The document outlines a behavioral weight loss and fitness program that uses applied behavior analysis principles including daily self-monitoring of nutrition, exercise, and weight; establishing exercise and nutrition habits through a progressive system of small changes; and integrating participants into a behavioral community for social support during the 6 month program.

1. Fat and SkinnerBehavior Analysis for Weight Loss and Fitness
January 8th 2016

2. The mission of our Branch Out Series is provide educa7onal opportuni7es to professionals interested in
understanding the broad applica7on of the science of behavior analysis.
ACE Provider: OP-­‐15-­‐2552
ObiGobi
INTRODUCTION
We are ObiGobi and Architects of the Knowledge Economy.

3. WEBINAR HOSTS
Fat and Skinner
Michael J. Cameron, Ph.D., BCBA-D
Sharing informa7on from the field of behavior analysis and behavioral medicine. My interest in using behavior analysis to op7mize
health and wellness.
David H. Freedman
David is a science, technology and business writer. Over the past few years, he has increasingly focused on health care, especially
with regard to the role of behavior change in preven7ng illness, and most especially with regard to obesity. David is also interested
in how these and other health-­‐care issues play out globally, and par7cularly in developing na7ons.
Summer LeFebvre
Summer is a Licensed Clinical Social Worker with a prac7ce in Anchorage, Alaska. Summer brings the perspec7ve of a person that
has been through each step of the program that will be described within this webinar.

4. Applications Applications
Safety
Environment
Behavioral Forensics
Verbal
Behavior and
Language
Aging
Autism
Clinical Therapy
Neuroscience
Applied Behavior Analysis
Diverse applica7ons of the science and you as a beneficiary

5. You will receive 1 CEU for
par7cipa7on. You will be required
to complete a survey and complete a quiz.
ACE Provider: OP-­‐15-­‐2552
Mechanics
A review of a stage-­‐based program for
establishing health promo7ng behaviors and
exercise adherence by Dr. Michael Cameron
Overview
A conversa7on with science writer, David
Freedman, on the role of behaviorally-­‐based
treatment programs to address body weight
and exercise adherence
Insights
Commentary and reflec7ons on a behavioral
approach to treatment by Summer LeFebvre
Progress
AGENDA
Overview of the Presenta7on

6. Definition
Behavior Health
Internal states influence behavior just as
powerfully as external s7muli. Consider:
• Reflux
• Migraine
• Menses
• Blood glucose levels
The Dependent Variable
The Society of Behavioral Medicine is a
mul7disciplinary organiza7on of
clinicians, educators, and scien7sts dedicated to
promo7ng the study of the
interac7ons of behavior with biology and the
environment, and the
applica7on of that knowledge to improve the
health and well being of
individuals, families, communi7es and popula7ons
Society of Behavioral
Medicine
Behavioral Medicine
Relevance for health and fitness
Behavioral Medicine is the interdisciplinary field concerned with the
development and integra7on of behavioral, psychosocial, and
biomedical science knowledge and techniques relevant to the
understanding of health and illness, and the applica7on
of this knowledge and these techniques to preven7on,
diagnosis, treatment and rehabilita7on

7. Relevance of Behavior Change
Factors Impacting Health
Environment Hereditary
Health Care Behavior Change
10%
Source: Schroeder, S. N Engl J Med 2007; 357: 1221-1228
7
50%
20%
20%

8. From a behavior analy7c perspec7ve ea7ng behavior is learned, suscep7ble to the same condi7oning mechanisms of all human
behavior, and amenable to environmental modifica7on. A behavior analy7c approach is different from generic and inclusive
systems
An interdisciplinary team of professionals including a Board Cer7fied Behavior Analyst, nutri7onist, and an exercise physiologist
working together. The team guides par7cipants over the course of 16 to 24 treatment sessions within a six month 7me frame.
The establishment of a behavioral community. The community should involve 10 to 20 par7cipants Par7cipants can meet and
communicate via text messages through HIPAA Chat.
Daily self-­‐monitoring of calories, fat, sugar, and salt intake. Daily monitoring of nutri7on, water intake and exercise. Calorie goals
based on Basal Metabolic Rate and progressive weight loss (e.g., one to three pounds per week).
Exercise goals of 1000 calorie (burn) per week or 150 minutes of moderate ac7vity.
Behavioral Weight Loss Program
Characterisitcs of a quality program

9. Begin with the end in mind.
Comprehensive measures are
required
Baseline
1
Assessment
3
Integra7on into a behavioral
community
Community
4
The establishment of habits
related to ea7ng and exercise
Rituals & Routines
5
Analysis of health-­‐promo7ng
and non-­‐promo7ng behavior
Analysis
6
An exercise intensity shaping
process
Exercise
7 8 9 10
Move from a technology-­‐
dependent system to an
independent system
Self Monitoring
2
A Progressive System
10 Steps to op7mal health
Use of the Construc7onal
Ques7onnaire based on the
work of Israel Goldiamond
Shaping
Data-­‐based decision making
for progressive change
Relapse
Par7cipants opera7onally
define a relapse and develop a
plan for management
Recovery
Personalized plan

10. Task List Item G-02: Consider biological and medical variables that may be affecting the client
Step 1 Begin with the End in Mind
Evaluator Measure Objective Information
Primary Care Physician Thyroid stimulating hormone (TSH) A level of 0.3 to 3.0 This test is recommended at the age of 35. A TSH
level above normal may indicate hypothyroidism
(an under active thyroid). A TSH level below
normal may indicate hyperthyroidism (an
overactive thyroid)
Primary Care Physician Fasting blood glucose 100 mg/dL (milligrams per deciliter) Results between 100 and 125 indicate impaired
glucose tolerance, also known as pre-diabetes,
which warrants follow-up evaluation and testing.
Results above 126 indicate the presence of
diabetes
Primary Care Physician Blood pressure 120/80 mm Hg (systolic pressure/diastolic
pressure, measured in millimeters of mercury)
High blood pressure (hypertension) is indicated
by results above 140/90. Results between 120/80
and 140/90 indicate pre-hypertension
Primary Care Physician Cholesterol Total cholesterol: 200 mg/dL or lower; LDL
("bad") cholesterol: 70 mg/dL or lower; HDL
("good") cholesterol: 40 mg/dL or higher
Cholesterol is measured in total and individual
readings
Primary Care Physician Blood count (hemoglobin) 13 to 17 g/dL (men), 12 to 15 g/dL (women)
grams per deciliter
A low blood count is associated with anemia and
should be discussed with your physician

11. Begin with the End in Mind
Evaluator Measure Objective Information
Primary Care Physician Body Weight Calculate your ideal body weight Determine your goal weight for the program
Self Evaluation Body Mass Index Calculate your body mass index Your Body Mass Index (BMI) is an estimate of
your body fat, based on your height and weight
Self Evaluation Circumference Measurements Using a measuring tape, measure your: bust, chest
(directly under the bust), waist, hips, upper arm,
thigh, calf, and ankle. You should also measure
your waist-to-hip ratio
Waist-to-hip ratio is determined by dividing your
waist measurement by your hip measurement.
Calculate your ratio
A certified personal trainer, athletic trainer or
strength and conditioning coach
Functional Movement Screen This is a quantifiable method of evaluating
basic movement abilities
This information will be used to design a fitness
program. The assessment will cost between
$75.00 and $100.00
Self Evaluation Resting Heart Rate (RHR)
You should try to measure your heart rate first
thing in the morning before you are active and
your heart rate rises. Simply count how many
times your heart beats in 1 minute
RHR is usually between 50 and 100 beats per
minute
Your heart rate reflects how hard your heart
works during exercise and tracking your resting
heart rate (RHR) over time can help you quantify
your fitness gains as it gets lower and lower
Task List Item I-03: Design and implement individualized behavioral assessment procedures

12.
Collect
Comprehensive
Baseline
Measures
Expect your health status to change in many ways

13. Personal Trainer
FITSTAR
WiFi Body Scale and Band
WHITINGS
Data Collec7on
MY FITNESS PAL
Step 2 Self Monitor and Quantify
A cornerstone of weight control programs and F-­‐O1: Use self-­‐management strategies

14.
Select
your
Self
Monitoring
System
Collect data on your comprehensive behavioral patterns

15. Life Style
Documenta7on of a preferred lifestyle (e.g., Vegan,
Vegetarian, Pescatarian, Mediterranean)
Body Weight
Between 115 and 125 pounds
Medical Measures
Blood pressure, blood glucose level, GERD
Exercise
Movement based on personal preferences
DEVELOP A HEALTH MISSION STATEMENT
Set your health goals and I-­‐O6: Make recommneda7ons regarding behavior that need to be established, maintained, increased, or decreased
Rosa’s Health Mission Statement
My goal body weight is between 115 and 125 pounds. My
fitness goals for my cardiovascular health include taking
dance classes or doing dance DVDs on a regular basis. I
will walk on the beach more and will eventually be able to
run/jog on it. I would like to swim in a pool more often to
increase my skill level in this area. I would also like to buy
a bike and ride it. To increase my flexibility, I will stretch on
a daily basis, with a special emphasis on ankle stretching.
I will increase my core, upper body and lower body strength
with exercises using my body weight as resistance. I will
incorporate exercise into my life 5 days a week
consistently.
I want to achieve these goals to decrease my blood
pressure, keep my blood sugar at a healthy level, reduce
the frequency and severity of my acid reflux, increase my
energy level, decrease my stress level and just feel better
in general. I would also like to see if meeting these goals
can increase my hemoglobin and vitamin D levels, as these
are too low. I would also like to see if meeting these goals
can decrease the frequency and intensity of my heart
palpitations. Overall, meeting these goals will decrease my
overall level of health and reduce my risks for a number of
health problems including diabetes and heart disease.

16.
Create
your
Health
Mission
Statement
Document your desired and comprehensive health outcomes

17.
Establish
Goals
and
IniDate
Small
Changes
Process goals
Short-term goals
Long-term goals
Event goals

18. BMR
Basal Metabolic Rate and basic
calcula7ons
Scatter Plot
A review of caloric intake and
ea7ng and exercise pacerns
Nutrition
A review of nutri7onal balance
Goal Setting
Process goals. Short-­‐term goals.
Long-­‐term goals. Event goals.
Exercise Preference
Cardio. Flexibility. Strength.
Gym-­‐Based. Home-­‐Based. Work-­‐
Based. Comfort-­‐Based
Technology
A review of Behavior
Interven7on Technologies to
support health change
Calorie and Exercise
Easing
Successive approxima7ons
toward caloric and exercise
goals
Trigger Analysis
Iden7fying consistent triggers
for food and exercise adherence
and non-­‐adherence
Step 3 Assessment
Personalized via the Mo7va7onal Interview and J-­‐01: State interven7on goals in observable and
measurable terms

19.
Collect
and
Review
your
Data
1. Your Basal Metabolic Rate
2. Scatter plot of your food and exercise patterns
3. Your nutritional profile (e.g., Nutritional Target Map)
4. Your exercise preferences
5. The low-tech or high-tech tools you prefer
6. Your calorie and exercise “easing” plan
7. Your triggers
8. Develop a “shaping” plan and make small changes
9. Plan and implement mini experiments
10. Analyze personal data

20. Virtual Community
Joining an on line community to
maximize accountability.
Accountability Change Management Building a Network Events
Building a Network
Establishing new connec7ons for
health promo7on and las7ng
behavioral change.
Proximate Community
Communica7ng health changes and
enlis7ng support from your
immediate community.
Events in the Community
Joining events where health
changes are validated (e.g., walking,
running, biking, hiking).
Step 4 Behavioral Community
The role of the community and op7mal health change and J-­‐06: Select interven7ons based on suppor7ng
environments

21.
Be
Accountable.
Create
a
Dashboard.
Report
Report your Key Health Indicators (KHI) to your
behavioral community. Communicate your intentions

22. Engaged in specific overt
modifica7ons. Using behavioral
interven7on technologies. Rituals
and rou7nes established
Action
Not ready for a change. Omission of
tacts
Pre-Contemplation
Sustaining ac7on for 6 months
and preven7ng relapse. Engaged in
problem-­‐solving behavior (e.g.,
vaca7on planning)
Maintenance
Gefng ready for change. Tac7ng the
issues (discomfort, medical
problems)
Contemplation
Zero tempta7on. No reliance on
contrived tracking systems. Transfer
of s7mulus control
Termination
Iden7fying and sefng process goals.
Observable and measurable
behavior (e.g., grocery shopping)
Preparation
Step 5 Rituals and Routines
An introduc7on to the Transtheore7cal Model (TTM) and G-­‐05: Describe and explain behavior, including
private events, in behavior-­‐analy7c (non-­‐mentalis7c) terms

23.
Plan
One
Good
Day.
Repeat.
Diversify
and
Intensify
Progressive and small adjustments for high probability success

24. Calorie Nutrition Problem Solving Network
Monitoring
Standards
Optimization
Personal Management
Step 6 Shaping
Engaged in the easing process and D-­‐05: Use shaping and set micro quotas
Exercise

25.
Establish
the
Targets.
Make
Small
Changes
for
Inevitable
Success
Caloric Intake (3500 reduction for 1 pound loss)
Fat, sugar, salt intake
Nutritional balance
Strength, flexibility, and cardio training
Expanding your health network

26. S
F
P
C
According to the American College of Sports Medicine (ACSM), adults should do
flexibility exercises two to three days, per week, to improve range of mo7on (ROM)
Adults require at least 2 hours and 30 minutes (150 minutes) of moderate-­‐
intensity aerobic ac7vity each week in addi7on to muscle-­‐strengthening ac7vity
and flexibility training
Adults require exercise outlets that are:
• Home-­‐based
• Work-­‐based
• School-­‐based
• Center-­‐based
Strength
Flexibility
Cardio
Preference
Step 7 Exercise
Intensity shaping and diversifica7on and I-­‐05: Organize, analyze, and interpret observed data
Studies from the Centers for Disease Control have found that muscle-­‐building exercise
can improve balance, reduce the likelihood of falls, improve blood-­‐sugar control,
and improve sleep and mental health

27.
Exercise
Based
on
Preference
and
Enjoyability
Exercise preference assessment. Consider the home-based,
school-based, and work-based setting. Also identify “comfort” routines
Sign Up

28. Step 8 Analysis
J-­‐05: Select interven7on strategies based on the client’s current repertoires
Fact 01Observations Fact 02 Fact 03 Fact 04
Your ea7ng pacerns
Your food preferences
Your exercise pacerns
Your exercise preferences
Your triggers (e.g., menses, restaurants,
alcohol)
High caloric intake from 6:00
to 8:00 PM
High carbohydrate
Morning time is best
Walking stairs at work
Consistent high calorie in
restaurants

29.
Data-­‐Based
Decsion
Making
for
the
Perfected
Self
Your guide to mini experiments and micro adjustments

30. J-­‐11 and programming for s7mulus and
response generaliza7on and J-­‐12,
programming for maintenance
Step 9 Define Relapse
The importance of opera7onally defining a
relapse and having a Personal Knowledge
System (PKS) design to allow you to recover
Relapse

31.
Define
Relapse.
Create
the
Recovery
Plan
before
it
is
Needed
The relevance of a Personal Knowledge Management (PKM) system

32. Step 10 Recovery Plan
J-­‐04 and selec7ng interven7on strategies based on client preferences
03 Stimulus Control
04 Macro Goals and
Micro Changes
01 Personal Knowledge
Management (PKM)
02 Self Monitoring

33.
Fill
your
Personal
PrescripDon
Your recovery plan should be authored by you before it is needed

34. Journal of Behavior Therapy and
Experimental Psychiatry
S7ckney, Miltenberger, and
Wolff (1999). A Descrip7ve
Analysis of Factors
Contribu7ng to Binge Ea7ng
Cameron, Maguire, and
McCormack (2011). Stress-­‐
Induced Binge Ea7ng: A
Behavior-­‐Analy7c Approach
to Assessment and
Interven7on
Normand (2008). Increasing
Physical Ac7vity through Self-­‐
Monitoring, Goal Sefng, and
Feedback
Hurley et al. (2015). The
Walking Interven7ons through
Tex7ng (WalkIT) Trial:
Ra7onale, Design, and Protocol
for a Factorial Randomized
Controlled Trial of Adap7ve
Interven7ons for Overweight
and Obese, Inac7ve Adults
Denham (2003).
Rela7onships between
Family Rituals, Family
Rou7nes, and Health
We are ObiGobi
Select ar7cles to keep you inspired
The behavioral processes involved in a person’s
self control are the same as those one would use
in controlling the behavior of others (Skinner, 1953)
Journal of Adult Development Behavioral Interventions Journal of Medical Internet
Research
Journal of Family Nursing

35. GET IN TOUCH
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33062
Phone
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