Health behavior change practice questions for the lifestyle medicine boards
Behavior change questions are often counseling vignettes. You pick the best next thing to say or do, based on the patient's stage of change and what they just told you.
ABLM exam domain: Fundamentals of Health Behavior Change
10%of the ABLM exam
~15of 150 physician questions
~12of 120 health professional questions
158questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
Behavior change theories: the health belief model, social learning theory and the transtheoretical model
Stage-matched assessment and responses within the transtheoretical model
Motivational interviewing, cognitive behavioral, health coaching and positive psychology techniques
Building and repairing the therapeutic alliance with open inquiry, reflection and empathy
Written action plans, follow-up, self-efficacy and relapse prevention
Family support and resources for sustained change
High-yield areas
Stages of change and the matching intervention for each
Motivational interviewing: OARS skills, change talk versus sustain talk, and responding to discord
SMART goals, action plans versus coping plans, and self-monitoring with feedback
Self-efficacy and the sources that build it
Relapse prevention and maintaining change over time
How to study it
Read each answer choice as something a clinician would say out loud. The right answer usually reflects where the patient is now, not where you want them to be.
Free practice questions: Health behavior change
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · easyFundamentals of Health Behavior Change
A health system serving mostly low-income patients considers embedding health coaches in primary care clinics to deliver an intensive lifestyle program for obesity: weekly sessions for 6 months, then monthly sessions through 24 months. In the PROPEL cluster-randomized trial of 803 adults in 18 Louisiana clinics, 67% of whom were Black, which result was reported at 24 months?
About 5% weight loss versus 0.5% with usual care
About 12% weight loss versus 2% with usual care
No significant difference from usual care in percent weight loss
About 5% weight loss, with more serious adverse events than usual care
Similar loss whether patients attended most sessions or few
Show answer and rationale
Answer: A. About 5% weight loss versus 0.5% with usual care
A (correct): Correct. Percent weight loss at 24 months was -4.99% with the intensive program vs -0.48% with usual care (difference -4.51 percentage points), with no significant difference in serious adverse events.
B (incorrect): Incorrect. Mean loss was about 5% vs 0.5%, not 12% vs 2%.
C (incorrect): Incorrect. The intensive program produced significantly greater weight loss (P<0.001).
D (incorrect): Incorrect. There were no significant between-group differences in serious adverse events.
E (incorrect): Incorrect. Patients attending at least 80% of sessions lost 7.07% vs 1.93% among those attending fewer, so attendance mattered.
Source: Katzmarzyk PT, Martin CK, Newton RL Jr, et al. Weight loss in underserved patients: a cluster-randomized trial. N Engl J Med. 2020;383(10):909-918 (PROPEL). Abstract Methods and Results (18 clinics; 803 adults; 67.2% Black; -4.99% vs -0.48% at 24 months; no difference in serious adverse events); Results, Weight Loss (attendance at least 80%: -7.07% vs -1.93%). https://pmc.ncbi.nlm.nih.gov/articles/PMC7493523/
Question 2 of 4 · easyFundamentals of Health Behavior Change
A 39-year-old man with obesity wants to build one new automatic health habit and will tie it to a consistent daily cue. Based on the habit-formation evidence summarized by Gardner and colleagues, which daily action is likely to reach peak automaticity most quickly?
Doing 50 sit-ups after brushing his teeth at night
Preparing a vegetable-based lunch after his shower
Drinking a glass of water with breakfast each day
Doing a 30-minute bodyweight circuit after work
Planning the next day's meals after each dinner
Show answer and rationale
Answer: C. Drinking a glass of water with breakfast each day
A (incorrect): The summary uses 50 sit-ups as its example of a more elaborate routine, which reached peak automaticity more slowly than simple actions.
B (incorrect): Preparing a full lunch is a multistep routine. More elaborate routines took longer to become automatic.
C (correct): Gardner and colleagues report that automaticity peaked more quickly for simple actions, such as drinking water, than for more elaborate routines, such as doing 50 sit-ups. Their advice is to choose a simple daily action toward the goal.
D (incorrect): A 30-minute circuit is an elaborate routine and would be expected to take longer to become automatic.
E (incorrect): Meal planning involves several decisions and steps, so it is more elaborate than a single simple action.
Source: Gardner B, Lally P, Wardle J. Making health habitual: the psychology of habit-formation and general practice. Br J Gen Pract. 2012;62(605):664-666. Section 'Habit formation and health': automaticity strength peaked more quickly for simple actions (for example, drinking water) than for more elaborate routines (for example, doing 50 sit-ups); Box 1 step 2: choose a simple daily action. https://pmc.ncbi.nlm.nih.gov/articles/PMC3505409/
Question 3 of 4 · easyFundamentals of Health Behavior Change
A 66-year-old man with stable rheumatoid arthritis usually completes his prescribed hand exercises. During medically assessed flares, pain makes the usual resistance intolerable. His rheumatology team has provided a flare-management plan and confirmed that gentle activity is appropriate. Which coaching plan best supports maintaining the exercise behavior?
Reduce the resistance for the entire month after each painful flare.
Add extra resistance sessions after symptoms settle to recover missed work.
Use hand discomfort as the daily signal to decide whether to exercise.
Agree on a flare-day routine and planned return to usual activity.
Pause the exercise goal until he achieves four consecutive pain-free weeks.
Show answer and rationale
Answer: D. Agree on a flare-day routine and planned return to usual activity.
A. Incorrect: A fixed month-long reduction may unnecessarily delay progression after recovery and is not matched to fluctuating capability.
B. Incorrect: Compensatory catch-up sessions can exceed current tolerance; a maintenance plan should adapt to the flare rather than create an exercise debt.
C. Incorrect: Using pain alone as the behavioral cue can make the routine inconsistent and promote avoidance; the medically agreed plan should guide adaptation.
D. Correct: An agreed coping plan preserves a manageable routine, accommodates changing capability and specifies how to resume the usual goal. Medical flare care continues separately.
E. Incorrect: Requiring a prolonged pain-free interval may postpone achievable activity even when modified exercise is medically appropriate.
Source: https://www.nice.org.uk/guidance/ph49/chapter/1-recommendations | NICE PH49, Recommendation 8: assess physical capability and tailor intervention; Recommendation 10: maintenance, coping plans for relapse and difficult circumstances, manageable routines and review.
Question 4 of 4 · moderateFundamentals of Health Behavior Change
A 52-year-old man lost 18 kg over the past year and is worried about regaining it. His clinician considers a maintenance program built on self-regulation theory and reviews the 18-month STOP Regain trial by Wing and colleagues, which compared face-to-face and Internet delivery of the same program with quarterly newsletters. Which finding is accurate?
Internet delivery reduced mean regain more than face-to-face delivery
Daily self-weighing was associated with a higher risk of regain
Mean regain was similar, about 5 kg, in all three groups
Face-to-face self-regulation with daily weighing cut regain
Participants entered after losing a mean of about 5 kg
Show answer and rationale
Answer: D. Face-to-face self-regulation with daily weighing cut regain
A (incorrect): Incorrect. Mean regain was 4.7 kg with Internet delivery versus 2.5 kg face to face; the significant difference in mean regain was between the face-to-face group and controls.
B (incorrect): Incorrect. Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more.
C (incorrect): Incorrect. Mean regain was 2.5 kg face to face, 4.7 kg Internet and 4.9 kg control.
D (correct): Correct. Mean regain was 2.5 kg with face-to-face delivery versus 4.9 kg in controls, fewer face-to-face participants regained 2.3 kg or more (45.7% vs 72.4%), and daily self-weighing was associated with lower risk of regain.
E (incorrect): Incorrect. Participants had lost a mean of 19.3 kg in the previous 2 years.
Source: Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355(15):1563-1571. Abstract Methods (314 participants with mean prior loss 19.3 kg; control newsletters, face-to-face or Internet program emphasizing daily self-weighing and self-regulation) and Results (18-month regain 2.5 kg face-to-face, 4.7 kg Internet, 4.9 kg control; regain of 2.3 kg or more 45.7%, 54.8%, 72.4%; daily self-weighing associated with decreased risk of regain). https://pubmed.ncbi.nlm.nih.gov/17035649/
For exam preparation only, not clinical advice.
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