Dr. Alex Jimenez, El Paso's Chiropractor
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Challenges on Lifestyle Modifications

Lifestyle modifications have shown to be an effective aid in treating chronic diseases, improving weight loss, reducing low-grade inflammation, and lowering blood pressure. Indeed, as studies show how effective these interventions are, health care providers had to introduce these lifestyle modifications to their treatment. Therefore, changing the previous structure in health promotion guidelines. Nevertheless, modifications, changes in structure, and a reorientation toward this new treatment method have brought challenges to both patients and health care providers.

Lifestyle modifications can face different challenges; health care reorientation and implementation have to go through organizational readiness; this can be applied to individual changes or environmental changes. indeed, McLean and colleagues reported that health reorientation is composed of three dimensions:

3 Dimensions of change:
§  Individual: the individual level is influenced by professional knowledge and commitment.
§  Organizational: to maintain implementation, health care management has to control resources and build the structure to foster change.
§  Environmental: hospital facilities have to follow the political and economic policies to significantly impact and foster the prevention and reversal of diseases.

Besides systematic and political health reorientation, individual lifestyle behavior is a multifaceted process that involves patient motivation and preparedness to achieve health goals. Furthermore, Prochaska and DiClemente’s design a model to describe 5 different stages of change in which patients move through.

Prochaska and DiClemente’s
§  Precontemplation: This stage describes a patient who is unaware of their condition and does not know how their behavior affects him or her. Also, this patient might be resistant to change.
§  Contemplation: In this stage, the patient knows how their behavior influences their health status and is willing to make a change.
§  Preparation: The patient prepares in anticipation of the modification they are willing to do. This stage can take as long as 6 months for the individual to be prepared to modify.
§  Action: the patient is modifying; this stage starts with changing behavior.
§  Maintenance: the patient has committed to behavior modification and has maintained the process for 6 months.



Lacey and Street conducted a comparative study between the WHO guidelines for nutrition and physical activity and the unhealthy behaviors of patients considered “precontemplators.” Conversely, the 5 stages of Prochaska and DiClemente’s were used as a survey; the data showed a higher prevalence of “precontemplators” regarding the WHO nutritional guidelines, followed by patients in the contemplation stage. Furthermore, the contemplation stage was the most frequent when compared to the WHO physical activity guidelines.

In conclusion, patients seem to be reluctant to follow dietary guidelines to achieve better health. On the other hand, they appear to be open because they need physical activity to improve their health status. Nevertheless, in this particular study, the contemplation stage was the most frequent for nutritional and physical behaviors. Also, only 22% of 828 subjects included in this study reported being in the “maintenance” stage of following the physical guidelines. In comparison, only 11% reported being consistent with the nutritional recommendations of the WHO.

WHO approaches to promote physical activity:

Learn more about how to introduce physical activity and reach your health goals.

A different study that followed the lifestyle modifications compliance and beneficial results on Metabolic Syndrome’s treatments recommended the next approaches to maintain behavioral modification:

Approaches that support change:
  • Conceptualization of motivation: this concept relies on the idea that motivation is a dynamic entity. Therefore, it is probable that it will require continuous attention in attaining the behavioral change. Some of the factors involved in a patient’s motivation are environmental determinants, personal and cognitive status.
  • Acceptance and change: Most of the patients already tried different ways to treat their diseases; therefore, when this comes to the clinician’s attention, their posture should remain empathetic and validate the patient’s experience.
  • Collaborative therapeutic style: The clinician must be willing to work collaboratively instead of being confrontational.
  • Functional analysis: a health care provider should talk about the changes in behavior and its function on a therapeutic approach. Furthermore, mentioning and analyzing the pros of the treatment will contribute to the patient’s will to change.
  • Support self-efficacy: Clinician should encourage their patients to know that they are capable of making a change, quit a bad habit, and engage in healthy behaviors. This self-efficacy will raise hope and self-awareness of patients’ great capacity to promote a healthy lifestyle.
  • Educate patients: Health care providers should promote a healthy lifestyle and inform patients how to engage in healthy behavior and the deleterious effect of following unhealthy lifestyles.

Lastly, there are many options, approaches, and activities to engage in changes or health status. Indeed, health care providers hold the information in their hands, and it is interesting to know the role that motivation plays in the commitment to new healthy changes. Therefore, as a health care provider, it is imperative to follow the prevention guideline and measure ourselves with the change stages to know where we stand on prevention strategies.

In a few words, “walk the talk.”

Lacey, Sarah J., and Tamara D. Street. “Measuring healthy behaviors using the stages of change model: an investigation into the physical activity and nutrition behaviors of Australian miners.” (2017).

Dalle Grave, Riccardo, Simona Calugi, and Marwan El Ghoch. “Lifestyle modification in the management of obesity: achievements and challenges.” Eating and Weight Disorders-Studies on Anorexia, Bulimia, and Obesity 18.4 (2013): 339-349.

Kardakis, Therese, et al. “Lifestyle interventions in primary health care: professional and organizational challenges.” The European Journal of Public Health 24.1 (2014): 79.

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