Chain breaking ice cream eating and watching television:

Our society has spent well over 30 billion dollars on weight loss products, yet despite this spending, the U.S. has not experienced significant improvement in rates of overweight and obesity or chronic disease.

Many diets and products focus on changing the amount of food consumed, the type of food consumed or adding supplements to influence weight loss or improvements in health.

Although it is well-known that weight loss requires creating a calorie deficit to lose weight, the value of behavior change to achieving long-term success is often overlooked. Food selection and the decision to eat are intricately connected to our environment, culture and traditions making behavior modification critical to sustainable change.

Behavior modification is more than just willing ourselves to restrict or eliminate food in our diet. To change a behavior it is essential to explore, in a non-judgmental manner, our daily food choices by keeping a detailed food record.

Keeping track of what was eaten, how much, where it was consumed, level of hunger, and a quick notation on why the food was selected can provide key information on how environment, culture and traditions influence our food decisions.

Dietitians employ several behavior modification techniques when working with clients interested in making food behavior changes. Three common strategies I use when I work with clients include:

this technique requires the individual to list the behaviors that tend to occur together such as eating ice cream while watching a movie.

Chain-breaking:

Dinner at 5 p.m. Do laundry. Help kids with homework. Put kid to bed. Wash dishes and clean the kitchen. See ice cream in the freezer. Make bowl of ice cream and watch TV show.

A strategy for breaking this behavior could be to wash the dishes after dinner to avoid going into the kitchen before watching television.

Stimulus control:

Involves reducing or removing the stimuli that is known to trigger the unwanted habit. Using the example above, the television may be a stimulus for eating ice cream that may require avoiding television watching at night or finding an activity to do while watching television such as folding laundry.

Cognitive restructuring:

Requires an individual to restructure their thoughts about eating. Instead of saying “I deserve this pint of ice cream for the stressful day I have had” we work with clients to develop strategies for non-food related rewards. “I have had a stressful day. I deserve this hour to go walk, talk with a friend, get a pedicure, golf etc.”

Changing food behaviors is key to achieving sustainable lifestyle changes for prevention and disease management. Before spending money on a promised product to improve health or weight loss, consider meeting with a dietitian. A Registered Dietitian Nutritionist (RDN) is highly skilled and trained to assess and evaluate how your food environment, culture and tradition is influencing food choices and can assist you in your journey to sustainable food-related behavior changes. continued from D1 closing too much and being triggering for individuals who are currently struggling,” said Johanna Kandel, CEO of the Alliance for Eating Disorders Awareness. “The calorie counting, getting on the scale — all of those behaviors can bring everything back up and start that inner conversation to go, ‘I should do this’ again.”

Kandel even fears that the conversation surrounding Collins’ own weight loss could be problematic, leading to a line of thinking that “‘if she can lose a little bit of weight and be OK, I should be able to.’ It’s not unlike an individual playing the role of an alcoholic having one or two drinks on set.”

Collins writes about her anorexia at length in her recently published memoir, “Unfiltered: No Shame, No Regrets, Just Me,” candidly discussing her addiction to diet pills and laxatives and how her eating issues affected her menstrual cycle. She says she thought long and hard about diving back into that mental space before agreeing to star in “To the Bone,” meeting with the head of the UCLA Clinic and attending Anorexic Anonymous groups.

“It was never a discussion of ‘Lily, we’d like you to get sick again,’ ” Noxon explains. “I knew she understood it and had lived it, but like me, she had a life that she was fierce about protecting.”

Turning to Collins, she adds, “I felt that really strongly from you — your life force, for lack of a better word. Obviously, we did everything we could to take precautions, but my gut was that Lily doesn’t want to go back there. She was strong enough that she could get close to the fire.”

Still, Collins found herself confronted by dozens of friends and family who expressed admiration for her weight loss in the midst of filming.

“There was an older lady I hadn’t seen in a while who saw me and said, ‘Oh, my God, look at you,’ ” she remembers. “And I was like, ‘I know, I’m in the middle of a movie and playing someone who is very sick, and I had to lose weight.’ And she was like, ‘No, what are you doing? I need to know.’ And she went over to my mom, and she was like, ‘Jill, have you seen Lily? She looks great! We need to get on that!’ And I got in the car, and she walked away, and I went, ‘Mom, that’s why this exists.’ ”

Even Noxon admits that working on “To the Bone” brought up old ways of thinking. Surrounded by tiny actors on set, she says, she often felt like she was “getting bigger and bigger and bigger.” One day, she turned to one of the film’s producers and said: “You need to tell me that I’m OK and give me a daily ‘Attagirl!’ ”

“Being an aging woman in Hollywood is no picnic,” Noxon acknowledges. “I’m a lot nicer to myself after making this movie. But I still have voices that tell me, ‘How dare you have a thigh?’ ”

It’s that firsthand experience with the struggle that made others in the eating disorder community confident “To the Bone” wouldn’t idealize anorexia.

“The idea that both Lily and Marti struggled with eating disorders — we knew they weren’t going to create something that was a howto guide,” says Liana Rosenman, cofounder of Project HEAL, an organization that has partnered with “To the Bone” and raises money to get those struggling into treatment.

“I do think this has the potential to be triggering for people who have eating disorders, but that said, everything triggered me before I was in recovery,” says Kristina Saffran, the other Project HEAL founder who met Rosenman at age 13 when they were both in treatment. “Not even just diet talk or juice cleanses. My dad would ask me to go for a walk with him, and I’d think he was saying I was fat and needed to go for a walk. In recovery, part of the process is learning to live in a world full of potential triggers and being OK.”

On Netflix, “To the Bone” is rated TV-MA — for mature audiences only — and features a disclaimer stating the movie “was created by and with individuals who have struggled with eating disorders, and it includes realistic depictions that may be challenging for some viewers.”

Noxon, meanwhile, is hopeful that many will look past the hand-wringing over the trailer and give the well-reviewed film — which landed a high-profile, reportedly $8-million acquisition at the Sundance Film Festival in January — a shot.

“There’s this idea that Hollywood sells over and over again: ‘If I just looked more like this, I’d be accepted,’ ” Noxon says. “I digested this value system that told me there was no one for me unless I reached a certain type of perfection. And as you get older, you realize that ideal is constantly changing. There’s no shape or body type that makes you more happy or more lovable. It’s the body you’re comfortable in that makes you happier and more lovable. I look around and see how women and men of all types find the love and the life they want.”