Thursday, March 20, 2014

Developing a plan for lifestyle change: A case study

Last week I went over the 5 things that a person should have when beginning to implement a Paleo diet. One of those things, and likely one of the most important, is a solid plan.  In this blog I will go over how I helped a client develop one of these plans and some strategies we used to get her on her way to living a healthier.  Below the steps of our plan, I'll use italics to define the thought process I used to come up with them.  I have changed her name to protect her anonymity.

Vicky is 38 year old stay at home mom with a very busy lifestyle.  She drives all of her kids to school and since the schools all start and end at different times and they are all in sports, she is constantly picking someone up or dropping them off.  Her diet is a Standard American Diet based on convenience and snacks all day long, but she doesn't mind spending a little time cooking meals.  She doesn't, however, like eating vegetables, especially cooked ones.  Other than that she will eat pretty much anything.  She states that she feels she gets enough physical activity rushing around taking the kids everywhere, she is just looking for an exercise program to help her burn off the 20 lbs she has put on over the past 2 years.  She has done P90x, Insanity, and T25 and has a history of mild shoulder issues.  She has Type 2 diabetes and gets IBS occasionally when she eats raw or undercooked vegetables.  She is completely cleared for exercise, but her movement assessment showed her to have insufficient flexibility and poorly working glutes.

1)Eat at least 1.5 cups of vegetables at every meal

After further discussing her distaste for vegetables, I learned that she doesn't like the texture of cooked vegetables.  She was instructed to begin making her 1st and 2nd meals the day before and place them in the fridge.  While she didn't like the texture of cooked vegetables, refrigerated ones were fine.  Since we started, she has begun eating more vegetables and the diversity in her diet is growing.


2)Remove grains, legumes, and dairy from the diet

Vicky's IBS and Type 2 diabetes lead me to believe she has a problem in her gut.  Grains, legumes, and dairy all contain proteins that humans don't digest very well, leaving protein to interact with the bacteria in the gut and potentially cause GI distress(I discussed this here).  I instructed her to remove these things from her diet for at least a month to see if that would help with either condition.  After 4 weeks both issues had improved greatly and she decided to limit her exposure to these foods.


3)Begin tracking your activity

I had Vicky purchase a Fitbit activity tracker and wear it for 3 days to get an idea of how much physical activity she was getting.  I told her not to worry about trying to get as many steps as possible because I wanted to see how active she was previously, which turned out to be about 60% of what she should be doing.  I told her to begin working to get more steps and to track her progress with the Fitbit.  She should increase her daily average by 1000 steps each week until she averages 10,000 per day.


4)Begin foam rolling and stretching 3 times per week

While Vicky wanted to jump right in on an intense training program, I informed her that this would be a bad idea.  Her lack of mobility and proper glute firing indicate that the activity she wanted to engage in would be detrimental to her goals at this time.  To get her ready for more intense exercise, we are working to restore proper movement mechanics by increasing her mobility and strength in the areas where she needs it.  While she wanted to dive right in, I made her realize how this would negatively impact her progress.  She was happy to hear that she could still see substantial progress towards her goal by simply being on her feet more and getting 10,000 steps per day in addition to changing her diet.  I informed her that this would be better for her goals down the road because when she plateaus we can add in more intense activity when it is safer.


Vicky's problems are very similar to those I see often, but it isn't the solution to the problems that is important.  The fact that she is addressing them and has a solid plan of attack to tackle her own personal hang ups when they come up is what is important.  Having general guidelines isn't helpful because they allow wiggle room which leads to making decisions that compromise attaining your goals.  While Vicky didn't all of a sudden begin following all of these letters to a T, she knew when she was doing something that would compromise her goals and that gave her a level of satisfaction, even if she did cheat from time to time.  There were other issues we had to address but the specific issues don't matter, we identified her strengths and weaknesses and developed a plan that used her strengths to help overcome her weaknesses.  Even if you can't completely solve the issues, realizing that they are there can allow you to avoid situation where they come up.