WIDLIMS podcast ep #4 – The secret to lasting behaviour change
In this short Solo Sunday episode, I discuss how we ought to counsel others on how to make lasting changes (and think about it when trying to implement change ourselves). I touch on...
- examples of health behaviours people commonly want to change
- using weight to illustrate why sustainable methods are key, including discussing why diets do not work
- how to re-frame your thinking regarding the goal of behaviour change
- how healthcare practitioners can learn and implement this into their practice
I chose the sprout as the feature image, because I believe we need to be sowing seeds for change gently, and to nurture them, just like we would nurture plants!
Mentioned in the episode
- What is the National Weight Control Registry? and why it its pretty bad (i.e. glorifying eating disorders…)
- why diets do not work (1, 2) and favouring intuitive eating from a young age instead
- English interview with anti-diet obesity researcher Erik Hemmingsson
- paper by Kwasnicka et al. discussing five themes for maintaining healthy behaviour changes
- my article for Clitbait on ‘How (not) to exercise in lockdown’, also discussing tips for how to implement healthy behaviours and attitudes with regards to physical activity
Background: why should we care about how to drive and maintain behaviour changes in the first place?
How many times have you not personally sworn to yourself that this time, you are going to follow through with X, Y or Z – with X, Y or Z being ‘losing weight’, ‘quitting smoking’, ‘eating more vegetables’, ‘meditating every day’, ‘going plant-based’ etc… I know I have certainly had a sudden desire for changing, planning excitedly, going ahead with my changes and suddenly… failing.
I would prefer to call that ‘failing’ though. Because it is pretty unrealistic to expect ourselves to sustain a behaviour change in the long term, which has only been initiated in a rash and unsustainable way.
Behaviour change takes time, it takes planning, and it encompasses five themes, as per the research of Kwasnicka et al. (1):
- motives for maintenance
- self-regulation
- resources (physical + psychological)
- habit (automatic + habitual behaviours are easier to sustain)
- environment and social influences (support systems + what is the norm?)
In this episode, I chose to use weight loss as an example. Far too many people are pre-occupied with losing weight, in an unsustainable manner (thanks, diet culture). This is despite there being ample research showing that long-term maintenance of any weight lost through the common method of dieting (caloric restriction) is very rare (2,3). We know that intuitive eating, for example, is a sustainable method correlated with healthy weight (4).
We also know that, as Hall & Kahan write (5):
The degree of weight loss and its maintenance should not be the sole metric of obesity treatment success. Rather, physicians should support and encourage patients to make sustainable improvements in their diet quality and physical activities if these behaviors fail to meet national guidelines94,95. Such lifestyle changes over the long-term will likely improve the health of patients even in the absence of major weight loss96.
Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012
There are exceptions, of course, such as those on the National Weight Control Registry. However, these individuals can be seen as often participating in behaviours that would be diagnostic for the eating disorder anorexia nervosa… which is certainly not a healthy goal to be advocating for (6, 7).
In the episode, I use weight loss as an example of how not to attempt changing your ‘health’ behaviour. And we must be mindful of how we advocate for patients’ changes in health behaviour, too.
We need to keep in mind the five themes, acting as facilitators but equally as potential barriers to successful maintenance of healthy behaviour change in our patients.
The only change worth having, is sustainable lasting change, when it comes to health. There is absolutely no point in going on a fad diet that will ‘improve’ your health or make you lose weight quickly, only to get back to status quo. We need to make status quo the new healthy happy balance. It is not easy, but it is our duty as healthcare professionals to do so, and to impart this message to patients, sensitively and in an accessible way.
What do you think? I would love to know.
get in touch with me @widlims on Twitter and Instagram.
REFERENCES
1) Dominika Kwasnicka, Stephan U Dombrowski, Martin White & Falko Sniehotta (2016) Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories, Health Psychology Review, 10:3, 277-296, DOI: 10.1080/17437199.2016.1151372 https://www.tandfonline.com/doi/full/10.1080/17437199.2016.1151372
2) A weight lifted on Medium. ‘Why diets don’t work and what actually does’ https://medium.com/@aweightlifted/why-diets-dont-work-and-what-actually-does-dfd6df2f23f2
3) Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-233. doi:10.1037/0003-066X.62.3.220 http://janetto.bol.ucla.edu/index_files/Mannetal2007AP.pdf
4) Denny KN, Loth K, Eisenberg ME, Neumark-Sztainer D. Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors?. Appetite. 2013;60(1):13-19. doi:10.1016/j.appet.2012.09.029 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511603/
5) Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018;102(1):183-197. doi:10.1016/j.mcna.2017.08.012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
6) https://www.todaysdietitian.com/newarchives/0419p12.shtml
7) Conason, Alexis. ‘No, Anorexia is Not the Secret to Treating Ob*sity: Prescribing a life threatening ED to people in larger bodies is fatphobia’ https://www.psychologytoday.com/intl/blog/eating-mindfully/201704/no-anorexia-is-not-the-secret-treating-obsity?amp=
