How to make a lifestyle change that lasts

Hi, I'm Julia Ebbens, a health content editor at Bupa. In this three part series, we will explore how to make a healthy change that actually lasts. We will address the science behind behaviour change, explain how to best prepare for and sustain a new change, as well as sharing some practical tips for dealing with setbacks.

I will be chatting to Sarah Griffiths, a behaviour change expert.

Julia Ebbens: Hi Sarah.

Sarah Griffiths: Hi Julia.

Julia Ebbens: As well as Julieta Correia, a Bupa health advisor. Hi, Julieta.

Julieta Correia: Hi, Julia.

Julia Ebbens:

I think most of us have a good idea how to be healthier. We know we should be more active, eat well, sleep better and manage our stress. But in reality, it can be really hard to make a healthy change that actually lasts.

I think it's helpful to know that it's not just a lack of willpower that makes it hard to change our health behaviours.

There's actually some science underpinning the struggles we have to make a lasting behaviour change.

Sarah, I know there's a model of change that explains the different stages someone is likely to go through when they're making a health change. Could you briefly talk us through what these stages are?

Sarah Griffiths:

Sure. So, this is a model known as the Stages of Change model. It's got several stages that someone may typically go through.

The initial stage is known as pre contemplation. So, this happens before any change is made.

And in this stage, you might not even be aware that you need to change something. Or you might deny that there's even an issue with something that you're already doing.

Julia Ebbens:

Interesting. So, for example, you might say to yourself, I know I eat lots of chocolate, but it doesn't really matter or there's no real impact on my health.

Sarah Griffiths:

Exactly. So, you haven't really accepted that a change is required.

Julia Ebbens:

Okay. So, what's the next stage in the change process?

Sarah Griffiths:

The next stage is the contemplation phase. So, this is where you're more likely to be aware that you have a habit or a behaviour that needs changing. But you can get stuck here. So, knowing you should make a change but not knowing how to proceed.

Julia Ebbens:

So, you're making progress at the contemplation stage really. Because you can at least accept that something needs to change. But it sounds like you actually need some extra support and encouragement to make it happen.

Sarah Griffiths:

Yes, and sometimes you can even go back a stage. So, when you're not sure how to change. So, you try to convince yourself that actually you don't need to change anything after all.

Julia Ebbens:

It seems like you can get stuck in a bit of an internal battle between moving forwards and staying as you are.

Sarah Griffiths:

Absolutely. But I think the good news is that from this second stage, you can also move forward to the third stage, which is preparation or preparing to change.

And this is where you start gathering information about how you'll actually make that change, such as reading relevant information online or speaking to someone who's already changed this particular habit or behaviour.

So, you might also start considering barriers that might prevent you from reaching your goal, and think about how you can overcome these.

Julia Ebbens:

This stage sounds a little more practical to me, like you're really doing the research you're planning and then you're actually taking those steps needed to facilitate change.

Sarah Griffiths:

Yeah. So, it's really putting the wheels in motion for the fourth stage, which is actually making the change.

So here you start to alter your behaviour, for example by committing to twice weekly runs or having a few alcohol-free evenings each week.

Julia Ebbens:

I think we all know that in the beginning you can have that initial motivation, then it's really easy to make these changes and then you probably feel quite happy with yourself, but normally something seems to get in the way and you can end up back where you started.

So how do you know that you've actually made a lasting change this time?

Sarah Griffiths:

So, when you've made a change consistently for around six months or more, then you've reached the maintenance stage.

You've probably gained confidence in your ability to change, and you've also probably had to overcome some challenges along the way.

But this doesn't, unfortunately, mean that you've made a lifelong change at this point, as relapses can still happen.

Julia Ebbens:

So, when you say relapse, what does this involve? Is it, for example, one day where you over-eat don't feel like working out or drink a little bit too much?

Sarah Griffiths:

I'd say so, rather than just having a slip up on one day or missing one work out. A relapse happens when one slip up leads to another and then another, and so on.

It's that negative mindset that I'm sure a lot of us recognise.

So, when you have a bit of a bad day, or you might have a few bad days, things aren't quite going to plan, and then you feel like you may as well just give up.

And then it becomes really hard to get back on track with the changes that you'd started to make.

And relapse is where you might move back a stage or two in the process before reaching that long term change.

I think it's really important to say that behaviour change is complex, and it can be really difficult. So, there can be a lot of movement back and forth between stages or even bypassing some of them entirely.

Julia Ebbens:

So, Julieta is a health advisor here at Bupa, and she's got loads of first-hand experience with the challenges a lot of people go through when trying to make positive health changes.

Listening to the stages of change that Sarah has mentioned. Does any of this sound familiar to you, and is it something you can relate to with your own health assessment clients?

Julieta Correia:

Definitely. We often see clients that are feeling stuck at the contemplation phase, which Sarah described, or move back from being actively working towards the health goals.

Challenges, such as having a busy job or having to build a new routine after having a new baby in the family, or simply not knowing what to do next because the previous attempts have failed, which is common in weight loss diets for example.

It blocks the sight of seeing what to do next.

Julia Ebbens:

Yeah, that sounds really frustrating. Do you remember anyone who's actually made the leap from the pre contemplation stage i.e when they're thinking about changing but they're not really sure if it's beneficial or something they can actually do to making the change?

Do you have an example of this you could share with us?

Julieta Correia:

Yes, there's several examples I would say, and worth mentioning that it’s definitely the best part of our job, because we see how people change and they achieve their goals. They feel healthier and happier as well.

I remember this particular client, was seeing a health advisor the year before. And was advised to improve his eating habits as he was found to be pre-diabetic. So just a parenthesis here. It has to do with the blood sugar levels found at that time of the assessment.

He was not aware that, the type of diet he was having at that time and not exercising was causing him harm and then was advised accordingly.

So, when I saw him this year, he has since start exercising, improved his diet by cutting fizzy drinks and chocolates as the main snack. And we not only saw that his blood sugar levels went back to normal, he was no longer pre-diabetic and we saw that cholesterol has improved, as well as an additional happy factor that he dropped two sizes on his clothes. So, only win-win situations.

From there we discussed, what went well. We reinforced the positive results and set the next goals he wanted to achieve as he was working to a better fitness level.

An inspiring journey for all of us. And, he also shared this at his workplace and started to influence his team.

Julia Ebbens:

Nice. So that sounds really positive. It's really nice to hear an example from real life when changes actually happen. So, thanks for that.

In our next podcast episode, we're going to delve deeper into some practical considerations for how to actually maintain that change going forwards.

But for now, for those listeners who are in that early stage of pre contemplation or even contemplation, but they're not really sure where to begin.

What type of questions should someone be asking themselves, Sarah?

Sarah Griffiths:

I think some good things to consider are what's your motivation for making the change? So maybe you want more energy? Improve your mood and that kind of thing.

So, identifying your reasons to change can help you to stay focused during setbacks.

Also, do you know how to make long term change? Is there a local service that can provide support or resources? Or maybe you can find some advice online through trusted websites like the NHS.

It can also help to think about what might be stopping you from making changes. Maybe you've tried to change this behaviour before, but only managed short term change. And so, you think that this time it will be too difficult, or you may be busy and you don't know how to make changes that fit with your lifestyle.

So, identifying barriers that can help you to think of solutions to those potential issues.

And then finally, what might trigger you to move back to relapse.

So maybe you've got an event coming up where it might be difficult to continue with any changes, like a holiday or a family or a work event. It can really help to think about how you could adapt your behaviour to cope with this.

Julia Ebbens:

Sounds like there's quite a lot to think about in these early stages, but hopefully later on it's going to help you.

On a practical level. I know that making SMART goals can be useful way for some people to focus on making a positive change.

Could you explain a little bit about what these are and how they might be able to help you at this stage of behaviour change?

Sarah Griffiths:

Yeah of course. So SMART is an acronym that can be used for making goals a bit more defined. And it's a really important step to achieve change.

Just as an example. So, wanting to exercise more is a good goal. But it's quite unclear. And this is where we can bring in SMART goals.

So, making your goals specific and measurable.

So, kind of like what? Achievable. like the how? Relevant, which will be the why? And timely, so the when?

So instead of increasing exercise as a goal this could be going for a 15-minute run on a Wednesday and Friday at 12 p.m. during your lunch break, when you know that you'll be working from home.

So make this achievable by starting small for a new behaviour that could be building up to a 15 minute run with walking, and then adding a short run into the walk, and then making the run part longer each time.

Julia Ebbens:

Okay, it sounds like the more precise you can be, the better the outcomes, ultimately.

Julieta, as a health advisor, have you got any tips for someone who is considering making a change? When I used to work as a health coach for the NHS, we used to ask our clients to think about their personal motivation for changing. And this is really so they can stay connected to this. And it can help them with setbacks if they happen during the change process.

Their motivation would be things like they want to feel more energy, they want to sleep better, or even just feeling less stressed. Do you have any other tips to share?

Julieta Correia:

Definitely. The motivation point is vital. This allows us to maintain the consistency and building habits towards the SMART goals that Sarah described.

As health advisors, during our assessments, we go through a discovery process. It’s like an interview, which allows us to work with the client in finding what changes they want to make and why they want to make these changes.

Rather than attaching a SMART goal to what they think they need to do based on their health goals. We aim to find actions that they are confident in doing so and motivated to do in a simple way.

Other tips we may look at are accountability partners, whether this would be a family member, a friend, or even us as a health advisor.

And another one would be having a vision for the future, which some people might want to transform this into a vision board, for example, which will keep the focus and a reminder of why they started in the first place.

Julia Ebbens:

Sounds like it's a really useful process to go to, to help people identify why they actually want to make the change in the first place.

So, we've discussed the stages of change. We also talked about some of the preparations you can take, such as asking yourself key questions and also making a few SMART goals.

Next time we'll talk more about the challenges of maintaining the change. We'll also share some top tips about how you can help yourself during this next stage of the change process.

Thank you for listening.

Julia: Hello, my name is Julia Ebbens, and I'm a health content editor at Bupa.

This is the second in a three-part series about how to make and sustain a healthy change.

Again, I'll be joined by Sarah Griffiths, a behaviour change expert, And Julieta Correa, a health advisor at Bupa. Hi Sarah

Sarah: Hi Julia

Julia: Hi Julietta

Julietta: Hi, Julia, Hi

Julia: So previously we talked about the stages of change, the initial process of considering and also planning for change, and most importantly, how to get started. This time we'll be discussing how to maintain a change, which is where I think a lot of us struggle. Sarah, can you please remind us of how this phase fits into the overall stages of change model, please?

Sarah: Yeah, sure. So the model shows how people typically move through a number of stages to reach long term behaviour change. And the first three phases are pre contemplation, contemplation and preparation where people move from realising that change is needed, and then thinking more about how to actually make those changes. And then the fourth and fifth stages are action and maintenance. So where changes are actually made and maintenance is an important step because it can be really easy to relapse, especially in those early days before reaching long term change. Or you can even move back to one of the earlier stages.

Julia: Must be really frustrating if you feel like you're moving backwards instead of forwards, But I think we can all relate to that. Julieta, do you have any first-hand experience of people who have gone backwards, so to speak, and maybe felt a bit demoralised that they weren't able to maintain the change?

Julietta: Yes, and it is common. It’s something important that we need to bring to our assessment, when we first see our clients, not letting them fall further back, or feeling further demotivated to a pre contemplation stage. Understanding what went well, what was difficult to maintain, is most definitely a step forward. As well as reevaluating the goals previously agreed and reassessing current readiness for change. So we often see this in clients that want to lose weight and for various reasons, from going for a longer holiday, or dropping motivational levels, they have regained that lost weight. So, looking at what didn't work, and focusing and moving forward is important from our side. And I believe our clients feel well supported in in doing so.

Julia: Yeah, that support sounds really crucial because when you're going it alone, it's actually really hard to motivate yourself again when you've had a setback. So Sarah, what would you say to someone who is struggling to maintain change? Because I think it's quite easy for us to blame ourselves. And we might just feel, oh, you know, we're lacking a bit of willpower. But I think there's more to maintaining change than that, isn't there?

Sarah: Yeah, definitely. It can be really tricky. So you're not alone if you struggle to maintain healthy changes. I think it's really natural to start off strong, full of enthusiasm, and then gradually feel as if you've hit a wall or you're just simply unable to sustain the changes that you've started to make. And part of the model that we're talking about shows that behaviour doesn't always follow a neat path. I think we all know people are very complex. We all have individual circumstances and challenges, and relapse can occur at any point in the process. But I think this is a great time to identify any potential barriers that might be preventing you from making a long term behaviour change.

Or it might be that you actually need some additional support to help you to fully establish a new habit.

Julia: Definitely. What type of barriers might prevent people from making change, do you think?

Sarah: So I think something that's really common is wanting to change too many things at once. So it could be that you want to exercise more, tackle your diet, and improve your sleep. So obviously that's quite a lot to try and change all at once. And it can be quite overwhelming, trying to do all these things.

So it's often better to choose one area and then maybe focus on a behaviour to help you with that until you're confident with that change before making another one. And some behaviours are also really deep rooted. So things like smoking might be something that you've done for many, many years. If you see yourself as a smoker, people that you socialise with, they're also smokers. It can also be hard to consider changing that.

Julia: So do you think some behaviours are probably easier to change than others?

Sarah: Yeah, definitely. I mean, if you look at something like drinking more water, then that’s going to be a bit easier to sort of fit into your daily routine. And it can also be that you've been told to change your behaviour. So rather than it being your decision, if you're trying to change something based on what other people have told you will be in your best interest, then that can be an extra challenge.

And this can lead to being a bit stuck in that pre contemplation and contemplation stage. So moving between thinking that you need to change, but also not really wanting to or not understanding quite why it's needed. And then I think another barrier that prevents change can be feeling like life's just too busy, that you don't have the capacity to try and tackle something else. And it can be really hard to think about additional things if you already feel like you're short of time and energy. And again, this is where additional support can be really beneficial.

Julia: Yeah, that makes a lot of sense. Julieta, do your clients ever share any specific reasons they might be unable to sustain a health change?

Julietta: They do actually. And we look at options together. Two frequent reasons are lack of time, which I believe we all relate to while managing a full-time job and children, etc, and part of their personal life, leaving them with less time to exercise, and cook healthy meals, or simply having had an injury or limited, movements that will force them to stop exercising as they were before.

Julia: So now we've discussed the type of barriers that can affect our ability to reach our health goals. In your opinion, Sarah, what is the key to better outcomes when trying to make a change?

Sarah: I think we all know really that planning can be an important part of behaviour change. So thinking of potential barriers that could knock you off course, how you might deal with those, that could be really helpful. But being in the contemplation stage for too long can actually lead to doubts about the need for change and lead to loss of confidence. And this can even move a person back into pre contemplation stage as well. I think we also know that people who are already making a change, even really small changes, are more likely to have better outcomes.

So making a small change is a positive first step, and it can lead to bigger changes. Sometimes you just have to bite the bullet and just go for it. Especially if you’ve thought about possible barriers that you might face along the way.

Julia: That sounds really useful. I think a lot of people don't consider what barriers they might encounter, and therefore they’re surprised when it actually happens. So that sounds like a good tip.

Sarah: Yeah, exactly. Other tips would be to start small. So if you want to stop smoking, it can be good to have a quit date. But you can break that down. So aiming for a day without smoking as that first step. Then two days, three days, a week, two weeks, and so on.

Or if your overall goal is quite broad, like getting fit or improving your diet, you could try to choose a specific and realistic behaviour that will help you to get there. And also I think this is really important is to identify something that you actually enjoy doing. So that could be running, gardening, walking, swimming, something that you've done before that you've actually enjoyed. So your target behaviour could be walking three times a week for 20 minutes. And then once you've achieved this goal, you could look to increase the frequency. And if you want to increase the intensity, you could add in a five minute run to the walk and then build up from there.

Julia: I think it's really important you pointed out that you need to enjoy what you're doing, because that is key to success, in my opinion. It sounds like you were also referring to SMART goals, which I know we discussed before. Is this stage a good time to maybe check in again with these and possibly tweak them if necessary?

Sarah: Yeah, exactly. So revisit your goals and make sure they're still working for you. Just as a reminder about making your goals specific, measurable, achievable, relevant, and timely. So you can define your goals and check in with them. If you're doing really well, then you might want to level up before you get bored and lose interest and motivation. And equally, if you find that it's not working or it's not fitting into your routine quite as you'd hoped, then reducing the intensity or the duration might be needed at first.

Julia: Yeah, so just making them realistic, basically.

Sarah: Yeah.

Julia: And is there anything to be said for rewarding ourselves for any progress that we do make?

Sarah: I think there can be a place for rewards to reinforce the positive changes that you're making. So that positive reinforcement can really help us with motivation, particularly in those early days when changing your behaviour feels like hard work. You know that you're going to get something back. But there I would say there are a couple of caveats to this. So the first would be to consider the type of reward.

So if you're changing your diet, then rewarding yourself with food after having a good day or looking forward to a takeaway at the end of the week, it might make it hard to get back on track. So we're also telling ourselves that we've got through something difficult, but actually we want this to be our new normal, so something that we wouldn't usually reward ourselves for.

Julia: So it could be, for example, going to the cinema or doing another activity that doesn't really have any relation to food.

Sarah: Yeah, exactly. And then the second point is that we tend to associate rewards after finishing something. But behaviour change doesn't really have an end point. So for example, maybe you want to reward yourself for losing weight that you've been looking to do for a long time. So you want to book a holiday, but then what happens after the holiday? So you might set a new goal, or you want to maintain where you are. But this could feel like starting again after having a break and make the chance of relapse a bit higher. So small rewards for reaching goals might be a better approach, a more effective for maintaining change.

So something like, buying yourself a new pair of jeans, for reaching a weight loss goal and then planning your new goal. Or how to maintain the changes that you've already put in place. And also, I think social rewards can be really effective. So things like catching up with really good friends, telling them how you're doing, and they can sort of tell you how amazing you are.

Julia: Definitely. I think that's really motivating when people sort of celebrate your successes as well. So sounds good. Julieta, do you find that people trying to make change actually benefit from changing their environment in some way? So, could be removing tempting foods from the kitchen, or even something like laying out your workout clothes the night before, things like that.

Julietta: Yes. And often that that's the case really, identifying the barriers each client faces. Encourage them to reflect and plan what can facilitate new habits to take place. So removing triggers such as having unhealthy snacks at hand, avoiding eating while watching TV, or while working on the computer, as you know, some of us still do. And overcoming barriers such as leaving all the workout gear ready to wear in the morning next day, are examples of changes in environments that facilitate change and are habit forming.

Julia: It sounds so simple, laying out your clothes, but actually when you wake up in the morning and you can't find what to wear can actually prevent you from working out altogether.

Sarah: Yeah... I think this makes a lot of sense, as there's really good evidence behind the role of restructuring your environment. And just going back to the example of changing your diet. So this could mean like not going down certain the aisles when you're in the supermarket to help you avoid buying those foods that you're trying to avoid, if that's possible. Or shopping online from a list and really trying not to add in any extras. I mean, something like stopping smoking. This could be getting rid of any leftover packs of cigarettes or tobacco to make it harder to smoke when you have an urge, and also removing things like ashtrays and other reminders of smoking from the house.

Julia: Yeah, you mentioned earlier that some changes are harder to make than others. So would you say there are any warning signs that people need to look out for? For example, they might need some extra help. This could be if they're really struggling to stop smoking or stop drinking alcohol.

Sarah: Yeah. So with smoking, you might feel like you can stop on your own and that you don't need any help. But if you find that you keep relapsing and you're finding it really hard to be smoke free for a long period of time, or if you're struggling to get out of that contemplation stage where you want to make a change but you don't know how to. Then it can be worth looking for additional support.

And I think that's where your GP or local stop smoking service can provide support, and they can sometimes provide aid such as nicotine replacement therapy. And then with drinking alcohol, so if you feel like you're losing control of this or that, you're struggling to reduce how much you drink. Or maybe other people have expressed concerns about your drinking, then I'd say again, contacting your GP can be the best place to start.

They can recommend additional support, and this also applies for other habits that you feel that you're not in control of and are struggling to change, or to address in some way. I think it's important to remember that some behaviours. Or deep rooted issues may require professional support, and we would always advise that if you're struggling with psychological difficulties and that can include addictive behaviours, then please seek help from a GP.

Julia: Julieta, do you have any additional tips or advice to share from your perspective?

Julietta: In cases of addiction where additional support is required, there are other means available that we encourage clients to consider. This could be a local support group to stop smoking, a GP, supporting the steps required to quit drinking alcohol, or even having talking therapy sessions that will help forming healthier relationships with food in the presence of an eating disorder. Our advice as health advisors as well as to GP's who see our clients provide not only this support, but also additional life coaching calls which will allow us to follow up with the clients on the goals that we set up, as well as the advice given.

Julia: Perfect. Thank you both. So, this concludes our second podcast. Next time we will address what to do when you have a setback or a relapse. As it’s otherwise known. But also why you shouldn't feel bad or guilty if you do experience this when trying to make a healthy change. Thanks for listening and see you next time.

Julia: Hello, I'm Julia Ebbens, a health content editor at Bupa, and this is our third and final podcast on how to make a healthy change. In this episode, we will be focusing on what to do when it all goes wrong. I'm here with Sara Griffiths. Hello.

Sarah: Hi Julia.

Julia: And Julieta Correa. Hi.

Julietta: Hi, Julia.

Julia: And together we will share some tips for coping with setbacks when trying to make a health change. Previously, we've talked about how to get started, and then we moved on to cover how to maintain a change, which for many people can be one of the hardest parts. This time we will focus on what to do when it all goes wrong. So this means if we have a relapse and we perhaps fall back into old behaviour patterns.

Hopefully this will reassure you that you're not alone, if this has been happening and you can feel more empowered and confident if or when this happens again.

Sarah, can you please remind us of where relapse fits into the overall stages of change model, please?

Sarah: Yeah, of course. So the stages of change model shows how someone typically progresses through various phases to achieve long term behaviour change. And the earliest stages are pre-contemplation, contemplation, and preparation. So that's where the decision to change and plans for change start.

And then the later stages are action and maintenance. So this is where the actual change occurs and are reinforced. So relapse can happen at any time between action and maintenance. And it's more common in the earlier days before reaching lasting change.

It's also possible to revert back to earlier stages, so it can be helpful to think about potential relapse triggers early on.

Julia: Definitely, it's nice to know it's something that could happen so you can be prepared for it and not worry about it too much if it happens. Julieta, can you share some real life examples of relapse that you've seen in clinic, for example, with smoking, exercise, or healthy eating changes?

Julietta: I think there's plenty of examples I could give. One of the most common ones is, a relapse that happens when someone is going through a more stressful period and they find comfort in foods, such as sweets, I’ll give an example, like chocolates and biscuits. And the habits, they early formed - they go off track. Other examples could be stop exercising due to changes in the environment, such as moving house or changing jobs, or even changes to the group of friends that somehow can influence our habits like, having more alcohol to take or even restarting smoking.

Julia: Definitely, it sounds like stress has a lot to answer for. Sarah. So why does relapse happen? Is it just because we get distracted with our day to day life? Or is there something more going on?

Sarah: Yeah, So there can be a number of reasons for this. It can be like a change to the usual routine, such as an upcoming holiday away or even the holiday season like Christmas. So if you want to change your diet or even reduce your alcohol drinking, I think the approach of Christmas festivities can really interfere with those best laid plans.

Or it could be something like a change in work pattern. So going into the office and not working from home may mean that it's more difficult to get out for your lunchtime walk or run, or it might knock your healthy eating off track. And as Julieta mentioned, stress can also be a big factor that interferes with our plans, particularly if the change feels difficult and it takes effort, and we already feel like we need to reduce the demands that we're putting on ourselves.

Julia: Sounds like we really need to be prepared for all of these potential changes.

Sarah: Yeah, definitely. And it can also be a result of setting unrealistic goals. So if you're not used to running and then decide that you want to run three times a week for 30 minutes each time, it might be quite difficult to maintain that behaviour. And it could also lead to avoidance. Or you could end up with an injury. And that could obviously really set you back.

Julia: Definitely.

Sarah: Yeah. So another thing to bear in mind is that some habit changes take longer to embed and become our new normal. So if we look at smoking, something that you may have may have done for many years, something that your body's got used to, often leading to kind of negative side effects when you stop.

It can take many attempts to quit for good and not achieving the results that we want to can make us feel like a failure, and that can move us back to that initial stage of pre contemplation, where we don't want to think about having to make a change.

So we can justify to ourselves that it's too hard to change. We've tried that. We weren't able to. So we can just carry on as we were.

Julia: Sounds like smoking is one of the harder behaviour changes to make. Which other behaviours would you say are the most difficult, or the ones you're most likely to relapse with?

Sarah: So I think exercise can be quite a tricky one. And it's definitely something that if you plan what you're going to do, that can make it easier. We can also be influenced by other people. So particularly in the early days of trying to make changes to our behaviour. Just going back to the example of smoking. So you might have friends or family who also smoke. Maybe they offer you a cigarette and you don't want to tell them that you've quit.

Feels a bit awkward. So instead you have a smoke with them and that can lead to another one. And obviously that can lead to an eventual relapse. And as we mentioned last time, if the behaviour that you're trying to change is tied in with your sense of identity and who you are, it can be really hard to break certain cycles of behaviour and challenge what other people think about you.

Julia: It does sound quite challenging. Definitely. Julieta, can you relate to any of these factors? Are they the types of issues your clients have previously linked to their own relapses?

Julietta: Stress has been a common cause. As it leads to question, what are we willing to do to make us feel better? It's a matter of prioritising, why we are keen to do so, as I think we can all relate to when you need to reprioritise.

The best is to work with our client to see positive experiences and learn from it. Looking for alternatives to the outcome we want to avoid and plan again literally as many times as we need to until it feels right. So breaking it down in small pieces, is something that we look at, very, very often just so the barriers don't seem so daunting and we feel that we have power over them.

Julia: Seems like stress is a really big issue for a lot of us. What would your top tips be for reducing stress?

Sarah: So if you feel like there's something that you can take control over, it can help you to just feel like you're managing your stress load breaking things down. Finding something that you can work on, actions that you can sort of look at.

And that can link to behaviour change as well. So if you're looking at working on your diet or your exercise, something that you can really feel positive about that makes you kind of balances out the stress that you might feel from other areas of your life.

Julia: So controlling what you can basically.

Sarah: Yeah.

Julia: Sounds good. Do you think the model of change actually takes into account some of the difficulties of making behaviour changes? I'd say on paper that the model shows how people progress through the stages. So that's like from pre contemplation through to maintenance.

But I think we all know really that people don't follow a straight path. People are complex. Behaviour change can be very individual and it can be really challenging. And as we've discussed before, it tends to vary depending on the behaviour that we're looking at. So you might go straight in into the preparation stage, find it relatively straightforward to change your behaviour, and then maintain that without experiencing any relapse. Or you might struggle at the contemplation stage or move back to this from action several times before achieving that lasting change.

Julia: So it's more like a theory, but sometimes for individuals it's going to look a little bit different in reality.

Sarah: Yeah. Yeah

Julia: So now we know all the different reasons that, relapse can happen. Hopefully we can be a bit kinder on ourselves in terms of understanding that relapses multifactorial and often the reality is we are subjected to lots of different stresses that can hijack that best effort and cause us to relapse. Moving forward, Sarah, how can we get ourselves back on track if we do experience episodes of relapse?

Sarah: I think it's really important to say that while it is possible to go back to the beginning of the cycle of relapse, it's more likely that you'll actually go on to achieve long term change, as you've already come quite a long way in that journey.

So take encouragement from that. It can be difficult if you've relapsed and gone back to the beginning kind of thing, but you can learn from what you've been through. Learn from those stages about what works for you so you can build on that when you try again.

And I think that's key, really. So just keep going, keep trying. Perhaps you know more about what you need to do differently now that you couldn't plan for earlier. So factor that in and recognise that maybe you couldn't have done it any differently before.

Maybe do some research, or you could reach out for support. And don't forget that planning the change that you want to make in more detail can also be really helpful. And this time you'll be more aware of relapse triggers. So it's great to think around those possible situations and have some back ups and ideas for tackling challenging times.

Julia: Absolutely.

Sarah: Yeah, And then also, maybe this time around you want to be accountable to someone. So this is something that can really help. If you've got someone that knows what you're trying to do and they can ask you about it.

Feeling like you don't want to disappoint someone. You don't want to admit that maybe things aren't working quite as you'd hoped. That can be a really good motivator. And that could be a friend, or someone in your family, or health care professional or a Bupa health advisor like Julieta.

Julietta: Absolutely.

Julia: For people who aren't familiar with the role of a health advisor, how would you describe what you do on a day to day basis and how it can help people?

Well, health advisors, can cover different areas in life, really. And that's, also compliments to the interviewer like approach we have in our assessments.

So, not all goes around about just diet and exercising sometimes it’s the stress levels. So we just mentioned this part of the podcast, or even an emotional reason or family member that makes us want to give a step forward. A classic example will be wanting to be better and healthier for our kids. So we help from those different perspectives.

So we touch on different areas of life that can affect our health from a physical, emotional, mental point of view. So based on that, we all have knowledge in terms of nutrition, basic health style, changes we can promote and encourage people to do we, assess the results. So we'll go through everything with our client. We have open conversations. And based on that, sometimes someone might start by saying -I really want to lose weight for this and that reason.

And we end up setting different goals because we come to realise that actually the changes that need to happen are not exactly what they expected or they visualised, because the knowledge about one's health kind of becomes more comprehensive as we go through the assessment.

So we advise that we guide the person to make those changes, which most of the cases people know exactly what they will need to start doing. And then we'll be there, for a further support in the future. But like

I said, with follow ups. So, I think it’s a welcome, a continuation. And, we leave our assessments with a confident feeling that they can make this change and they'll have the support to do so.

Julia: That sounds like a really valuable process. So thanks for explaining that. So now we know that it's not our fault if we sometimes struggle to sustain a health change. And we also know how to get back on track again.

So hopefully we will all feel more confident going forward. I think it's good to remember that making any kind of healthy change can be hard work but knowing that it's normal to go for these different phases can help us to feel less alone.

The reality is that making a positive change to our health is one of the best things we can do for ourselves, so don't give up and remember that you can overcome setbacks and move forwards. Sarah, if you had one final piece of advice for people listening, what would it be?

I think this would be easy to remember why you wanted to change your behaviour in the first place. So what was the motivation? You might have lost sight of this, so it can really help to revisit your original reasons for change. You might want to be healthier, have more energy, feel less stressed, just be a bit happier in life.

And it's also important to remember that you couldn't have relapsed back to normal behaviour without achieving some change, even if it was just for a short time. So you can really use that to remind yourself that you can do it again.

And this time, hopefully you know a bit more about how to tackle the challenges and setbacks that come along the way. And then make that long lasting change.

Julia: Sounds good. And Julieta, what would your top tip be?

Julietta: It's actually something you mentioned earlier, even if you didn't realise, it’s kindness. So it might not be as an expected thing because we're talking about behavioural change.

But, this seems to be an important piece when we're changing habits towards healthy living, because we need to be kind to ourselves. So any setback, anything that goes out of what we planned, can impact our motivation not in the best way. Can lead to feelings of disappointment, frustration, some looping, negative thinking, But accepting that being kind to ourselves and trusting that there will be other action plans or other habits we can create together, will definitely lead us to a happier and healthier life.

Julia: I think that's a lovely place to end. So thank you, Sarah and Julieta, and thank you for listening.