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.
Eating out poses a special challenge when calorie counting because restaurant portions are overgenerous; your best bet is to ask for a to-go box and put half your order away before you start eating.
The most important number you need to pay attention to is the serving size. It’s easy to eat too much if you aren't aware of how many servings are in a bottle or box and you consume the whole package, thinking it’s a single serving.
If you eat quickly, your brain won’t get the message that you are full in time, says Kathy Hubbert, MS, RD, of EatRight Weight Management Services at the University of Alabama at Birmingham. “Put the fork down between each bite,” she advises.
Be it chocolate or bacon, totally banning a favorite “unhealthy” food from your diet sets you up for temptation. Instead, use your calorie-counting skills to build in a small indulgence now and again.
If you are out with friends and get talked into dessert, don’t beat yourself up. “Guilt can set in and, for some people, that gets them moving in a backwards direction,” says Hubbert. Even if you did enjoy your indulgence, put it in perspective — it’s just one mistake compared to all your good diet choices yesterday, today, and the ones you'll make tomorrow.
Hanging all your feelings of success on the numbers on the scale can be a diet disaster. You should only weigh yourself once a week, says Gail Curtis, assistant professor at the Wake Forest University Health Sciences department of physician assistant studies in Winston-Salem, N.C. Curtis recommends tracking other short-term health goals, such as eating more veggies, walking daily, or drinking water instead of soda, that will give you a sense of accomplishment.
Even if you could achieve your diet goals by calorie counting alone, you would be more successful (and healthier) if you were physically active. “The number one barrier to exercise that I hear is time,” says Hubbert. National recommendations are at least 30 minutes of moderate physical activity most days of the week. You can break this up into three 10-minute segments per day, says Hubbert.
Eating in response to sadness, boredom, or stress wrecks your calorie counting for at least one day. “We learn to associate food with feeling better,” says Hubbert, a self-confessed boredom eater. When you become aware of your urge to eat in response to emotions instead of hunger pains, find something else to do that will distract you for 10 or 15 minutes, such as taking a walk, says Hubbert.
“There is diet fatigue if you go on a diet,” says Curtis. “Most people can stay on a diet about three months and then they are done with it because they can’t stand it.” Instead, focus on making healthy lifestyle and diet choices that you can live with for a long time.
“I’ve seen people completely go back to square one,” says Hubbert. “They make one mistake and it starts a whole cycle.” The remedy? If you make a mistake, admit it, forgive yourself, and get back on track right away.
Follow Arya M. Sharma, MD on Twitter: www.twitter.com/DrSharma