Weight Loss is Not a Behaviour!
Monday, October 7, 2013
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 have 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; “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.
@DrSharma
Edmonton, AB
Monday, October 7, 2013
Interesting take on the issue! Its all very depressing though….like there is no cure to obesity ever….
Monday, October 7, 2013
Excellent article!
It makes me feel good because I know that even though my behaviors have not helped YET with the weight loss I want to accomplish they are never-the-less healthy with many being long term ones but others being changes, like increasing my veggie and fruit servings by two or three more servings a day beyond my usual five. Meanwhile, I am reducing my protein levels and starch food levels due to exercise changes. My fat intake has been twenty to twenty-five percent of calories for about forty years because then my gallbladder remains silent, and I have not had an attack in about twenty years even thought he stones are still there so they actually are doing me a favor in terms of reinforcing behavioral change.
Your article will lead me to being more creative for changes. One recent one that makes me happy is that I figured out a higher reduced vision substitute for my standing computer desk. This way when I am actively using the computer I can stand and move some to music. Another change is having the computer read my mail to me while I do physical work. Both will add to caloric expenditure now that eye bleb surgery has forced me to give up my long-term joy of serious natural weight training and try other options in shorter bouts.
I really wish my physicians gave better guidance, though. Instead I am having to read or hear what online resources I can and then try to figure out my options by trial and error, and not only for weight control. Is helping people find their options for positive behavioral changes under taught in med school, or are medical practices afraid that approach may lead to lawsuits, or what?
Monday, October 7, 2013
That is so smart and wise, and speaks yet again to the irrational fixation our culture has on “weight loss” and physical size. Our culture doesn’t measure, notice or reward behavioral change – and we absolutely don’t reward it if it isn’t linked to some measurable, culturally-laudable outcome. Which means that those of us who do change behaviors don’t FEEL the reward from it in that BF Skinner fashion, and thus aren’t likely to stick with it, unless we have the self-esteem to just keep ourselves boosted regardless of what anyone else thinks.
Example: I started riding a bike this summer, after not having ridden one for 25 years. I gave myself a whole little series of challenges and goals that I wanted to achieve: learn how to shift…learn how to ride safely in traffic…learn how to ride safely at night…ride at least 40 minutes…ride at least 60 minutes…ride a trail that includes hills…etcetera. I have accomplished all these things, and I’m getting better and better, and I LOVE it. I am a total bike fan now, and I am going to CRY BITTERLY when the weather makes me put the bike away (because “become an all-season biker” is not on the behavioral change list quite yet). I succeeded at the behavioral goal of becoming a consistent, frequent bike-rider. However, if my behavior change had been “lose weight by biking”, I would consider myself a failure – because that didn’t happen. If friends or peers look at me and think, “Omg, that biking sure hasn’t helped her lose weight – she’s still fat!”, and if I internalize their dismay and judgment, I probably won’t value the changes that I made, and I might stop biking, because I’m not getting the weight-oriented affirmation that I’d decided biking had to result in.
Luckily, that is not going to happen – no way! – but my point is, yeah – valuing behavioral change of all kinds would be SO much smarter than valuing anything having to do with weight or body size.
Monday, October 7, 2013
Hi Dr. Sharma! Wise message today! Overweight people often say, “I want to lose weight,” to me. I ask, “What are you doing to make that happen?” When they say something vague, I ask,”What specific actions are you taking during the day?” I question them about: 1) food journaling; 2) calorie counting; 3) regular exercise at least 3 times per week; 4) drinking 8 cups of water per day; and 5) attending a weekly weigh-in meeting like TOPS. That is my process of actions–that actually works. Little daily actions done consistently produce the weight loss magic. 😀
Monday, October 7, 2013
To continue the sports analogy:
Doctors are like a coach who says to a player who kicks a ball toward the net but doesn’t score
“kicking the ball toward the goal does not mean you automatically score a goal”,
… and then leaves it at that.
No figuring out what behaviour WOULD be effective.
No developing training routines to teach that behaviour and use it until it becomes automatic.
No help whatsoever.
Tuesday, October 8, 2013
You are spot on.
Now, if we can only get “health autorities” to get it too…
First, they set weight loss as a modifable behavior, which it is not, of course, since weight is not a behavior at all. Then, they focus on motivation alone (monetary penalties, shame, and humiliation should increase motivation, right?). But behavior change is not only about motivation. You also need the ability / capacity / confidence to go with the motivation.
I think it would benefit everyone if we focused directly on behaviors, for that is all we can actually change. Plus, if we say drinking soda (or whatever behavior) is bad, then it is bad for everyone, no matter what their weight. So it might also help with fat discrimination.
Tuesday, October 8, 2013
I agree, health professionals including all my colleagues are the biggest challenge. This is why the Canadian Obesity Network has such a strong focus on professional education – just wish we had more resources and funding for this.
Tuesday, October 8, 2013
Amy, that is beautiful and you are beautiful for doing it!
Would it help you get back on that bike in Spring and help you on good Winter days with clear streets if you got a stationary exercise bike and put it near a tv so you could use it while relaxing like I do with some of my weights? I was lucky enough to find my stationary bike as a give-away when someone in our area advertised one that was no longer wanted. (Of course when they insisted on it being free we took them a gift afterward.) Oh, and the base on the one I got is weighted and therefore it is heavy so you might want to have someone along when picking up that sort of item. I got my cardioglide for $25 through an advertisement, too. Granted, new equipment is usually in better shape so you have to weigh the various aspects but many people do not use exercise equipment or buy the wrong things for their own likes and dislikes — so really try new or costly equipment beforehand and be honest with yourself about liking it or not so that you will have something that you will use. Maybe a mountain bike is in your future for biking outside in worse conditions.
Wednesday, March 2, 2016
I thought it would help everyone for weight loss. if we motivated on behaviors.drinking is bad,then it is bad for everyone, no matter what their weight. So it must also help with fat.