“Behavior is what a man does, not what he thinks, feels, or believes.” ~ Emily Dickinson
We all KNOW that getting the fries in addition to the bacon cheeseburger is not the healthiest choice, but we DO it anyway. When it comes to our ability to lose weight and maintain that weight loss, knowledge is only a part of the puzzle. Whether you have personal experience weight struggles or work in the weight maintenance arena of health care, we all know that the story is a whole lot more complex than know = do. I was at the 35th Annual Meeting & Scientific Sessions of the Society of Behavio(u)ral Medicine in Philadelphia last week and weight loss was a HOT topic.
While the debate continues to rage regarding what “diet” yields the best results – see our previous Real Food Wins Every Time! – we at No Baloney feel that the behavioural aspects of successful and sustainable weight maintenance need far more press. Understanding internal and external motivators and barriers offer much more insight than what fad diet might help in a pinch!
My highlights from SBM this year seem to focus on investigating what factors help people succeed, and which hold them back from goal attainment. While outcomes were focused on weight loss, you could apply many of the principles below to adopting and maintaining any health behaviour, whether physical activity, smoking cessation or sunscreen use!
“Social networks: Do they help or hinder weight loss?”
Ginger Winston, MD, MPH, Weill Cornell Medical College
The Small Changes and Lasting Effects (SCALE) trial is an ongoing randomized study investigating the effect of promoting small lifestyle changes (e.g., choosing water vs. pop, hiding junk food, etc.) in African American and Latina women with and without positive affect affirmation (shifting negative thoughts to positive). The investigators presented an interesting assessment of the impact of social network members’ influence on weight loss success.
Not surprisingly, weight loss in those with one or more social network member described as “helpful” was improved. Conversely, in those with no helpful family or friends, or a least one person they identified as “harmful”, experienced weight gain rather than loss.
How were friends or family “helpful”? They provided encouragement through words or their own behaviour, such as joining in for support with healthy eating and increased physical activity. In contrast, family and friends “harmful” to change made negative comments and gave criticism, often purposefully engaging in persistent unhealthy behaviours in front of participants. Weight loss was also improved in those without friends that they perceived to be overweight or obese, perhaps suggesting an influence of social norms.
“A randomized trial comparing weight loss treatment delivered in large versus small groups.”
Gareth R. Dutton, PhD, University of Alabama at Birmingham
Group interventions for weight loss are often more economically feasible than providing one-on-one coaching. Group interventions may also be superior to individual interventions, particularly in women (1). Such groups may provide a unique opportunity for behavioural influencers such as social support, vicarious learning, and role modelling that one-on-one coaching are lacking.
But does group size impact success? This pilot study randomized 66 individuals to six months of identical lifestyle change content, but provided in either a weekly small group setting (10 – 12 people) or large group (30 people). Meetings were carried on in a monthly basis for a subsequent six months. Weight loss in small group participants was roughly double by six months compared with large groups, with subsequent weight maintenance at 12 months versus weight regain in the large group.
Small group participants reported feeling more “engaged” in their groups and had improved self-monitoring behaviour, as demonstrated by more consistent tracking of dietary intake via food records.
“Who loses, maintains or gains? Profiles from a weight loss and maintenance trial.”
Amanda N. Szabo, PhD, Kansas University Medical Center
In a secondary analysis of 359 individuals who completed a 6 month weight loss intervention (meal replacements with weekly group sessions) followed by a 12 month follow-up period (with health coaching), several distinct characteristics emerged for those who were successful at weight loss and maintenance (defined as loss of >14%). When compared with those who experienced weight regain, maintainers did the following:
- attended more group sessions
- ate more fruits and vegetables
- were more physically active
- took more steps
Interestingly, group attendance and weight loss at 2 months were found to significantly predict overall weight control success at 18 months.
No Baloney’s advice? Both forks and feet continue to be essential for sustainable weight control… BUT support from others is crucial too. Surround yourself with supportive people! If friends and family are not supportive, you could kick them to the curb (easier said than done!) OR ask them to get on board and tell them what kind of support you need. Here’s a great how-to starter article on finding support to achieve your goals.
Develop your network of support for healthy eating and physical activity! Whether a group you join (Weight Watchers is the perfect example) or create with friends, family or colleagues, look for people with similar goals and meet regularly – weekly seems to be the “magic number”, at least for the first several months. We loved the Girlfriends’ Diet Club article in Eating Well magazine that profiled three neighbors who banded together to meet their goals. They cooked meals for each other, walked daily and shared recipes.
For more tips on behavior modification for weight control, this list from University of California San Francisco is looooong but thorough.