"Just do it" isn't enough: change comes in stages. Tufts University diet & nutrition
letter, 07474105, 19960901, Vol. 14, Issue 7
"JUST DO IT" ISN'T ENOUGH: CHANGE COMES
Section: SPECIAL REPORT
The release earlier this summer of the Surgeon General's report entitled Physical Activity
and Health certainly was well intended. But its advice was far from ground-breaking.
Americans had heard it before in countless other official reports: Get some exercise.
Perhaps because more than 60 percent of adults still are not heeding the call to engage in
enough physical activity, the report tries to make "enough" sound simpler than ever.
Walk, rake leaves, wax your car, wash windows--just do something.
Why won't people get off the couch and move their bodies? For that matter, why won't
they eat less fat, make a salad, or have fruit for a snack when they know these things are
good for them?
James Prochaska, PhD, a psychologist and head of the Health Promotion Partnership at
the University of Rhode Island, says it's because change doesn't begin with action. Thus,
whenever advice to change starts with the admonition to act--which is most of the time--it
Fewer than 20 percent of a population that needs to make a change are prepared for
action at any given time, Dr. Prochaska says in his book Changing for Good (William
Morrow and Company, New York, 1994, $22). "Yet more than 90 percent of behavior
change programs are designed with this 20 percent in mind." Everyone else falls through
Dr. Prochaska says action is the fourth of 6 stages of change (see page 5). Apparently,
he's onto something. His approach has been used successfully by, among others, the
National Cancer Institute to help people stop smoking, by the National Institutes for
Alcoholism and Alcohol Abuse to help people stop drinking, and by the Centers for
Disease Control and Prevention to curb behavior that leads to HIV infection.
To find out more about the stages of change, we conducted an exclusive interview with
Q: Don't many people make changes cold turkey? After all, you hear so many people say,
"I quit smoking once and for all on January 1st"; or "I woke up one day and said, 'That's
it!' and began to exercise."