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Fat and Skinner From The Branch Out Series

CE Course:

Join Dr. Michael J. Cameron Ph-D, BCBA-D and renowned Author/Journalist David H. Freedman as we explore how to establish behavioral patterns that promote weight loss, exercise adherence and overall health and fitness.

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Fat and Skinner From The Branch Out Series

  1. 1. Fat and SkinnerBehavior Analysis for Weight Loss and Fitness January 8th 2016
  2. 2. The  mission  of  our  Branch  Out  Series  is  provide  educa7onal  opportuni7es  to  professionals  interested  in understanding  the  broad  applica7on  of  the  science  of  behavior  analysis. ACE  Provider:  OP-­‐15-­‐2552 ObiGobi           INTRODUCTION   We  are  ObiGobi  and  Architects  of  the  Knowledge  Economy.  
  3. 3. WEBINAR HOSTS Fat  and  Skinner Michael J. Cameron, Ph.D., BCBA-D Sharing  informa7on  from  the  field  of  behavior  analysis  and  behavioral  medicine.  My  interest  in  using  behavior  analysis  to  op7mize   health  and  wellness. David H. Freedman David  is  a  science,  technology  and  business  writer.  Over  the  past  few  years,  he  has  increasingly  focused  on  health  care,  especially   with  regard  to  the  role  of  behavior  change  in  preven7ng  illness,  and  most  especially  with  regard  to  obesity.  David  is  also  interested   in  how  these  and  other  health-­‐care  issues  play  out  globally,  and  par7cularly  in  developing  na7ons. Summer LeFebvre Summer  is  a  Licensed  Clinical  Social  Worker  with  a  prac7ce  in  Anchorage,  Alaska.  Summer  brings  the  perspec7ve  of  a  person  that   has  been  through  each  step  of  the  program  that  will  be  described  within  this  webinar.  
  4. 4. Applications Applications Safety Environment Behavioral Forensics Verbal Behavior and Language Aging Autism Clinical Therapy Neuroscience Applied Behavior Analysis Diverse  applica7ons  of  the  science  and  you  as  a  beneficiary    
  5. 5. You  will  receive  1  CEU  for par7cipa7on.  You  will  be  required to  complete  a  survey  and  complete  a  quiz. ACE  Provider:  OP-­‐15-­‐2552 Mechanics A  review  of  a  stage-­‐based  program  for   establishing  health  promo7ng  behaviors  and   exercise  adherence  by  Dr.  Michael  Cameron   Overview A  conversa7on  with  science  writer,  David   Freedman,  on  the  role  of  behaviorally-­‐based   treatment  programs  to  address  body  weight   and  exercise  adherence Insights Commentary  and  reflec7ons  on  a  behavioral   approach  to  treatment  by  Summer  LeFebvre   Progress AGENDA Overview  of  the  Presenta7on
  6. 6. Definition Behavior Health Internal  states  influence  behavior  just  as powerfully  as  external  s7muli.  Consider: •  Reflux •  Migraine •  Menses •  Blood  glucose  levels     The Dependent Variable The  Society  of  Behavioral  Medicine  is  a   mul7disciplinary  organiza7on  of clinicians,  educators,  and  scien7sts  dedicated  to   promo7ng  the  study  of  the interac7ons  of  behavior  with  biology  and  the   environment,  and  the applica7on  of  that  knowledge  to  improve  the   health  and  well  being  of individuals,  families,  communi7es  and  popula7ons Society of Behavioral Medicine Behavioral Medicine Relevance  for  health  and  fitness Behavioral  Medicine  is  the  interdisciplinary  field  concerned  with  the   development  and  integra7on  of  behavioral,  psychosocial,  and  biomedical  science  knowledge  and  techniques  relevant  to  the  understanding  of  health  and  illness,  and  the  applica7on   of  this  knowledge  and  these  techniques  to  preven7on,   diagnosis,  treatment  and  rehabilita7on
  7. 7. Relevance of Behavior Change Factors Impacting Health Environment Hereditary Health Care Behavior Change 10% Source: Schroeder, S. N Engl J Med 2007; 357: 1221-1228 7 50% 20% 20%
  8. 8. From  a  behavior  analy7c  perspec7ve  ea7ng  behavior  is  learned,  suscep7ble  to  the  same  condi7oning  mechanisms  of  all  human   behavior,  and  amenable  to  environmental  modifica7on.  A  behavior  analy7c  approach  is  different  from  generic  and  inclusive   systems   An  interdisciplinary  team  of  professionals  including  a  Board  Cer7fied  Behavior  Analyst,  nutri7onist,  and  an  exercise  physiologist   working  together.  The  team  guides  par7cipants  over  the  course  of  16  to  24  treatment  sessions  within  a  six  month  7me  frame.       The  establishment  of  a  behavioral  community.  The  community  should  involve  10  to  20  par7cipants  Par7cipants  can  meet  and   communicate  via  text  messages  through  HIPAA  Chat.       Daily  self-­‐monitoring  of  calories,  fat,  sugar,  and  salt  intake.  Daily  monitoring  of  nutri7on,  water  intake  and  exercise.  Calorie  goals   based  on  Basal  Metabolic  Rate  and  progressive  weight  loss  (e.g.,  one  to  three  pounds  per  week).     Exercise  goals  of  1000  calorie  (burn)  per  week  or  150  minutes  of  moderate  ac7vity.       Behavioral Weight Loss Program Characterisitcs  of  a  quality  program  
  9. 9. Begin  with  the  end  in  mind.   Comprehensive  measures  are   required   Baseline 1 Assessment 3 Integra7on  into  a  behavioral   community Community 4 The  establishment  of  habits   related  to  ea7ng  and  exercise   Rituals & Routines 5 Analysis  of  health-­‐promo7ng   and  non-­‐promo7ng  behavior Analysis 6 An  exercise  intensity  shaping   process Exercise 7 8 9 10 Move  from  a  technology-­‐ dependent  system  to  an   independent  system Self Monitoring 2 A Progressive System 10  Steps  to  op7mal  health Use  of  the  Construc7onal   Ques7onnaire  based  on  the   work  of  Israel  Goldiamond   Shaping Data-­‐based  decision  making   for  progressive  change   Relapse Par7cipants  opera7onally   define  a  relapse  and  develop  a   plan  for  management Recovery Personalized  plan
  10. 10. Task List Item G-02: Consider biological and medical variables that may be affecting the client Step 1 Begin with the End in Mind Evaluator Measure Objective Information Primary Care Physician Thyroid stimulating hormone (TSH) A level of 0.3 to 3.0 This test is recommended at the age of 35. A TSH level above normal may indicate hypothyroidism (an under active thyroid). A TSH level below normal may indicate hyperthyroidism (an overactive thyroid) Primary Care Physician Fasting blood glucose 100 mg/dL (milligrams per deciliter) Results between 100 and 125 indicate impaired glucose tolerance, also known as pre-diabetes, which warrants follow-up evaluation and testing. Results above 126 indicate the presence of diabetes Primary Care Physician Blood pressure 120/80 mm Hg (systolic pressure/diastolic pressure, measured in millimeters of mercury) High blood pressure (hypertension) is indicated by results above 140/90. Results between 120/80 and 140/90 indicate pre-hypertension Primary Care Physician Cholesterol Total cholesterol: 200 mg/dL or lower; LDL ("bad") cholesterol: 70 mg/dL or lower; HDL ("good") cholesterol: 40 mg/dL or higher Cholesterol is measured in total and individual readings Primary Care Physician Blood count (hemoglobin) 13 to 17 g/dL (men), 12 to 15 g/dL (women) grams per deciliter A low blood count is associated with anemia and should be discussed with your physician
  11. 11. Begin with the End in Mind Evaluator Measure Objective Information Primary Care Physician Body Weight Calculate your ideal body weight Determine your goal weight for the program Self Evaluation Body Mass Index Calculate your body mass index Your Body Mass Index (BMI) is an estimate of your body fat, based on your height and weight Self Evaluation Circumference Measurements Using a measuring tape, measure your: bust, chest (directly under the bust), waist, hips, upper arm, thigh, calf, and ankle. You should also measure your waist-to-hip ratio Waist-to-hip ratio is determined by dividing your waist measurement by your hip measurement. Calculate your ratio A certified personal trainer, athletic trainer or strength and conditioning coach Functional Movement Screen This is a quantifiable method of evaluating basic movement abilities This information will be used to design a fitness program. The assessment will cost between $75.00 and $100.00 Self Evaluation Resting Heart Rate (RHR) You should try to measure your heart rate first thing in the morning before you are active and your heart rate rises. Simply count how many times your heart beats in 1 minute RHR is usually between 50 and 100 beats per minute Your heart rate reflects how hard your heart works during exercise and tracking your resting heart rate (RHR) over time can help you quantify your fitness gains as it gets lower and lower Task List Item I-03: Design and implement individualized behavioral assessment procedures
  12. 12.         Collect  Comprehensive  Baseline   Measures   Expect your health status to change in many ways
  13. 13. Personal  Trainer FITSTAR WiFi  Body  Scale  and  Band WHITINGS Data  Collec7on MY FITNESS PAL Step 2 Self Monitor and Quantify A  cornerstone  of  weight  control  programs  and  F-­‐O1:  Use  self-­‐management  strategies  
  14. 14.         Select  your  Self  Monitoring   System   Collect data on your comprehensive behavioral patterns
  15. 15. Life Style Documenta7on  of  a  preferred  lifestyle  (e.g.,  Vegan,   Vegetarian,  Pescatarian,  Mediterranean) Body Weight Between  115  and  125  pounds   Medical Measures Blood  pressure,  blood  glucose  level,  GERD Exercise Movement  based  on  personal  preferences   DEVELOP A HEALTH MISSION STATEMENT Set  your  health  goals  and  I-­‐O6:  Make  recommneda7ons  regarding  behavior  that  need  to  be  established,  maintained,  increased,  or  decreased   Rosa’s Health Mission Statement My goal body weight is between 115 and 125 pounds. My fitness goals for my cardiovascular health include taking dance classes or doing dance DVDs on a regular basis. I will walk on the beach more and will eventually be able to run/jog on it. I would like to swim in a pool more often to increase my skill level in this area. I would also like to buy a bike and ride it. To increase my flexibility, I will stretch on a daily basis, with a special emphasis on ankle stretching. I will increase my core, upper body and lower body strength with exercises using my body weight as resistance. I will incorporate exercise into my life 5 days a week consistently. I want to achieve these goals to decrease my blood pressure, keep my blood sugar at a healthy level, reduce the frequency and severity of my acid reflux, increase my energy level, decrease my stress level and just feel better in general. I would also like to see if meeting these goals can increase my hemoglobin and vitamin D levels, as these are too low. I would also like to see if meeting these goals can decrease the frequency and intensity of my heart palpitations. Overall, meeting these goals will decrease my overall level of health and reduce my risks for a number of health problems including diabetes and heart disease.
  16. 16.         Create  your  Health  Mission   Statement   Document your desired and comprehensive health outcomes
  17. 17.         Establish  Goals  and  IniDate  Small   Changes   Process goals Short-term goals Long-term goals Event goals
  18. 18. BMR Basal  Metabolic  Rate  and  basic   calcula7ons   Scatter Plot A  review  of  caloric  intake  and   ea7ng  and  exercise  pacerns   Nutrition A  review  of  nutri7onal  balance Goal Setting Process  goals.  Short-­‐term  goals.   Long-­‐term  goals.  Event  goals.   Exercise Preference Cardio.  Flexibility.  Strength.   Gym-­‐Based.  Home-­‐Based.  Work-­‐ Based.  Comfort-­‐Based Technology A  review  of  Behavior   Interven7on  Technologies  to   support  health  change   Calorie and Exercise Easing Successive  approxima7ons   toward  caloric  and  exercise   goals   Trigger Analysis Iden7fying  consistent  triggers   for  food  and  exercise  adherence   and  non-­‐adherence   Step 3 Assessment Personalized  via  the  Mo7va7onal  Interview  and  J-­‐01:  State  interven7on  goals  in  observable  and   measurable  terms  
  19. 19.         Collect  and  Review  your  Data   1.  Your Basal Metabolic Rate 2.  Scatter plot of your food and exercise patterns 3.  Your nutritional profile (e.g., Nutritional Target Map) 4.  Your exercise preferences 5.  The low-tech or high-tech tools you prefer 6.  Your calorie and exercise “easing” plan 7.  Your triggers 8.  Develop a “shaping” plan and make small changes 9.  Plan and implement mini experiments 10. Analyze personal data
  20. 20. Virtual Community Joining  an  on  line  community  to   maximize  accountability. Accountability Change Management Building a Network Events Building a Network Establishing  new  connec7ons  for   health  promo7on  and  las7ng   behavioral  change. Proximate Community Communica7ng  health  changes  and   enlis7ng  support  from  your   immediate  community. Events in the Community Joining  events  where  health   changes  are  validated  (e.g.,  walking,   running,  biking,  hiking).   Step 4 Behavioral Community The  role  of  the  community  and  op7mal  health  change  and  J-­‐06:  Select  interven7ons  based  on  suppor7ng   environments
  21. 21.         Be  Accountable.  Create  a   Dashboard.  Report     Report your Key Health Indicators (KHI) to your behavioral community. Communicate your intentions
  22. 22. Engaged  in  specific  overt   modifica7ons.  Using  behavioral   interven7on  technologies.  Rituals   and  rou7nes  established Action Not  ready  for  a  change.  Omission  of   tacts Pre-Contemplation Sustaining  ac7on  for  6  months and  preven7ng  relapse.  Engaged  in   problem-­‐solving  behavior  (e.g.,   vaca7on  planning)   Maintenance Gefng  ready  for  change.  Tac7ng  the   issues  (discomfort,  medical   problems) Contemplation Zero  tempta7on.  No  reliance  on   contrived  tracking  systems.  Transfer   of  s7mulus  control   Termination Iden7fying  and  sefng  process  goals.   Observable  and  measurable   behavior  (e.g.,  grocery  shopping)   Preparation Step 5 Rituals and Routines An  introduc7on  to  the  Transtheore7cal  Model  (TTM)  and  G-­‐05:  Describe  and  explain  behavior,  including   private  events,  in  behavior-­‐analy7c  (non-­‐mentalis7c)  terms  
  23. 23.         Plan  One  Good  Day.  Repeat.   Diversify  and  Intensify   Progressive and small adjustments for high probability success
  24. 24. Calorie Nutrition Problem Solving Network Monitoring Standards Optimization Personal Management Step 6 Shaping Engaged  in  the  easing  process  and  D-­‐05:  Use  shaping  and  set  micro  quotas   Exercise
  25. 25.         Establish  the  Targets.  Make   Small  Changes  for  Inevitable   Success     Caloric Intake (3500 reduction for 1 pound loss) Fat, sugar, salt intake Nutritional balance Strength, flexibility, and cardio training Expanding your health network
  26. 26. S F P C According  to  the  American  College  of  Sports  Medicine  (ACSM),  adults  should  do   flexibility  exercises  two  to  three  days,  per  week,  to  improve  range  of  mo7on  (ROM)       Adults  require  at  least  2  hours  and  30  minutes  (150  minutes)  of  moderate-­‐ intensity  aerobic  ac7vity  each  week  in  addi7on  to  muscle-­‐strengthening  ac7vity   and  flexibility  training     Adults  require  exercise  outlets  that  are: •  Home-­‐based •  Work-­‐based •  School-­‐based •  Center-­‐based   Strength Flexibility Cardio Preference Step 7 Exercise Intensity  shaping  and  diversifica7on  and  I-­‐05:  Organize,  analyze,  and  interpret  observed  data Studies  from  the  Centers  for  Disease  Control  have  found  that  muscle-­‐building  exercise can  improve  balance,  reduce  the  likelihood  of  falls,  improve  blood-­‐sugar  control,   and  improve  sleep  and  mental  health  
  27. 27.         Exercise  Based  on  Preference   and  Enjoyability   Exercise preference assessment. Consider the home-based, school-based, and work-based setting. Also identify “comfort” routines Sign Up
  28. 28. Step 8 Analysis J-­‐05:  Select  interven7on  strategies  based  on  the  client’s  current  repertoires Fact 01Observations Fact 02 Fact 03 Fact 04 Your  ea7ng  pacerns   Your  food  preferences   Your  exercise  pacerns   Your  exercise  preferences   Your  triggers  (e.g.,  menses,  restaurants,   alcohol) High caloric intake from 6:00 to 8:00 PM High carbohydrate Morning time is best Walking stairs at work Consistent high calorie in restaurants
  29. 29.         Data-­‐Based  Decsion  Making  for   the  Perfected  Self     Your guide to mini experiments and micro adjustments
  30. 30. J-­‐11  and  programming  for  s7mulus  and   response  generaliza7on  and  J-­‐12,   programming  for  maintenance   Step 9 Define Relapse The  importance  of  opera7onally  defining  a   relapse  and  having  a  Personal  Knowledge   System  (PKS)  design  to  allow  you  to  recover   Relapse
  31. 31.         Define  Relapse.  Create  the   Recovery  Plan  before  it  is   Needed   The relevance of a Personal Knowledge Management (PKM) system
  32. 32. Step 10 Recovery Plan J-­‐04  and  selec7ng  interven7on  strategies  based  on  client  preferences   03 Stimulus Control 04 Macro Goals and Micro Changes 01 Personal Knowledge Management (PKM) 02 Self Monitoring
  33. 33.         Fill  your  Personal  PrescripDon     Your recovery plan should be authored by you before it is needed
  34. 34. Journal of Behavior Therapy and Experimental Psychiatry S7ckney,  Miltenberger,  and     Wolff  (1999).  A  Descrip7ve   Analysis  of  Factors   Contribu7ng  to  Binge  Ea7ng   Cameron,  Maguire,  and   McCormack  (2011).  Stress-­‐ Induced  Binge  Ea7ng:  A   Behavior-­‐Analy7c  Approach   to  Assessment  and   Interven7on     Normand  (2008).  Increasing   Physical  Ac7vity  through  Self-­‐ Monitoring,  Goal  Sefng,  and   Feedback     Hurley  et  al.  (2015).  The   Walking  Interven7ons  through   Tex7ng  (WalkIT)  Trial:   Ra7onale,  Design,  and  Protocol   for  a  Factorial  Randomized   Controlled  Trial  of  Adap7ve   Interven7ons  for  Overweight   and  Obese,  Inac7ve  Adults   Denham  (2003).   Rela7onships  between   Family  Rituals,  Family   Rou7nes,  and  Health   We are ObiGobi Select  ar7cles  to  keep  you  inspired The behavioral processes involved in a person’s self control are the same as those one would use in controlling the behavior of others (Skinner, 1953) Journal of Adult Development Behavioral Interventions Journal of Medical Internet Research Journal of Family Nursing
  35. 35. GET IN TOUCH Thank you for Attending our Webinar ACE Provider OP-15-2552 Address CentralReach 2745 E Atlantic Boulevard Second Floor Pompano Beach, Florida 33062 Phone Direct Line: +800.939.5414 careteam@centralreach.com mcameron@obigobi.com Social Media Facebook.com/CentralReach Twitter.com/@CentralReach