Ashlee Williams, MD (Host): At the start of a new year or following a milestone birthday or new medical diagnosis, many of us set goals for ourselves to make positive lifestyle changes. But creating new habits takes time and energy. So, what can you do to increase your likelihood of success?

Welcome to the Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Michelle Arthurs, a primary care physician and leader in the Lifestyle Medicine Program at Kaiser Permanente, about techniques and tactics you can use to set goals and make healthy, sustainable changes. Welcome, Dr. Arthurs. Thank you so much for joining me today.

Michele Arthurs, MD: It's my pleasure. Thanks for having me, Dr. Williams.

Host: Okay. So, let's get started. Why are resolutions important for making healthy changes?

Michele Arthurs, MD: It's a great question. It's a great place for us to start. Resolutions are a commitment to change, and it's a wonderful way to sort of refresh, recommit to ourselves and recommit to other people that are important in our lives at the start of any year. They can help us get on track. They can help us stay on track. And when we think about the time frame for making changes and resolutions to help keep them stick, studies do show that at about 21 days of maintaining a change in our life, whether it be a dietary change, an activity or exercise change, a mental health commitment, if we can stick with it for those three weeks, those 21 days, we have a much better chance of success and sustainability with the change that we have started for ourselves.

Host: All right. So, why is it important to understand your motivation for your goal or resolution?

Michele Arthurs, MD: Absolutely. So, the why is super important. It's the internal motivator for us. It's what keeps us going. It's what helps keeps us motivated, helps keep us centered, and helps us keep our eyes on the prize. That's for what's in front of us. That's our motivation. So, it might be even for our kids. It might be for a family member. "I want to be healthier so that I can hang out more with my grandchildren." It helps us think seriously about what we're doing and why we're doing it. For example, are we going to try to eat healthier to lower that cholesterol and therefore decrease our risk for a cardiovascular event like a heart attack or stroke? Do we want to be able to do a 5K with our family? And that may take time for us to get conditioned and in shape to be able to do it. And if you understand your why, and the why is your true north, it's going to help you be successful and stay successful.

Host: It sounds like if I'm going to run a 5k with my family, I need to have some goals for my entire family. Like I need to motivate everyone, right?

Michele Arthurs, MD: think that would be a good thing to consider. The more the merrier. And yeah, when families make change together, we all get the benefit within that nuclear group. And it can become a tradition.

Host: So, what are your thoughts on having five, 10 goals at one time?

Michele Arthurs, MD: Good question. This is often something that comes up with patients when we're talking about change. It's really about knowing you, knowing what you are able to hold on to, what you are able to sustain. And for some of us, It's going to be one change at a time, and that's perfectly great. So if that's your personality, I can handle one change at a time, then you focus on that one change, you attain it, and then you can move on to the next goal, when you feel that you've been well grounded and been able to hold onto what your commitment to yourself has been.

There are people and, gotta love them, who are able to make more than one change at a time. And that's fantastic. If you were able to do that, go for it. And I would really encourage you to make sure that these goals, if there's multiple of them, that they're reachable. They're reachable, and you set yourself out even little minor milestones along the way, so you can track your progress and you could recognize how far you've come.

Host: Yeah. I love saying that we need to make a goal that's reachable. I think that helps with the motivation. So, what would you say is the best way to set goals?

Michele Arthurs, MD: Oh gosh, it's great. So, it's really a thought process And I would encourage everyone to consider about really just sitting down, having some protected time; writing things down in a particular pattern here, which I'm going to explain. We don't want to take 30 seconds and say, "All right, I've decided I'm going to go to the gym three times a week." You know, that's not doing the change justice. We want to be able to sit in our space, whatever that might be, and come up with some SMART goals. So, there are some letters and an acronym, everybody loves those, that can help us get on track and stay on track.

So, you want to break your goals into steps. S is for specific. Is it a journal? Is it a note on your iPhone? Is it your screensaver? Is there some way that you take a picture of it and anytime you pick up your phone, you see exactly what it is that you have written down? Is it going to be on your calendar? So, let's say if your current weight is around 200 and you want to lose 20 pounds or about 10% of your body weight by the end of the year, you set a goal to lose two, three, maybe even four pounds a month so that you're doing it at a steady pace that's attainable, not rushed, and achievable. We want to keep ourselves encouraged. At some level, we have to be our own coach here too. Our own coach, our own cheerleader, and so forth.

Host: And more about the marathon and not the sprint, right?

Michele Arthurs, MD: Oh, that is yes, yes, yes. So well said. It is about the marathon. And we have to prepare for the marathon, right? If we don't, it's not going to go. So the same is true, absolutely, with any type of goal for change. You want to make sure that we have a way to measure our success. If it's a number, that's great. If we've decided as our goal that we're going to be more connected to the friends in our lives or try to reinvigorate some friendships that may have fallen by the wayside during the pandemic. What's a measurable way to quantify that? How often are we going to see these people? How often are we going to reach out to them? What are we going to do? And in keeping a record in some way of that helps us realize that we have had success, that we've made strides, that we've had movement.

And as you said, Dr. Williams, it's not about the sprint, Sprints are exhausting. They're not terribly the way we want to do very much. But along the way in that marathon, you're going to pass by the five-mile marker, whatever that might be with your goal, then the 10-mile and so forth. And at each of those mile marker, you can celebrate. And you can do this to celebrate multiple goals too. And don't be afraid of congratulating yourself. You're working hard. You don't have to wait until you reach your goal to give yourself a pat on the back and recognize how hard you've been working.

Host: I think pats on the back at any time, even the small wins, are important.

Michele Arthurs, MD: Yes. Yes, absolutely. And there's so many ways. And just if anyone is thinking about how to improve nutrition, I tend to shy away from the word diet because that can make us feel like there's a standard start time and then there's an end time. But a lifestyle change, a nutrition change, is forever. No, it's not really a diet. And a simple thing to do is to consider how you construct your plates when you're eating.

And, Dr. Williams, I brought my favorite little plate with me today because I was really hoping I'd have a chance to share this. But you'll see here that this is a way to think about your plate. There's three parts, three colors, and you can guess. The green means vegetables, plants. So if we can focus on half of our plate as plants or vegetables, we're in a good spot. And the other two little corners over here would be a protein. It doesn't have to be meat. And the other side is going to be carbohydrates. And we also want to be mindful of the carbohydrates that we choose. I know we don't have time to talk about all of that today, but focus on the green. Focus on the green.

There are so many ways to start in a way that's measurable, that's attainable, in a way that we can do it with some small changes that can make a big difference.

Host: Yeah. I love what you said about taking away the word diet and saying lifestyle change, right? Because there's so many different diets out there, but it's what you can stick to and what works for you. And making the long-term lifestyle changes is really how people are most successful.

Michele Arthurs, MD: Yeah, absolutely. And sometimes, it's human, right? We get in this trap where it has to be like all or nothing, right? And if it's not all, we failed. And we've done nothing, right? And so, think about something that is doable for you. We're not saying you got to be vegetarian. Nobody's got to be vegan or vegetarian, but move towards that. What is that gonna look like for you? If you have meat three times a week, go down to two or one. Find a way to decrease the amount of animal products that you eat and this will help you have most likely a lower cholesterol and a lower cardiovascular risk and a lower risk for diabetes as well. So, something that you can do, and it's not all or nothing. And I find that way of thinking very, very, I mean, honestly, just human. You know, nobody's perfect, nobody's got it all figured out.

Host: Yeah, I love it. I love it. I remember when the keto diet was really big, and still a lot of people are doing that. But I baked cookies for the office and I offered one of my colleagues a cookie who was on the keto diet and he said, "Why would I eat that?" And I thought, "Well, it's okay to take a break every now and then," right? Because again, no one is perfect.

Michele Arthurs, MD: And we have to have some sense of balance in our life. The pendulum can't stay swung in one direction. So, it's okay to have exceptions. They're not failures. So if you're going to a four-year-old's birthday party and there's some cake, go for it, but maybe not the size that they're going to hand to you. You might need to cut that serving down a little bit or, you know, ask for a smaller amount for whatever reason. And those things are good. Like, our social lives are very, very surrounded by these types of celebrations and really how food kind of plays into all of that. So, there's room to be human about this whole thing.

Host: Yeah, so true. Okay, Okay. So on that tip, should we tell other people about our resolution?

Michele Arthurs, MD: Sure. So, that's a great question. And again, whoever is listening and whoever's considering this think about what's going to work best for you. you may not want to tell anyone and that's okay. You don't have to. You can hold this on the inside and be the true north for yourself and stay focused and so forth.

But, or, and, there are benefits to telling another person. And as you mentioned earlier, Dr. Williams, you know, it could be a family event. And that can even, you know, enhance the reward that comes to it when you see other people that you care about joining with you and improving their lives in some way. There's a benefit to either side if you want to do it yourself or you want to do it with friends, family, whatever, or a partner.

There's also apps that are available. We have so many apps that do so many different things. And there are some of them that are really, really helpful to guide us and keep us on track. So, that's another way to consider having that focus and that kind of level of making sure that we are honoring the resolutions and the goals that we've set for ourselves.

Host: Yeah, I feel like there's an app for everything now. Do you have other tips for staying on track, other than apps?

Michele Arthurs, MD: Oh, sure. I think it's important for us to realize that change is incremental. It's not a black or white situation. It's not a day or night situation that, on a Monday and a Tuesday, we may meet our goal of having a plate half full of vegetables. But come Thursday, Friday, you know, it may not be there. But in the next month, we've been more successful having three more days a week that have met our goal. And we can look back and realize that, you know, in December of 2023, we had no vegetables. And now, look at us here in March, and we're eating the kale, we're eating the spinach, carrots, whatever it might be.

And giving yourself permission to treat yourself is a good idea too. I mean, I think most of us enjoy the sense of a reward in some way, whatever it might be. I've had a patient tell me that when she had met her goal of losing about 30 pounds, she was going to buy herself a new pair of shoes, and she really wanted these shoes. And so, there you go. I mean, there's that wonderful reward and excitement. And, you know, we get to feel even better about what we've done when we do that for ourselves.

We also want to think about just moderation in general. I would encourage everyone to be patient with the inner you in whatever way that you need to. Don't let the aspects that are challenging or what we think of as a failure, but it's really not, it's not a failure, it's an exception. Don't let that bog us down, and make sure that we keep our focus on what our goal is. And moderation can work for many of us. Again, not for all of us, but it's an option.

Host: I always think treat yourself is a great thing. Do you have any other tips that you would like to share?

Michele Arthurs, MD: Sure. I I want everyone who's listening to think about changes in a broad sense. And I'm going to give you some ideas to think about. You know, for some of us thinking about nutrition, it can be hard. In discussing with patients, I've also heard patients say, "I'm just not in a place where I can really devote this amount of time in theory to making any changes to my nutrition." So, think about your sleep habits. Do you need to have a more regular bedtime? Do you need to have a better going to sleep routine that doesn't involve screens? Do you have any concerns about the amount of time that you might be looking at your phone or any particular apps that we've mentioned? Can you set limits for yourself and realize that the time that you spend on a device is time that's missing from the rest of your life? I encourage patients to put one of the control apps to monitor screen use and look back in a week and realize that you might have missed 24 hours on your phone. That's a whole day missed that's gone. And the same is true for our kids. You know, if we're working together as a family to really explore any area in our life that could benefit from a change.

So, the most common ones this time of year are exercise, right? And nutrition. It seems like the exercise equipment flies out of the stores this time of year. So, there's so many ways for us to consider intervening for ourselves in our lives. And I would say give yourself grace. Give yourself the grace to keep going. If you have a stressful situation in your life, and you fall away from the daily commitments that you've made to yourself, that is okay. That happens. I can't think of a time in anyone's life where, you know, you wouldn't have something like that happen. And giving ourselves grace in that moment can help us, you know, really provide the attention needed to pull ourselves back up and keep going.

Host: Well, thank you for this great information, Dr. Arthurs. It sounds like there are a few key takeaways for anyone looking to make a change. One, understand your why and what's motivating you. Two, the best way to begin is to start with a SMART goal: specific, measurable, achievable, relevant, and time-bound. And three, find an accountability partner or system that works for you. And give yourself grace.

For more tips from our doctors and other healthy living advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you from all of us at Kaiser Permanente. Be well.