Question: Many people have made a New Year’s resolution to lose weight and improve their health. Often they sign up at a fitness center or buy an exercise machine, use it a few times and stop. How can people break this pattern?
PROFILE
Hilary Valentine
>> Title: Occupational therapist and assistant clinical administrator
>> Organization: Manakai o Malama Integrative Health Care Group and Rehabilitation Center — Malama Kou Ola Kino Program
>> Education: Master’s in occupational therapy from Boston University
>> Contact: hilary@manakaiomalama.com
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Answer: Too many big changes in a short period of time are often unsustainable. We put ourselves too far outside our comfort zone. Some people respond best to small changes to their routines, while others respond great to one big change at a time. The key is really understanding how you operate and what works for you. Our program guides participants through a variety of self-discovery activities to help them learn about their strengths and weaknesses. Once this occurs, participants are better equipped to set plans and goals for themselves that are achievable and sustainable.
Q: You talk about separating weight loss goals from "the more important goal of self-acceptance and increased confidence." Why is that important and how do you accomplish it?
A: The belief that you are able to make positive change in your life through your actions is a cornerstone of making sustainable lifestyle changes. We call this belief "self-efficacy." When patients see how the changes they have made begin to impact their health, it motivates them to maintain those new behaviors and look for other ways of improving their health. This is most often accomplished by encouraging participants to begin with changes they are comfortable with. For example, a participant might decide to begin by switching from a sugary coffee drink to coffee with milk. This simple change can make a positive impact in their health over time.
Q: How does our body image prevent us from getting in better shape?
A: This also ties into the concept of building self-efficacy. When someone begins to feel good about who they are, they begin to take care of themselves better. Our thoughts guide our actions. Participants in the Malama Kou Ola Kino program that are able to change their outlook and gain new skills are more independent in their ability to continue making positive changes in their lifestyle habits and routines.
Q: Your program includes the use of a psychologist. What is the role of the psychologist?
A: As part of the Malama Kou Ola Kino team, the psychologists play a key role in helping participants sort through emotions and/or symptoms such as anxiety and depression. They use cognitive behavioral therapy techniques, which is a specific tool set that sorts through the triggers of a particular behavior. They help the participants work through past experiences that are holding them back from making changes in the present.
Q: You are an occupational therapist. Occupational therapists are known to work with children or adults with disabilities. What is the role of occupational therapy in a weight loss program?
A: Occupational therapists help individuals with habit change, which is essential to making sustainable changes for weight loss. As medical professionals, we also understand chronic conditions and the consequences of not managing them effectively. With the participants of the Malama Kou Ola Kino program, the occupational therapist functions as their personal health navigator. We help them better understand their medical conditions, educate them on various health behaviors and work with them on developing new habits, roles and routines that better support their health through goal setting and participation in health-enforcing activities.
Q: What medical or pain issues do people need to watch out for when starting a new exercise program?
A: Anyone with excess weight is at an increased risk for pain, and the onset of a new exercise routine can often set off this pain. It is important for everyone to consult with their medical provider before beginning a new exercise routine.
All of the participants in the Malama Kou Ola Kino program are referred to us by their medical provider. They have been identified as individuals at high risk for chronic conditions such as diabetes, or they are facing possible complications to a chronic condition that is not well controlled. As a team we work with the patient to develop an individualized healthy living plan, while educating them on and improving their ability to self-manage their conditions.
Q: What diet do you advocate, and is it the same for all patients?
A: We have a naturopathic physician that provides the participants with specific dietary recommendations. As an occupational therapist, I work with participants on their eating routines. This is the how, when, why and where they eat, rather than what they eat. However, in general I advocate for a whole-food diet that includes a balance of healthy macronutrients (fats, protein, carbohydrate). I am always encouraging patients to increase their plant-based food intake and lean protein. This includes vegetables, fruits, nuts, beans, whole grains, as well as fish, chicken and possibly bison, if they are adventurous.
Q: What lifestyle changes do you advocate?
A: As the occupational therapist I help the participants implement the recommendations their medical provider has given them. I always encourage slow, steady changes. Remember the tortoise and the hare? We all know who wins the race. Another way I explain this is consistency over intensity. Being consistent with an exercise routine you enjoy over the next year is going to have a more lasting impact on your health than a 30-day challenge.
Q: Tell me more about your program.
A: The Malama Kou Ola Kino program is targeted to people who have tried to lose weight or improve their health but have not been successful on their own or with other programs. We take an integrative approach by providing them with a variety of individualized services to target their unique needs. The services include occupational therapy, psychology, naturopathic medicine and physical therapy. Each participant works one on one with these professionals to develop their own healthy living plan. While in the program the participants work through the logistics of maintaining a healthy lifestyle, ways to make healthy habits convenient in their schedule, how to incorporate meaningful and enjoyable activities into their daily routines, and develop social support networks. These components help us get to the core of what has prevented the participants from reaching their health goals in the past.
Q: How much does your program cost, and how much of my time does it require?
A: To participate in our program, you need a referral from a physician because the services are provided by occupational therapists, physical therapists and psychologists. Physicians refer patients into the program who have diagnoses that have potential for improvement if the patient is able to make sustainable lifestyle changes, for example obesity or diabetes.
When referred by a physician, the services are covered by most insurance carriers, such as HMSA.
