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Taking small steps pays off, Northwestern health study says

By Andrea L. Brown, Special to the Tribune

July 11, 2012

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It may seem obvious to everyone but the guy on the couch, but a recent study by Northwestern University says that small steps are key to achieving a healthier lifestyle. In other words, get up from that couch, turn off the TV, and take your hand out of the potato chips.

The Northwestern study says small changes in behavior can be the spark needed to make significant strides toward improving general health. The study followed a group of people who acknowledged they eat high-fat foods and lead a sedentary lifestyle.

Despite ingrained habits, participants increased their physical activity and also ate more fruits and vegetables. With the help of a handheld computer and the promise of financial incentives, their behavior persisted for several months — even though the study did not require them to adhere to specific diet and exercise guidelines after three weeks.

"It's something that people can do. It sticks," said Bonnie Spring, a professor of preventive medicine at Northwestern University Feinberg School of Medicine and lead author of the study published May 28 in Archives of Internal Medicine. "There is something about increasing fruit and vegetable intake that increases people's confidence to make other healthy changes."

For long-term success, tracking progress and rewarding small victories helps, Spring said. Study participants received handheld computers to record exercise and food intake. They were also paid for their trouble.

In addition to compensation, accountability was the main incentive for study participant Joy Latuvnik, 32, of Elk Grove Village.

"The higher motivation was somebody else was counting on the information," Latuvnik said. "I wasn't completely doing it for myself."

Overweight most of her life, Latuvnik said she had never counted calories or paid attention to food labels, nor was she accustomed to physical activity. Following instructions to reduce trans fats to no more than 20 grams a day and exercise for about an hour until she was winded, Latuvnik said she shed 25 pounds and lowered her blood pressure in about two months.

"It was quite eye-opening," Latuvnik said about the diet guidelines. "It was very surprising to me as to how much saturated fat I was taking in on a normal day."

Once the study was over and she was no longer reporting her activities, Latuvnik said she reverted to her old habits.

But Spring said it was surprising enough that study participants such as Latuvnik followed the guidelines for the five months, when their only duty was to report their food consumption and activity.

"We really didn't think that folks would maintain these behaviors," Spring said.

An approach that seems obvious is not always followed in the doctor's office, Spring also said.

"If you are a physician, and you have limited time to deal with patients, you advise people to change diet and physical activity," Spring said.

Urging patients to adopt healthy habits related to diet and exercise poses immense challenges for physicians, said Dr. Geeta Maker-Clark, a family physician with NorthShore University HealthSystem.

In addition to facing time constraints in their practices, doctors receive limited nutrition training in medical school and during residency, Maker-Clark explained.

Maker-Clark said she has successfully weaned from medication patients with decades-old chronic conditions.

"I like adding things before removing things," Maker-Clark said. "The human psyche responds better to the addition of joy versus the removal of joy."

Patients often leave her office with handouts containing recipes, meditation tips and even a grocery shopping list compiled during a consultation.

Helping patients alter lifestyle choices may be time-consuming, but Maker-Clark said time spent on the front-end offsets hours many doctors devote to testing and adjusting medications.

"In the long run, the payoff is more helpful for the patient, and it's also better for the doctor because it decreases dependence on these continued appointments," Maker-Clark said. "Patients don't need to follow up as often with me."

Maker-Clark said studies such as the Northwestern report bolster approaches that promote lifestyle and behavior changes to make people healthier.

"I'm very pleased to hear there is more and more work being done on lifestyle changes for the management of chronic diseases rather than medication management," Maker-Clark said. "I think that's where the answer lies."