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February 2020

Narrowing the Focus

I feel very fortunate to be able to be involved in the wellness efforts of many people at many levels. In the medical-based clinical setting, it is a one-to-one encounter. In one of the eleven graduate­level classes that I have designed to explore the many aspects of lifestyle, the encounter is one person guiding the focus for 15–50 people, and sometimes in a large group auditorium or ballroom setting, it is one person guiding 100 or more people. Each setting has its unique characteristics. All are necessary in order to personalize wellness plans for individuals. Some people need information. Some need empowering through accountability, first to another and then to themselves. One hundred people require 100 plans.

The Common Thread

There is 1 common thread that runs through almost all the thoughts that people have about how to become a well person: “I have many changes to make, and I need to make all of them as soon as possible.” Most of the classes I teach are structured so that there are 4 4-hour sessions spread over a 2-week period, and 1 assignment I frequently give in this classroom setting after they have been together for the initial session is to ask each individual to share how they are different (how they have changed) as a result of the initial session. I ask them to list 1 way in which they are different. It is amazing how very few people can list only 1 change. Most want to share a number of things they have changed, even after only 1 meeting. They are not used to narrowing the focus. A person that hears a discussion on the importance of starting the day with a good breakfast and switches to a bowl of whole-grain, unsweetened cereal with nonfat milk, and some fresh fruit for a sweet taste, instead of their normal (a sugar frosted cereal, a spoon of sugar, and 2 percent milk) has really made 3 separate and significant changes. This is an excellent group of changes, but frequently long-term success is more likely if these 3 changes were made over a 3-week period (1 change per week).

List All the Weaknesses

We are very used to having someone point out all the weaknesses at once. It is really better to be “underwhelmed” than overwhelmed by all that must be changed. Even when you see a long list of what you need to modify, remember to work on only 1 change at a time. My warning is not to get “global.” For example, when looking at the dietary fat intake, it is better to refrain from saying, “I am going to wipe fat from the planet, or at least from my entire eating plan.” The alternative is to “narrow the focus.” When attempting to reduce fat, select 1 item or 1 behavior:

Examples:

 Drop 1 fat level on the milk you put on your morning cereal. (Go from 2 percent to 1 percent, or from 1 percent to skim.)

 Go from light mayo on your turkey sandwich to fat-free.

 Go from a large popcorn at the movies to a small.

 When eating at a pizza restaurant, eat 1 slice instead of 2.

 If every dinner meal always has meat (cows, pigs, turkeys, fish, game, etc.), hold the meat for 1 dinner per week.

 Tell the deli person who makes your turkey sandwich each noon to hold that slice of cheese. (Take turkey or cheese, not both.)

How to Narrow the Focus

The main technique that I have found patients in the clinic setting experience success with has been the 1-item log (diary) used over a specific time frame. This is not a fancy preprinted form. It is usually a 1-sheet, simple, tacked-to-the-refrigerator-type log that is kept current. It is never recall. It is kept current. It has a date and 1 other category. Remember, the focus is narrow. The only time that I recommend more than 1 category is when a patient has already been very successful in another area of behavior change. It may be an area that, in the past, was the “narrow” focus, and now it does not need the same mental energy to work. It is now a habit. Putting this on the daily focus log reminds the person that they have been successful in behavior-changing in the past. It is a good motivator, a pat-on-the-back, to see the success in writing. For example, if someone has their exercise going daily, a category for exercise would provide some very visual feedback to the person that says, “I’m doing great” in my exercise, and I can do just as good in my new “narrow focus” area of emphasis.

Narrow Focus Log

The 1-page log, for someone doing great with their exercise and now wanting to make sure that they always eat fruit at lunch, could look like the following. It could be a piece of notebook paper posted on the refrigerator. Try this format. Pick your own area on which to place that narrow focus.

Date

Exercise (minutes)

Fruit at Lunch (name of fruit)