94: The Motivation Checkup Episode 3: Small Steps, Lasting Change

 In this episode, we explore why starting small is actually the most effective way to build lasting habits. Big goals can feel overwhelming, and relying on motivation alone often sets us up for failure. By focusing on tiny, repeatable actions — what we call minimum viable habits — you can protect your confidence, maintain consistency, and slowly train your brain to see yourself as someone who shows up. We break down the psychology behind small wins, explain why doing less can actually lead to more, and give practical examples you can start today to make real, sustainable progress. 

Chapters

• 0:00 Banter, Birthdays, And Best Dinner
• 5:55 Head Spa, Dim Sum, And TV Talk
• 14:31 Kicking Off Motivation Series Part Three
• 16:15 The Myth Of Big Effort
• 18:40 Why Small Changes Work
• 21:48 Breaking All-Or-Nothing Thinking
• 23:12 Practical Tiny Habits For Health

Transcript

SPEAKER_02: 0:06

Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area.

SPEAKER_00: 0:21

And I'm Nicole Rufo. I'm a nurse.

SPEAKER_02: 0:23

And we are so excited you were able to join us here again today. Well, catch us up. What's been going on? Um, what is top of mind when you think banter for this week?

SPEAKER_00: 0:36

For this week. Uh wait. I don't know. A lot, I guess.

SPEAKER_02: 0:43

Yeah.

SPEAKER_00: 0:45

We had my birthday.

SPEAKER_02: 0:47

What a great day.

SPEAKER_00: 0:48

That was a really great day. Right? We had, I know we say this like every other week, but probably actually the best dinner that we've ever had.

SPEAKER_02: 0:57

This might have been it. Yeah. And then we like compared notes with some of our friends, and we we can definitely talk about how we spent our um the rest of our weekend. But I mean, like I that there's no Michelin star with it, but that might have been I feel like that's the best restaurant we've been to.

SPEAKER_00: 1:15

Yeah. I yeah. I have no other words.

SPEAKER_02: 1:22

So where where do we go? No one knows. They we didn't talk about this.

SPEAKER_00: 1:27

We went to vetery. Uh yeah, I'm so tired. I understand.

SPEAKER_02: 1:36

That's all right. I can start this over. No, it's okay. We're keeping it authentic. Let the people know that, like, you know, we do this even when we're not a hundred percent. Yeah, we're sleepy. We stayed up late. So you went to vetery? All right. Well, it sounds like you're um a little more interested in your your puzzle over there. Um this is the first and only restaurant I have ever been to with an emouge boosh.

SPEAKER_00: 2:11

You keep saying that.

SPEAKER_02: 2:13

Well, yeah, because it's a funny thing to say. Um there's a fantasy podcast that I listened to that the the woman says like her episode is the emoji boosh to the to the real one. It's fantasy focus. And I was like, oh, an emouge boosh. And then when they whipped out the emouge boosh, I was like, oh my god, no kidding. And they're just like, yeah, just sling it back. It's a chicken tortellini that is just waiting for you to be to devour it. So we did that. Um, what were the two? Oh gosh. Um, tough to even recall how detailed they were. But it was such a it was a nice experience because I had gotten Nikki the the pasta book, Mark Vettry's pasta book for Christmas. And I had been taking a couple minutes to read about it. And, you know, he like it seems like he's an artist, and he was talking about making the pasta and what pasta means to people, and it just made it all the more meaningful going to his restaurant to be able to be like, oh wow, I know a little bit more about this guy. And it just it meant more.

SPEAKER_00: 3:30

Yeah, it's a little discreet. It's nice because it is like inside, I feel like is kind of like laid back.

SPEAKER_02: 3:43

Yes.

SPEAKER_00: 3:44

But it's still I don't know, like a fine dining experience. Like it's like a tasting menu situation.

SPEAKER_02: 3:56

Well, there is a tendency for some of these places to be very loud, and I would say that it was a pretty calm environment to be able to go there and sit and just enjoy. So that was very nice. Did not take that for granted. Um, the they definitely added in a pasta for us, which was very nice.

SPEAKER_00: 4:16

Yeah, that was really good. The little ravioli with like squid.

SPEAKER_02: 4:20

Ravioli with squid, the most memorable thing. And I mean, we just put it in, you just take a bite, and it was the spinach gnocchi. Oh my god. That was like the creamiest, most unexpected thing.

SPEAKER_00: 4:35

Yeah, and it's in the new cookbook. So I think we're gonna make it.

SPEAKER_02: 4:39

It's in the cookbook. Then uh they had bronzino, which ended up being very good, and we had venison, but the pastas were just what was the other pasta? There was like this um oh man. This is like a brown sugar brown sugar, it's like a flat noodle tortellini.

SPEAKER_00: 5:02

Oh, that had um like the veal ragu in it.

SPEAKER_02: 5:06

Yes, yeah, that was so all the pastas made fresh there and it looked that they had like a little upstairs area where they were doing things. But that was our experience at Vetri. Um, it was absolutely delicious, and I mean, definitely a celebratory occasion for your birthday. Um, how else did the day go? Tell the good people if you're willing to share. Maybe tell us about the head spa.

SPEAKER_00: 5:31

Yeah, we went to what are those head spa places? The same one that I went to last year for my birthday, but you joined me this time because you couldn't miss out.

SPEAKER_02: 5:43

Yeah, I wanted to see what you were doing.

SPEAKER_00: 5:44

So we did that, that was really nice. And then we bopped around and like did a little shopping.

SPEAKER_02: 5:52

Candy.

SPEAKER_00: 5:53

Went to the candy store.

SPEAKER_02: 5:55

I have a new appreciation for it. I do.

SPEAKER_00: 5:57

I like the candy store. It's cute. They have all the cute Valentine's Day ones. Uh well.

SPEAKER_02: 6:06

I have no idea how they keep the lights on.

SPEAKER_00: 6:09

I know. We've only been there what, like two or three times, and we're always the only people in there.

unknown: 6:15

Yeah.

SPEAKER_02: 6:16

I wish them luck.

SPEAKER_00: 6:17

I really stay open because I like it.

SPEAKER_02: 6:22

He always finds his way barking when we're doing this. We're only six minutes in. And then we got to see some of our dear friends last night. How did that go?

SPEAKER_00: 6:32

Oh, that was so fun. We uh stayed out way later than I thought we would.

SPEAKER_02: 6:38

And I had no inclination to stop here.

SPEAKER_00: 6:42

Just yapping away.

SPEAKER_02: 6:43

Yeah. They are uh and then we told them about this, and they were like, well, Kristen was really excited to come on, and we probably will have her on as a guest. Um, she has a very specific set of skills that I think will be very useful. Um, for not for this episode in particular, but she's also a holes aficionado that maybe we can probably. Yeah, I'm talking about the Disney movie. Um, all that with Stanley Hill Nats, Family Curses, Six Foot Holes, Kissing Kate Barlow, Onions, Sam, you know, the whole bit. I can fix that. Yeah, so that's um we're looking forward to hopefully soon having her on. I mean, why not? That'd be great. Um, dim sum. We we transgressed.

SPEAKER_00: 7:42

Yeah, so we uh we went and got dim sum, and we were going to go to Tom's Dim Sum. Our favorite in media. There is a Tom's dim sum in Philly that we love, same place, same people, whatever. But then there was some sort of like suburban drama that I personally love. And I think it was one of the chefs that used to be at Tom's dim sum in media went two doors down, opened his own restaurant called Dim Sum Mania, and it's like the same venue. Yeah. And I love it.

SPEAKER_02: 8:21

And both places were busy.

SPEAKER_00: 8:23

I mean, uh apparently, like, someone's getting sued or something. Oh my goodness. Probably the guy that opened dim sum media or dim sumania.

SPEAKER_02: 8:33

Dim sum media would make sense though.

SPEAKER_00: 8:36

It would. It would make sense.

SPEAKER_02: 8:38

But dim sum mania gives more like of a frenzied vibe. Love those cold noodles. For the title, they definitely tasted different than the cold noodles at Tom Dimsom.

SPEAKER_00: 8:47

They did, but that's okay.

SPEAKER_02: 8:48

I think I prefer the Tom S Dimsom ones.

SPEAKER_00: 8:51

They were so tasty.

SPEAKER_02: 8:52

The curry chicken was good. It was a little spicy. It wasn't exactly how I thought it would come out, but it was still delicious, and I think everyone was surprised at the table. So that's great. What else are we dealing with here? Um, we've been enjoying some of our television shows. Um, we, you know, watching Stranger Things still, Tell Me Lies. What a Oh my god. That's a crazy show.

SPEAKER_00: 9:17

I don't think I've ever watched a show and have hated a character so badly.

SPEAKER_02: 9:24

Yeah, the only one that comes to mind is Joffrey Baratheon.

SPEAKER_00: 9:27

Oh Game of Thrones.

SPEAKER_02: 9:29

That little He was pretty hateable. He did a good job. He's pretty hateable. Or Cersei. She's pretty hateable too. But this guy seems but he's like hatable in a real life.

SPEAKER_00: 9:40

He's like evil. Yeah, because it's like he's a more relatable, he's a more yeah, real life hateable. And he and the actress that plays Lucy are dating in real life. Like the couple that the couple that's together in the show is dating in real life, and they were dating like before the show. I think it was like right before either of them got the part. And she, I saw a clip of her like on some podcast or some interview or something, and she was saying that like people have are like sending her messages, like being like, break up with him, he's a terrible person. Oh my god. She's like, No, he's actually really nice in real life. And they also, I don't know why in this season they really like whoever is in charge of like hair should probably be fired because like Lucy has like her horrific wig, and then they did a botch job on Bree's haircut.

SPEAKER_02: 10:38

Oh yeah.

SPEAKER_00: 10:39

Like there, so in real life, he has like long hair, like similar to yours.

SPEAKER_02: 10:44

Oh.

SPEAKER_00: 10:45

And he like just like looks different and like not like a terrible person.

SPEAKER_01: 10:49

Yeah.

SPEAKER_00: 10:50

But you know, I don't I don't know how to describe it where it's not cut, it's not like buzz. Is that what it is? A crew cut? Yeah. But it's like a crew cut, but there's no like any sort of like fade on the side or any sort of like style to it.

SPEAKER_02: 11:04

A straight zero around. That's a specific type of haircut for a person.

SPEAKER_00: 11:10

It is.

SPEAKER_02: 11:10

Really?

SPEAKER_00: 11:11

I feel like a specific type of person has that haircut.

SPEAKER_02: 11:13

Yeah, the it's a tough sell in the show that she's so obsessed with him and he's so mean to her.

SPEAKER_00: 11:20

Well, yeah, she's like a dumb college girl.

SPEAKER_02: 11:25

Yeah, that's a good point. Yeah.

SPEAKER_00: 11:27

Who then like also has issues and you know. You know. So what's your new puzzle of my new puzzle that you got me for my birthday. You got me other things for my birthday too. This was like the stocking stuffer of presents. Um, it's what's it called? It's called Dog's Beach Party. And it's a picture of three dogs on the beach enjoying some Bevraginos, and they have like sunglasses and lays on. And then my mom also got me a puzzle for my birthday. And it's um, it's like a scuba diving corgi. So I'm excited for that one.

unknown: 12:10

Wow.

SPEAKER_02: 12:12

That one's very cute. I actually have a thought that I want, you know, what something we've been doing is the um the is it connect for? What's it called? Oh, connections. Connections. Um, the New York Times connections. And like I cool thing to do if anyone is um yeah, it could be like a universal experience because we do them. Um the I Some days I'm like, I'm really on it. Some days they I definitely see that they have silly patterns where they give a word and they add a letter somewhere in the word of the things that are related. And I don't know.

SPEAKER_00: 12:50

Those ones kind of and some of the categories, like we saw at the end of the year, there was a TikTok of this girl did like the craziest connections categories of 2025. Yeah, but some of them really are stretches. So, yeah, like it's a stretch, like you're hurting yourself, like because you're stretching so hard to find how these words are connected. And some of them are like seriously maddening. I was one of my patients was doing it one time, and he's like, Yeah, like I try to do it every day. And I was like, Oh, yeah, my husband and I will do it a lot at night, like before we go to bed. And he goes, You like to get angry before you go to bed? I was like, Yeah, I guess it's not like the best thing to do to wind down for the night because we get so worked up.

SPEAKER_02: 13:35

I do stare at it for a while too, and then it's like the minutes.

SPEAKER_00: 13:39

Staring at our phone before bed, nodding. But like the categories sometimes are so like it'll be like like world dictators of history minus the second letter. You're like, what? Yes, what are you talking about?

SPEAKER_02: 13:57

Does it end up being really hard? Yeah, I don't know. I like it. I'm bad at wordle. I just I love the wordle. I I don't, I yeah, you're good at it. You are.

SPEAKER_00: 14:09

I do get it like I would say nine times out of ten. I haven't gotten my starter word yet, I don't think.

SPEAKER_02: 14:20

Like which word you use to try to Yeah, I always do reach first. I was just thinking about that. Reach. All right, what do you say? Should we get started?

SPEAKER_00: 14:30

Sure.

SPEAKER_02: 14:31

Awesome. So, what are we gonna talk about today, Nick?

SPEAKER_00: 14:34

Today, in part three of our motivation series, we're talking about making smaller changes instead of big ones.

SPEAKER_02: 14:43

Let me ask you something.

SPEAKER_00: 14:45

Another question.

SPEAKER_02: 14:47

When you decide to make a health change, do you tend to think I need to go all in? A brand new routine, a big plan, big expectations. And then a few weeks later, it quietly falls apart. If that sounds familiar and you're not doing it wrong, you're doing exactly what our culture has taught us to do. We've been told that real change requires big effort, big sacrifice, and big results fast. Looking at you, biggest loser. Today I want to talk about why starting small isn't weak. It's actually one of the most evidence-based ways to create lasting health change. And I would argue that the big myth is that bigger effort equals better results. And there's a common assumption that sounds logical but causes a lot of harm. When we assume more effort means more commitment, bigger changes mean faster success, and small steps don't really count, we disagree or disregard that the human how the human brain works. Because big changes require things like more planning, more decisions, which we talked about last week, can be harmful, more motivation, and more recovery when life gets busy. And as we talked about previously, those things rely heavily on willpower, which is already a limited resource. But small changes do something different, they don't overwhelm the system, they start to build trust between you and your brain. And so the real goal is confidence, not perfection. So here's the shift I want you to hear clearly. The goal of early behavior change isn't results, it's confidence. When you succeed consistently, even in something small, your brain learns I can do this. And that belief matters more than intensity because confidence is what makes people keep going when motivation disappears. So the question is why small changes work? And we'll talk about what we know now. Small changes work because they do a few important things, they reduce friction, like we talked about last week. They lower the it's very biochemical of us, the activation energy needed to start, or the how much oomph do you need to have? I hope that comes out in a podcast. Oomph, do you need to have to get things started? And they also protect motivation during stressful periods. This gets back to one of the arms of our motivation episode, the first one. This builds what psychologists call competence, that sense of capability we talked about before. When people feel competent, they continue. When they feel overwhelmed, they stop, even if the plan was quote unquote perfect. And starting small isn't about lowering our standards, it's about creating conditions where success is more likely. Let's frame this that all or nothing thinking is the enemy. One of the biggest barriers to health change is all or nothing thinking. It sounds like if I can't do it perfectly, why bother? I missed a day, so I failed. This doesn't count unless it's intense. Does that sound familiar or relatable? I was even literally doing this to myself when I pulled my my calf or a little calf strain. I was like, oh I got up and walked for 40 minutes at like a pretty good clip. And I was like, oh, but I didn't do anything. I feel like I didn't. I'm doing it to myself. But small steps interrupt that pattern. They give you permission to show up imperfectly and consistently. And consistency beats intensity every time. So why don't you take us through what starting small may actually look like in a practical sense?

SPEAKER_00: 18:49

Yeah, we can talk about some practical examples. Um start with exercise again, another big one. Instead of just saying, I'll work out every day this week or I'll work out five days a week. You can say I'll walk for five minutes after dinner. And then five minutes might turn into 10, might turn into 20. You might be out there for a half an hour. There you go. Getting 30 minutes of moderate, two intense exercise five days a week. Um for nutrition, which is arguably probably one of the harder ones. Instead of saying I'm going to do an entire overhaul of my whole entire diet, or I'm gonna start this really super clean total opposite of how I've been eating diet, you can say I'm going to add like one serving of vegetables into one meal every day. Yeah. And just start adding in from there instead of restricting. Perfect. Right off the bat, because restricting is harder than adding in.

SPEAKER_02: 19:52

So much harder.

SPEAKER_00: 19:54

Um, for better sleep schedule, instead of saying, I'll try to fix my sleep schedule, you can say. I'll go to bed at this time or like 10 minutes earlier than I was, or I'm not going to look at my phone when I get into bed. Big one. Those sorts of things.

SPEAKER_02: 20:14

Yeah, and these things aren't placeholders, they're foundations. They're things to get started because most lasting routines start exactly like this quietly, but consistently. So here's something powerful. Every time you follow through, even in a small way, you reinforce an identity, a version of yourself that you are. I'm someone who shows up for myself. That identity matters more than the behavior itself. Small wins don't just change habits, they change how people see themselves. And people protect identities far more than reliably they do goals. Something to know is that progress isn't linear, and that's normal. Even small changes won't be perfect. Life gets in the way. Some days you feel good, some days you don't. Motivation waxes and wanes. The difference is this small habits are easier to restart. They don't require guilt to maintain them, and they survive busy seasons, and that's the goal. Not perfection, but resilience. So let's think of one health goal that you've been avoiding, and now ask yourself, what's the smallest version of this I could do? What is something so small it almost feels too easy that I could do? And that's probably the right starting point. If it feels easy, that doesn't mean it's meaningless. It means it's repeatable. This ties directly into the last two episodes, where small steps reduce reliance on willpower, something that is a limited resource. And they build motivation through repeated success. And support, competence, autonomy, and confidence are all important for these things too. You're not lowering the bar, you're building a more stable runway to get started. Health change doesn't happen because people push harder, it happens because people keep going. All of these things are the hard work in between the moments that you think about your health or between your doctor's appointments. Those moments are big, salient moments and reviews of your health, but all of the hard work happens consistently in between. And that's why small steps keep you going. So this week, don't ask yourself, am I doing enough? Instead, think, am I doing something I can repeat? That's where real change begins. But most importantly, thank you for coming back to another episode of Your Checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. You can check us out on our website. You can also send us an email, yourcheckuppod at gmail.com, on our Instagram, or we're on threads. Share us with a loved one or a neighbor, but most importantly, stay healthy, my friends. Until next time, I'm Ed Doleski.

SPEAKER_00: 23:13

I'm Nicole Rico.

SPEAKER_02: 23:14

Thank you and goodbye.

SPEAKER_00: 23:15

Bye.

SPEAKER_02: 23:22

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.