Previously I blogged about the limitations of traditional theories to explain behaviour change, discussing how a complex systems approach that accounts for unplanned events may lead to better understanding of behaviour change and improvements in treatment outcomes. But how do these theoretical ideas translate into practice? What is known about how unplanned external triggers affect body weight? And how can this knowledge be leveraged to increase the success of behaviour change interventions?
A study by Ogden and Hills at the University of Surrey, UK addresses these questions and examines the mechanisms behind successful long-term health behaviour changes related to weight loss and smoking cessation (1). The study explores “bright spots” (success stories) and investigates the perceived triggers of behaviour change and explores the factors that contribute to sustaining these changes over time.
They recruited individuals who either successfully maintained a weight loss of at least 28 lbs over three years or who remained smoke free for at least three years(1). Using in-depth semi-structured interviews, the researchers identified two prominent themes. First, the majority of subjects who maintained weight loss or remained smoke-free reported that initial change in behaviour was triggered by a life event, rather than a series of planned actions and a gradual shift in cognition. Some triggers could be perceived as negative, while others were positive. Examples included severe threats to health (e.g. hospitalization or heart attack), relationship problems or significant milestones (such as a landmark birthday, desire to become pregnant). This supports Resnicow and Vaughn’s call for a new framework for behaviour change that encompasses unplanned, sudden behaviour changes (2) as discussed previously.
Secondly, Ogden and Hills observed that changes were more likely to be sustained over time when three conditions were present:
- the behaviour no longer served the same purpose to the individual as it had previously (e.g. eating no longer provided comfort, smoking no longer provided relief from stress),
- the individual experienced a perceived or real reduction in choice with respect to the behaviour (e.g. unable to afford to buy cigarettes, bariatric surgery limited amount of food that could be consumed, smoking was socially unacceptable among friends)
- the individual underwent a shift in his or her beliefs regarding the behaviour, and gained understand of how the behaviour contributed to his or her problems (e.g. smoking causing coughing and breathlessness or eating high fat foods when taking orlistat causing loss of bowel control)
Together, the authors propose that these three conditions facilitate the development of a new sense of identity. In turn, this enables the initial change in behaviour to be maintained over time. If a behaviour is no longer perceived as rewarding, if it is increasingly difficult to engage in, and if the behaviour is perceived as contributing to problems, the likelihood of successfully maintaining the behaviour change is greater. Returning to the analogy of the spinning lottery balls described by Resnicow and Vaughan (2), these observations from Ogden and Hills provide insight into what strategies could be used to help “spin the balls” in such a way to facilitate interactions that support long-lasting change. For example, programs that help individuals find healthy outlets for stress or supports that make healthy choices easier would be helpful for sustaining changes over time.
In my next post, I’ll discuss a follow-up study by Ogden and colleagues that explores the nature of the life events that precipitate weight loss or weight gain in more detail(3). Please stayed tuned!
1. Ogden, J., & Hills, L. (2008). Understanding sustained behavior change: the role of life crises and the process of reinvention Health:, 12 (4), 419-437 DOI: 10.1177/1363459308094417
2. Resnicow, K., & Vaughan, R. (2006). A chaotic view of behavior change: a quantum leap for health promotion. International Journal of Behavioral Nutrition and Physical Activity, 3(1) 25 doi: 10.1186/1479
3. Ogden J, Stavrinaki M, Stubbs J. Understanding the role of life events in weight loss and weight gain. Psychology, health & medicine. 2009;14(2):239-49 http://www.ncbi.nlm.nih.gov/pubmed/19235083