Pamela Malo, MHS, RD, Arivale Coach
[Arivale Hot Topics address health stories currently in the news. The Arivale Clinical Team’s commentary on these news articles is not a review of the scientific evidence, nor an endorsement of a specific study, and is not meant as official medical opinion.]
Most people who have tried to lose weight realize the hardest part isn’t getting the weight off in the first place but keeping it off. Many have experienced the frustrations of “yo-yo dieting” and much research effort has focused on strategies for successful weight-loss maintenance.
A new study – published April 23 in the International Journal of Obesity and highlighted in the media – has observed good long-term results with a habit-based approach for losing weight and keeping it off.
Habits are obviously a core component of any successful behavior-change program. The goal is for a new habit to become automatic so you don’t have to think about it constantly, which increases the risk of relapse over time. Previously, studies have shown it takes on average around 66 days to establish a new habit, which the researchers took into account in designing their study.
Researchers from the Institute of Health and Sport at Australia’s Bond University studied 75 adults between the ages of 18 and 75 who were overweight or obese. Participants were randomized to one of three groups: a wait-list control group, an intervention group focused on forming new habits (“Top Ten Tips”), or an intervention group focused on breaking old habits and building behavioral flexibility (“Do Something Different”).
The Top Ten Tips program is a self-guided, leaflet-based intervention focusing on seven behaviors associated with reducing calorie intake, two behaviors promoting physical activity, and one behavior to promote routine. Examples include portion control, healthy snack foods, getting 10,000 steps per day, and keeping to a meal routine.
The Do Something Different program is managed via a mobile app and focused on increasing behavioral flexibility in general. While target habits in this program might relate to food or activity, they could also be things like “drive a different way to work today” or “write a short story.”
For the study, Top Ten Tips was implemented for 12 weeks and Do Something Different for nine weeks to ensure the 66-day goal for habit formation was met.
The results of the study were very favorable. Both intervention groups lost significantly more weight than the control group and, importantly, continued to lose weight after the end of the intervention, sustaining a weight loss of 10-12 pounds in the year after the study. Moreover, 65% of people in both intervention groups met the clinical goal of losing at least 5% of their initial weight.
Participants in the intervention groups also saw improvements over baseline in BMI, waist circumference, weekly exercise, reported anxiety, and more.
This study clearly highlights the importance of habits in long-term weight loss success. Furthermore, it shows that both forming new habits and breaking old habits can be effective strategies.
One criticism is that the two intervention groups were run for different lengths of time. However, researchers note that since both groups achieved lasting weight loss of a similar amount, this difference doesn’t appear to have impacted the outcome.
While the success of this approach can’t be denied, the study somewhat unfairly cites only comparison research on weight-loss maintenance that is unfavorable, making the statement that “most individuals who lose weight regain 40% of it in the first year and most of it in the next three years.”
The common myth that weight-loss programs aren’t successful is belied by much published evidence. For example, studies using long-term cognitive-behavioral interventions such as the Diabetes Prevention Program and Look AHEAD trials actually get long-term success rates for weight loss that are better than those cited in the current study. And, the National Weight Control Registry documents thousands of people who have lost at least 30 pounds and kept it off for at least a year.
The bottom line is that building food and exercise habits that become automatic behaviors is a key component to weight loss, but so is addressing unhelpful thought patterns and developing problem-solving skills to support long-term maintenance. Most important is to get support for the journey – don’t try to go it alone. While there are some rare folks who are able to lose weight and keep it off on their own, most research shows that long-term support and accountability is key to getting off the yo-yo diet cycle.