Shahar Madjar, MD

Are habit-based interventions beneficial in long-term weight maintenance? Two weeks ago, I wrote here about a 2019 study by Dr. Gina Cleo and her colleagues published in the International Journal of Obesity that attempted to answer this question.

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.

The Ten Top Tips program is easy to understand and memorize. The tips are based on prior research and accumulated experience. It just makes sense that following these habits will result in weight loss. The program encourages individuals to plan ahead by thinking about how to fit the tips into their daily routines; to be realistic about the rate of adaptation of the habits; and to track their progress on their cellphone, a calendar, or a notebook (because “record-keeping helps the habits stick”).

Here are the 10 top tips:

1. Keep to your meal routine by eating roughly at the same time each day.

2. Cut down the calories and swap to good fats (forgo take-out foods, processed meats like bacon, butter, and fried food, and instead choose reduced fat dairy products, fat from plant oil such as olive oil, nuts and oily fish).

3. Step up and walk off the weight.

4. Pack a healthy snack.

5. Look at the labels of packaged food.

6. Sit less: get up on your feet.

7. Caution with your portions.

8. Think about your drinks and make water your first choice (alcohol, soda, and fruit juice are rich in calories).

9. Focus on your food (avoid watching TV, being on the go, or working while eating).

10. Don’t forget your five-a-day fruits or vegetables.

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 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 a long-lost friend or relative, going to a live concert, trying a new sport, or spending 15 minutes in writing a short story. 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.

Each week, Dr. Gina Cleo called the participants with an open ended question: “How have you managed on the program this week?” Then, problem-solving strategies were discussed and the participants were reminded to keep a food diary for self-monitoring purposes.

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.

Interestingly, after 12 months (long after the intervention has ended), both of the intervention groups continued to lose weight: an additional weight loss of 2.4 kg in the Ten Top Tips group and an additional weight loss of 1.7 in the Do Something Different group. At 12 months, both intervention groups lost 5% or more of their body weight–a change that is clinically important.

Were the participants happy with these habit-changing weight-loss interventions? In a later study, published in 2018 in the BMJ Open (an online, open-access medical journal published by the British Medical Association), Dr. Gina Cleo and her colleagues interviewed 15 individuals who participated in either the Ten Top Tips program or the Do Something Different program. The participants reported positive experiences both during and after the interventions. They reported that they particularly enjoyed the shift in focus from diet and exercise to everyday habit changes. They experienced increased level of energy, increased confidence, and improved self-awareness.

The results of these and other studies show that focusing on habit-changing is an effective weight-loss intervention both in the short and long term. Can all relevant, evidence-based diet advice fit on a single flash card? I will tell you the answer in my next article.

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.