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5 Crucial Behavior Change Variables

These key elements of behavior change can determine how successful a client is.

Family using behavior change strategies in the kitchen

Behavior change theories are used to explain what drives a person to make a change and keep at it. Five key variables—person, condition, treatment, relationship with the healthcare provider, and environment—seem to play the greatest roles in determining whether a person will follow through on a nutrition or coaching recommendation (Sirur et al. 2009; Desroches et al. 2016).

Let’s walk through each of these five variables:

1. Person. Characteristics may include a person’s beliefs about nutrition; expectations of the change’s outcome; or their home life, behavior patterns, nutrition knowledge and skill in translating knowledge into daily behaviors.

2. Condition. Characteristics include severity or chronicity of a disease being treated. This also applies to diseases/conditions people try to avoid through nutrition changes, as well as outcomes they pursue such as weight loss, improved sports performance or more muscular strength.

3. Treatment. The difficulty, complexity and extent of nutrition changes required to best prevent or treat a condition—or optimize performance—play a role in how well someone follows through with a nutrition recommendation. For example, physicians often encourage a DASH eating plan for patients with hypertension or a Mediterranean diet for those at risk of heart disease. Patients who think the eating plan is easy to understand and follow are more likely to make the recommended changes. On the other hand, if a patient thinks the diet is too complex and hard to follow, adherence is unlikely.

4. Relationship with the healthcare provider. Adherence also depends on how well the client connects with the health and fitness professional and (when applicable) the extended care team. People look for engagement, trust, respect and understanding. Using client-centered communication techniques such as motivational interviewing helps to strengthen the relationship between client and provider.

5. Environment. People belong to a greater community, which includes their home, school, work and favorite social settings. The beliefs and culture around food and eating in these settings play an important role in determining nutrition intake and adherence. Moreover, food factors such as media and marketing, pricing, access, and policies influence nutrition adherence. These environmental factors are best understood in the context of the social ecological model (see the“ Behavior Change Theories and Nutrition Adherence” chart, above).

See also: Behavior Change: What the Research Tells Us

Problem-Solving Skills for Behavior Change

Lapses are a normal part of behavior change. Incorporating relapse prevention and problem-solving skills training into nutrition coaching sessions can enable clients to address the barriers to adherence (Middleton, Anton & Perri 2013) by providing a structured way to troubleshoot challenges before they happen. Here are helpful steps to follow:

1. Identify potential problems

  • Help clients recognize that problems are “normal” and can be planned for and managed.
  • Use open-ended questions and reflective listening when encouraging the client to explore potential obstacles to continuing a behavior change. For example, “What is the most difficult part about maintaining this nutrition change?”
  • Encourage the client to elaborate.
  • Help the client detail factors that contribute to the problem.

2. Explore possible solutions

  • “Tell me about a time in the past when you had this problem and overcame it.”
  • “What might make it easier to continue this nutrition change?”
  • “How might you address this problem?”
  • Brainstorm to create a list of potential solutions.

3. Make a plan

  • Detail the potential positive and negative consequences of several possible solutions.
  • Choose a potential solution to pursue.
  • Help the client create a process-focused SMART goal strategy that includes a series of steps to take when a problem arises.

4. Implement the plan

  • Help the client put the agreed-upon plan into action.
  • When problems emerge, implement the plan’s processes and evaluate their effectiveness.

5. Evaluate the plan

  • Assess how well the chosen solution helped to solve the problem.
  • If your problem-solving skills fall short, start again at step 2, exploring other possible solutions.

Source: Middleton, Anton & Perri 2013.

See also: Nutrition Adherence: Making Lifestyle Changes That Stick


Desroches, S., et al. 2016. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database of Systematic Reviews, (2), CD008722.

Middleton, K.R., Anton, S.D., & Perri, M.G. 2013. Long-term adherence to health behavior change. American Journal of Lifestyle Medicine, 7 (6), 395–404.

Sirur, R., et al. 2009. The role of theory in increasing adherence to prescribed practice. Physiotherapy Canada, 61 (2), 68–77.

Natalie Digate Muth, MD, MPH, RD

"Natalie Digate Muth, MD, MPH, RDN, FAAP, is a board-certified pediatrician and obesity medicine physician, registered dietitian and health coach. She practices general pediatrics with a focus on healthy family routines, nutrition, physical activity and behavior change in North County, San Diego. She also serves as the senior advisor for healthcare solutions at the American Council on Exercise. Natalie is the author of five books and is committed to helping every child and family thrive. She is a strong advocate for systems and communities that support prevention and wellness across the lifespan, beginning at 9 months of age."

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