If It's Not about 'Diet and Exercise', how Do We Change our behavior to manage weight? Canadian Obesity Guidelines

When one thinks about ‘behavior change’ in obesity management, one may automatically assume that this means ‘diet and exercise’.

Not so. To advise someone struggling with weight to ‘diet and exercise’ or ‘eat less and move more’ is not doing anything to address the barriers to changing behaviors, and is unlikely to be successful in the long term.

The chapter on Psychological and Behavioural Interventions in the 2020 Canadian Adult Obesity Clinical Practice Guidelines helps health care providers as well as people struggling with weight understand how to approach behavior change in order to optimize success in obesity management. Psychological intervention to help support changes in behavior is one of the Three Pillars of Obesity Management, and should be incorporated into all weight management plans for weight loss, improved health and quality of life.

Key point: ‘Diet and exercise’ is not a behavior change, nor an intervention. Behavior changes in weight management include strategies like goal setting, self monitoring, problem solving, and cognitive restructuring. The outcome of using these behavioral strategies is a healthier lifestyle. It’s a shift from doing what the health care provider simply tells a patient to do (only works short term), to supporting sustained behavior changes that result in a healthier lifestyle that the individual is able to sustain long term.

This Guidelines chapter advises health care providers, and people who carry excess weight, that:

Any successful treatment plan need to be sustainable – ie, something that the individual can stick to for the long term.
It is important that people working to manage their weight are encouraged to build self esteem and confidence to overcome their barriers to success.
There is not one pathway to success. Behavioral goals should be individualized, and be important to the person, not just to the health care provider or program.
There are many types of behavioral strategies that can be helpful. Find a health care provider with expertise in behavior change who can help you identify strategies that are relevant for you and your weight journey.

Important barriers and strategies to address include:

Associative learning : eating in habitual scenarios (eg at the weekly get together with friends) or in response to cues (donuts in the office kitchen)
Cravings: which have a lot to do with the hormones released in the brain in response to food (dopamine and opioids), stronger in some people than others. It is important to help people struggling with cravings to develop coping skills to manage cravings.
Cultivating good self-regulation skills: keeping that sleepy executive in our brains awake, exercising restraint and making good choices (check out this awesome cartoon-enhanced YouTube video by coauthor on this chapter, Dr David Macklin, who explains this)
Self bias: people struggling with weight often have negative weight-biased beliefs about themselves. When a goal is activated while negative emotions/attitudes are present, motivation tends to wane. Studies show that people with high self bias don’t do as well in weight management, so it’s important for clinicians to ask about internalized weight bias and to help address this as part of any behavior change program.
Realistic weight loss expectations: People who struggle with weight generally report that they would expect to lose around 20-25% weight, which is generally not achieved outside of having bariatric surgery. This excessive weight loss expectation can result in a feeling of failure and having a negative impact on the person as well as their desire to continue with weight loss efforts. (As Dr Vallis said in our recent Guidelines webinar – and I love this – rather than thinking about having what we want, think about wanting what we have. This can help you feel a sense of satisfaction in the success you ARE having in your weight management journey, and feeling satisfaction is an important part of maintaining that success long term.)

NOTE: This blog is not intended to be a full synopsis of the chapter. There is a wealth of information in this chapter that is beyond the scope of one blog post. I encourage everyone to read the recommendations and key messages in full, and to dig in to the entire chapter!

Stay tuned for much more on the Obesity Guidelines in coming weeks!

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