Last week, I gave the plenary key note talk at the 2013 Obesity Help Conference in Anaheim. I also held a standing-room-only workshop in which I discussed behaviour change.
One of the points I made at the workshop was to remind the audience that weight loss is not a behaviour.
Let me explain: When I tell patients to stop smoking, they know exactly what to do, namely to stop putting a cigarette in their mouth and inhaling its smoke. That's a behaviour they can change. When they stop smoking they have "successfully" changed a behaviour -- that's behaviour change, end of story.
But, when I tell a patient to go and lose weight, I haven't actually told them what BEHAVIOUR to change.
Rather, to use the smoking analogy, it is as though I had simply told my smoking patients to go out and reduce their cardiovascular risk, leaving it up to them to figure out how exactly to go about doing that.
Some of my patients may perhaps realize that quitting smoking is by far the most effective way to lower their risk. Others may not and merely try to reduce their salt intake or start exercising, neither of which is likely to reduce their cardiovascular risk to the extent that smoking cessation would.
This is exactly why I would be very specific as to exactly what behaviour I want my smoker to change -- namely to STOP smoking.
If I wanted them to eat less salt or start exercising, then that is exactly what I would tell them to do.
Those are BEHAVIOURS that they can change.
Contrast this to a doctor telling his patient to lose 20 pounds.
This may seem like a specific and achievable goal, but it is not a BEHAVIOURAL goal because the doctor has not "prescribed" a BEHAVIOUR, he has simply "prescribed" an outcome.
To use a sports analogy, kicking the ball at the goal is a BEHAVIOUR, scoring a goal is not!
In fact, with no further instructions, the doctor is leaving it up to his patient to figure out exactly what BEHAVIOUR they would perhaps need to change. Start eating breakfast? Eat more fruits and vegetables? Keep a food journal? Join an exercise program? Take a stress management course?
Of course, his patientss could "successfully" change their BEHAVIOUR and do all of the above only to find that not much happens to their weight.
Would they have "failed" at behaviour change? Of course not! After all they have "succeeded" in changing their behaviour.
But have they also "succeeded" in weight loss? Maybe, maybe not.
To be clear:
"I want to cut my daily caloric intake by 500 calories" is a behavioural goal and "I want to lose one pound a week" is not (indeed, you may well find yourself "successfully" cutting your daily intake by 500 calories without coming anywhere close to losing one pound a week -- let alone 20 pounds any time soon).
Thus, we must remember that BEHAVIOURAL interventions can only aim to change behaviours (this is where SMART goals come in -- more on this here).
The only real measure of "success" of a BEHAVIOURAL intervention is whether or not your patients have "successfully" changed their BEHAVIOUR.
There are many BEHAVIOURS that will make them healthier, but there is simply no BEHAVIOUR that GUARANTEES sustainable weight loss.
This is why weight loss is not a BEHAVIOURAL goal.