Shahar Madjar, MD

Perhaps obesity is a problem of “bad behavior,” or just bad habits. Take the existence of the cookie jar as an example. It seems that the world has conspired to put extra pounds on me just by presenting jars of free cookies everywhere. These ubiquitous, free cookies are delicious, don’t get me wrong, but lethal nevertheless. I find them when I check into hotels, at the front desk-a symbol of “home away from home” with their enticing aromas of fresh sweetness. I can’t escape the cookie jar at work either because the cardiology nurse in the office next door happens to be a baker. I want to write a new rule for myself: Don’t be a Cookie Monster!

Enticing calories come also in packages larger than cookie jars. A sign of a bad habit is any type of food that comes in a bucket. A bucket of Kentucky (deep) fried chicken, for example, or popcorn topped with butter at the movie theater. Here is a rule I formulated years ago, one that applied to portion-control in general, and advice I don’t always follow: If it comes in a bucket, don’t eat it!

And along any highways and byways, and inside towns and cities-more inviting calories, in even bigger boxes: McDonalds, Burger King, Domino’s, Hardee’s-food comes cheap and in large quantities-inviting in its savoriness, saltiness, and in its high fat content. It brings about memories of comfort-stops on roads trips (“We have a long way to go, did everyone pee?”), kid’s meals, and ice cream swirling, vanilla and chocolate, in tall waffle cones.

More calories await at home and they seduce me at the worst of times. It is Sunday evening and a busy week awaits at the office and in the operating room. At these moments, I identify an unusual streak of anxiety at my core, perhaps even anticipatory boredom. And I ask myself, Should I treat myself to another serving of cake? The answer is No. But I bite into it nevertheless.

Being caught with my hand in the cookie jar, stopping at fast-food restaurants, reaching for comfort in calories-these are all bad habits. Can breaking old habits, or adapting new ones, help people shed pounds, maintain a healthy weight, become healthier?

In 2019, in the International Journal of Obesity, Dr. Gina Cleo from Bond University, Gold Coast, Australia, and her co-authors have published the results of a randomized controlled trial aimed at answering whether habit-based interventions are beneficial in long-term weight maintenance.

The researchers randomly divided the participants in the study into three groups: One group was introduced to the Ten Top Tips program in which participants were encouraged to create healthier habits; another group was introduced to the Do Something Different program, an intervention designed to break old habits; and the third group remained on the waiting list and served as a control group.

Altogether, 75 individuals were recruited to the program which took place for 12 weeks, from July to October, 2015. Their mean age was 51 years, and their mean BMI was 34.5 kg/m2, a number that put them in the obese category. After the intervention, at 12 weeks, participants in the Ten Top Tips lost 3.3 kg, and participants in the Do Something Different lost 2.9 kg. The weight loss in these groups was significantly more substantial than in the waitlisted control group which lost only 0.4 kg.

The Ten Top Tips program is straight-forward. It includes tips like “Cut down the calories,” and “Step up and walk the weight.” The ten tips are simple to understand and to memorize. They are based on prior research and accumulated experience. It just makes sense that following these habits will result in weight loss.

The Do Something Different program is an entirely different story. It doesn’t focus on food, or on exercise. Instead, it encourages people to try new and different behaviors and activities-with different people and in different circumstances-every day. It offers a list of 50 different activities such as buying a different newspaper, calling an out-of-touch friend, going to a live concert, or trying a new sport. How then is it supposed to help people lose weight? According to Dr. Gina Cleo, “we proposed that increasing behavioral flexibility may lead to consequential destruction of the chains of habits that maintain unhealthy living.” In other words: the hypothesis was that changing a person’s habits in domains unrelated to diet and physical activity will somehow lead to that person’s weight loss. I must admit that the idea sounds somewhat implausible.

In my next article, I will provide more details about the programs (including a list of the 10 tips), and information regarding the long-term success of these programs.

EDITOR’S NOTE: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.