training, Health Trainers have offered a wide range of support to clients, including referrals, signposting, accessing services from Age UK, organising respite care and supporting improvements in eating habits.

The RSPH qualification is set at Level 2, involves 16 hours guided learning time and is assessed through a multiple choice exam. Graham Rushbrook then led participants through a workshop session, asking participants to assess how the organisations, systems, disciplines and professions that they represent make it harder for clients to change.

Participants suggested that if behaviour change interventions are to be successful and sustainable:

-      There needs to be a holistic focus on the client, enabling underlying issues as well as health behaviours to be addressed. The client needs to be at the centre of the decision making process and interventions must be tailored to their needs.

-         Frontline staff need to buy into behaviour change techniques and training needs to be provided to enable them to work effectively with clear and consistent models. Communication between frontline services is vital if clients are to be treated holistically and effectively.

-    Behaviour change interventions need to be better understood by funders and management. This will involve recognition of the timescales involved (behaviour change interventions are not quick-fix) and also that quantifying results may not be possible in traditional ways.

Participants then looked at how these difficulties could be turned into opportunities for improving health. The focus in behaviour change theory on joined up services and holistic interventions, as well as developing partnerships was deemed an opportunity. In addition, moving the focus from assessing interventions based on quantity to assessment based on quality was seen as a huge opportunity for health improvement. It was also noted that behaviour change training can be achieved with little funding where training is offered in-house and that by sharing best practice between organisations and services, there is a great opportunity to ensure that behaviour change interventions meet their potential.

Next Steps

RSPH Training Solutions, will be running training sessions throughout 2013 to build understanding about behaviour change and to also build capacity to deliver the Behaviour Change qualification and training.  Our first date for this will be on the 26th February followed by a Train the Trainer programme on the 5th March.  For further information on opportunities to share best practice and offer in house training please contact Gina Mohajer, 0207 265 7327 or visit Training Solutions homepage. 

We will also be hosting further seminars around behaviour change to facilitate an engaged discussion with funders and commissioners about the case for supporting this type of intervention.  The next one will be in March, to register your interest, please contact Gina. 

Combating the myth that creativity 

is linked with mental illness!

The belief that creative people are more likely to suffer from mental illness, is an ancient notion that has transcended through the years and has long been part of our popular culture. The tortured artist or the visionary genius who succumbs to his/her own personal demons, is an image that is perhaps a little too familiar.   However, how legitimate is this concept ? Are creative people really prone to increased mental health issues? Or is being “creative” actually the coping mechanism to improve mental health?

Reverse the stigma

Previous studies, namely recognised as being poor and often subject to bias, have shown a link between creativity and mental illness. This could be a result of artists and writers who kill themselves often becoming high profile news items, and hence distorting the truth.  Artists and writers who live contented and well-balanced lifestyles are likely to attract less attention.

The study

Researchers from Gothenburg University and Uppsaala University in Sweden, sought to distinguish the association between creativity and mental disorder and whether in fact a correlation existed. The study used Swedish health records to identify more than a million people diagnosed with various mental illnesses. They compared the incidence of creative occupations among people with mental illness  against a matched sample of “healthy” people.

The study identified that people in creative professions were significantly less likely than people in other professions, to be diagnosed with schizophrenia, schizoaffective disorder, depression, anxiety disorders, alcohol abuse, drug abuse, ADHD or to have committed suicide.  The only exception to this was writers.  It was found that people who wrote for a living were twice as likely to suffer from schizophrenia and bipolar disorder and more likely to experience depression and anxiety disorder.

The study was however unable to identify how or why, people with certain creative talents or dispositions would be more likely to experience mental health problems.  For example, does being a writer lead to psychiatric problems? Or, do mental health suffers turn to creative pursuits in order to express themselves?

Arts/Culture as a way to improve mental health

Over the past few decades, research has emerged around the positive impact that arts/culture can have on health, particularly mental health. One such cohort study by a Norwegian researcher, Koenraad Cuypers, performed statistical analysis on the health data of 50,797 Norwegians, as part of the Nord-Trodelag Health Study. The evidence derived from the study showed that participation in cultural/creative activities were significantly associated with good health, good satisfaction with life, low anxiety and depression.  Further information on arts and health studies can be found at The Arts Research Monitor by clicking here http://www.artsresearchmonitor.com/articles.php?catUID=6 

  

In the UK, health professionals and creative artists have worked together for over 25 years using the arts to support healthcare and health promotion. Thus, the importance of arts as a way of improving health must not be underestimated. Whether you are watching a concert, visiting an art gallery, painting, singing, dancing or reading – these creative activities have been recognised as effective ways to decrease stress, create community cohesion and improve social interaction as well as providing a sense of relief from everyday life.

Dr. James Aw, Medical Director of the Medcan Clinic Toronto stated that; “Hobbies and interests outside of work are important for health. New experiences and expanding social networks through art and culture is one piece of the armamentarium in achieving optimal health and living well.”

Early 2013 the RSPH will be holding a new programme, "New Horizons," to address an emerging and widening interest in how the arts can positively impact health and wellbeing.  For further information or to register your interest please contact Gina Mohajer.

To conclude

From the Swedish study, although cause and effect was not ascertained, it nevertheless, highlighted the importance of good mental health and ensuring that those who suffer from mental disorders have the appropriate support and information available to them.    

The RSPH has been involved in promoting the benefits of mental health and demonstrating how this can be achieved. Good mental health is integral for all parts of life, not only for the individual but also for the affects it has on family, relationships, work and society as a whole. Thus, it is imperative for mental health to remain at the top of National and Local Government agenda and policy.

To read RSPH full report on Mental Health please click here.

Are you looking for creative ways to engage people in taking care of their minds?

Mindapples founder Andy Gibson will be presenting a half-day seminar at RSPH in London on November 15th, sharing lessons learnt about engaging people in the positive side of mental health.

The session will cover:

Tips and techniques for talking about positive mental health with the general public

The science of resilience and what psychology can teach us about looking after our minds

A selection of interesting facts about the workings of the mind that will engage and benefit your communities

A chance to share tips between participants about the most effective ways of engaging people in taking a more active role in maintaining their mental health

This session will particularly benefit health trainers, community workers and other professionals seeking to promote mental wellbeing and build resilience in patient groups and communities.

The cost of the workshop is £50 per person, if you are interested in attending please contact Gina Mohajer 

Why we should take that extra little time and have a nutritious and whole grain breakfast

Are you one of those people who eats breakfast on the go? Not really thinking about what is going in your mouth so long as it does the job of filling you up?  Or worse yet, do you skip breakfast all together, simply because you do not have the time?

Research has shown that breakfast is the most important meal of the day; increases concentration, helps with weight loss and lowers cholesterol levels.  However, it is what we consume for breakfast that will make the fundamental difference to our health. 

Cardiovascular disease accounts for one-third of deaths worldwide, of which unhealthy diets is a major risk factor.  We are reminded time and time again of the many health benefits of consuming a diet that is rich in fibre, whole grain and cereal.

Numerous studies over the years have supported the argument that these types of foods can reduce the risk of developing certain diseases including, coronary heart disease, colon cancer, diabetes and other chronic conditions.

However, why do so many of us choose to ignore these dietary recommendations? Is it because we are lazy, stuck in rut and don’t know how to make changes? Or is it because we know certain foods are good/bad for us but don’t really understand why?

As John O’Mullane and Carol Muir author of the Fat Factor point out;

“When it comes to diet related problems...you need to be armed with the necessary background information that will allow you to make informed decisions”.

Why is whole grain food good for us and what can we do to make sure we have enough of it in our diet?

Grains consist of three parts, the Bran (the outer layer which contains the fibre, omega-3 fatty acids, vitamins and dietary minerals) the Endosperm (the main part which is mostly starch) and the Germ (the smallest part which contains vitamin E, phosphorus, magnesium, folate and thiamine).

When grains are refined, i.e the bran and germ is removed (to make white flour, white bread, pastries) it leaves behind the energy-dense but nutrient-poor endosperm portion of the grain.  This process strips away more than half of wheat's B vitamins, 90 percent of the vitamin E, and virtually all of the fibre. 

Refined grains and cereals often have a higher GI, which means that it causes a sharp rise in blood sugars and hence causes the pancreas to work even harder.

Phillip Mellen, M.D., lead author and an assistant professor of internal medicine said "Years ago, scientists hypothesized that the higher rates of chronic diseases we have in the West, including heart disease, are due, in part, to a diet full of processed foods.”

The benefits

Whole grains help protect against Heart Disease, Type 2 Diabetes, Cancer and Obesity

“A growing body of research shows that returning to whole grains and other less-processed sources of carbohydrates and cutting back on refined grains improves health in myriad ways” Harvard School of Public Health.  

Numerous studies over the years are pointing to the conclusion that whole grain and better health walk hand in hand.  A major research study from the Wake Forest University of Medicine, analysed seven studies involving 285,000 people between 1966 and 2006.  From the data they found consuming whole grains on a daily basis lowered the risk of cardiovascular disease considerably.

“Eating an average of 2.5 servings of whole grains each day is associated with a 21 percent lower risk of cardiovascular disease compared to consuming only 0.2 servings”, said Mellon.

The main reason for this reduction in heart disease is because whole grain, as opposed to refined foods, decreases blood pressure, lowers cholesterol in the blood stream and steadies insulin levels. 

Type 2 Diabetes

A large study of 160,000 women whose health and dietary habits were followed up over 18 years, found that those who consumed 2 -3 servings of whole grains a day were 30 percent less likely to have developed type 2 diabetes than those who rarely ate whole grains.  As such, researchers estimate that swapping white rice for whole grain could lower diabetes risk by 36 percent. 

Cancer

The data on cancer is a little more ambiguous, however, the properties contained within whole grain such as phytoestrogens (plant estrogens), the essential minerals such as, magnesium, selenium and manganese, are believed to protect against some cancers.  A Norwegian study found that people who ate the highest amount of whole grains reduced their risk of death from cancer by almost 25 percent.  A consistent protective effect has been observed when whole grains are eaten three to four times a week. 

Healthy Bowel Movement and Weight Control

The fibre in whole grains helps prevent constipation by increasing the movement of food through the digestive tract.  As a result, this decreases levels of destructive bacteria and the build up of carcinogenic compounds.  Wheat fibre can bind certain toxins and remove them from the large bowel.

Moreover, high fibre foods including wholegrain breads, cereals and oats, can be an effective way to help loose weight healthily.  Not only are whole grains naturally low in saturated fat they take longer to digest and create a feeling of fullness – discouraging overeating. 

What are whole grain foods and how much should we be eating? 

Examples of whole grain foods include rye bread, brown rice, oatmeal, barley, bulgur wheat, wheat berries and flours such as whole wheat.  Although there are no standard guidelines on how much whole grain we should eat, it is recommended that we consume at least three servings of whole grain a day.  Swapping white bread and white rice for brown, having more whole wheat and whole grain cereals are just some suggestions.  For information and useful tips on how to incorporate whole grain into your diet click here 

Altering our diet is not always easy, but making small changes can have far reaching and positive affects to our health and what better way to start than with breakfast! 

Read more on the benefits of whole grain by click here.  

Whole grains should be eaten as part of a balanced diet. 

Publication of the No Health Without Mental Health: Implementation Framework

The RSPH has supported and contributed to a new mental health implementation framework, which sets out what organisations can do to make the 6 high-level objectives of the Governments mental health strategy “No Health Without Mental Health” a reality.
The framework sets out :-

• What changes are needed to turn the strategy into a reality
• How progress in implementing the strategy will be measured and reported
• What local organisations can do to implement the strategy
• How local action will be aided by Government and other national organisations

The Royal Society for Public Health will develop a range of accessible, short training programmes and a linked accredited qualification to support the implementation of the framework. The programme will focus on increasing awareness about mental health and wellbeing within the many professions, practitioner groups and organisations in the voluntary, public and private sectors who work to improve population health and wellbeing. It will aim to strengthen capacity and capability to provide universal and targeted support at community and workplace level and be aligned with existing peer-to-peer approaches such as health champions and community connectors.

The RSPH Level 2 Award in Understanding Mental Health and Wellbeing will be available later this year. If you are interested in registering to find out more please email Richard Burton at rburton@rsph.org.uk

If you would like more details on the RSPH's training programmes please register your interest with Gina Mohajer at gmohajer@rsph.org.uk

The framework can be viewed here: http://www.dh.gov.uk/health/2012/07/mentalhealthframework/

Fish-tastic – benefits of oily fish

Nowadays with all the marketing and access to information, most people are aware that eating oily fish regularly has many health benefits, including preventing heart disease and lowering cholesterol.  However, a recent news article went a step further and reported that oily fish can significantly cut the risk of prostate cancer death.

In the UK around 11,000 men die from prostate cancer every year.  Therefore, will increasing ones intake of salmon and mackerels really reduce the risk of dying from prostate?

The report came from a study of 525 men with prostate cancer in Sweden.  The study assessed the men’s diets in the year before they were diagnosed with the disease, and they were then followed for 20 years to identify which of them died from the prostate cancer.  The study was published in the American Journal of Epidemiology and was carried out by researchers from the Harvard School of Public Health and other research centres in the US, Iceland and Sweden

The findings illustrated that those men who had a higher consumption of omega-3 fatty acids from fish, had a lower risk of having died from their prostate cancer.  Whereas men whose prostate cancer had not spread at the time of diagnosis and who had a higher rate of consumption of saturated fats (bad fats that raise cholesterol) were more likely to have died from their disease.

Although further research needs to be carried out before a firm conclusion between, oily fish and surviving prostate cancer, can be established, it is nonetheless true that foods high in omega-3 bring many health benefits.

Why is oily fish good for us?

Incorporating oily fish in our diet has been recognised as boosting our health. Not only is oily fish an excellent source of lean protein, it also contains good levels of important nutrients such as selenium, magnesium, vitamins B12, B6 and B3 and are rich in omega-3 fatty acids (EFA’s).  Therefore oily fish has been identified as playing a vital role in helping to reduce the pain of arthritis, lowering blood pressure and warding off cancer and heart disease.

Tracy Parker, heart health dietician at the British Heart Foundation said, “'The omega 3 in oily fish is good for overall heart health as well as improving survival levels after heart attack because of its anti-inflammatory properties, which help keep the heart blood vessels healthy”.

These fatty acids are also recognised as reducing depression, balancing hormones and are important for maintaining healthy skin.

What fish is oily and how much should we consume?

Fish such as anchovies, mackerel, salmon, sardines, trout, tuna and whitebait contain long-chain omega-3 fatty acids 

The Food Standard Agency (FSA) has recommendations for the amount of fish people should consume each week, and this varies for men and women.  The reason is that although oily fish is good for you, it also contains low levels of pollutants that can build up in the body. 

It is advised that men and boys consume up to four portions of oily fish a week, whereas women should have up to two portions.  Each portion is around 140g.

For further information on the benefits of oily fish, please visit the Food Standard Agency website here.  

RSPH In Conversation With… Professor Susan Michie

The Royal Society for Public Health (http://www.rsph.org.uk), with support from the Philipp Family Foundation, continues its series of podcasts, investigating key issues facing Public Health, with an international perspective.

In our interview with Professor Susan Michie, the topic is Behaviour Change, and how ”Western” lifestyles are storing up long term problems for the general population. With illustrations from the UK and around the world, Professor Michie discusses the huge economic cost of ill health, and the circumstances required to support people in making change to their lifestyles.

As the cost of health care continues to rise, and the UK Health Service is required to make substantial savings, this topic is of crucial importance. The majority of causes of ill-health are linked to people’s behaviour, whether through their lifestyle choices, their take up of vaccination and screening programmes or the way in which health care is delivered, so it is vital to learn lessons from other countries and from previous behaviour change campaigns.

You can listen to the interview with Professor Susan Michie, and previous podcasts with Professor Richard Parish and Professor Sir Michael Marmot now on the About Us page of the RSPH website or by clicking here. 

RSPH In Conversation With… Professor Sir Michael Marmot

The Royal Society for Public Health (http://www.rsph.org.uk), with support from the Philipp Family Foundation, has launched a series of podcasts, designed to tease out some of the key issues facing Public Health today, not just in the UK, but around the world.

In the first interview, RSPH is In Conversation With Professor Sir Michael Marmot, who discusses how a health-centred approach to policy-making results in a fairer society for all, illustrated with examples from across the world.

Sir Michael is Professor of Epidemiology and Public Health at University College London and is perhaps best known as author of the influential report on health inequalities, Fair Society, Healthy Lives. In this interview, he discusses his research into how social processes impact on the causes of illness, and illustrates how anyone who works with the public can have a positive effect on Public Health.

This series of interviews comes at a time of critical importance, with rates of obesity rising, more stress-related illness than ever before and severe pressure on budgets in all areas of healthcare. Professor Richard Parish, Chief Executive of RSPH, introduces the interviews, setting out the key themes and the interconnection between them. “We are delighted that so many eminent people have been prepared to share their views through these podcasts, and we all believe it is vitally important for the issues around Public Health to be discussed and understood by the widest possible audience. As Local Authorities take on responsibility for this area, there is an enormous opportunity to put health at the centre of policy making, and use scarce funds wisely to improve the health of every community.”

You can listen to the interviews with Professor Richard Parish and Professor Sir Michael Marmot now on the About Us page of the RSPH website. http://www.rsph.org.uk/en/about-us/podcasts.cfm. The next podcast, RSPH In Conversation With Professor Susan Michie, on the subject of Behaviour Change, will be released on July 3rd. 

Why making just two lifestyle changes can have positive and far reaching affects on health

A recent study, at the Northwestern University Feinberg School of Medicine, found that changing one bad habit can have a positive knock on effect on other behaviours.  A simple step such as watching less television, can simultaneously reduce the amount of time one spends snacking on unhealthy foods – as these two behaviours are closely related.   As such, the notion that you must radically transform your life in order to be healthier is not necessarily true and often hard to maintain.  Making just a couple of small changes, as the study demonstrates, can have a real and long lasting impact on people’s health.

The study was conducted by Bonnie Spring, professor of preventive medicine at Northwestern University Feinberg School of Medicine, in an attempt to find out the most effective way to spur people to change common bad health habits.  204 adult patients with unhealthy habits, were given the following treatments; an increase in vegetables/fruit and physical activity and decrease in fat and sedentary leisure.  Over the course of the three weeks, the patients had to record their daily data into a personal digital assistant in order to establish if they met their goals. 

After the three weeks, patients no longer had to maintain their “healthier” lifestyles, but were still required to send data three days a month for six months.

After the completion of the six months, the study found that the patients kept to their new healthier lifestyle changes rather than reverting back to their old habits.  Around 86% of the participants said that once they had made the initial change, they tried to maintain it.  By incorporating fruits and vegetables in their diet empowered them to believe that they were in fact capable of change. 

The results indicated that the most effective way to improve health required two key behaviour changes, namely cutting the amount of time spent watching TV or on the computer and eating more fruits and vegetables.  It is believed that these two simple changes could have long lasting results.   

Spring said, "Just making two lifestyle changes has a big overall effect and people don't get overwhelmed."

The majority of the population, where obesity is most prevalent, often lead unhealthy and sedentary lifestyles, putting them at high risk for heart disease, diabetes and cancer.  Spring argues that it is often hard for doctors to know where to initiate change in unhealthy habits, without discouraging or offending patients.   Thus this “two way” simple approach enables others to make realistic and manageable changes by giving them confidence to carry it out.

“With this simplified strategy, people are capable of making big lifestyle changes in a short period of time and maintaining them”  


Photo by Sina Bahrami http://5127.co.uk/