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The power of small changes



a row of 5 pears with successively more bites taken out of each one: the last pear on the right is eaten down to the core

If you're reading this, it's unlikely that you don't know about the obesity crisis. The most recent estimates are that over one-third of U.S. adults are obese (having a Body Mass Index over 30). You might think it's a simple problem with a simple solution: weigh too much? Lose weight. Yet anyone who's tried to lose a significant amount of weight can tell you that it's not nearly so simple. Worse, we now know that the vast majority of people who do manage to lose a significant amount of weight will gain it back.

Just last week I was involved in a discussion of large-scale strategies to address the problem with overweight and obesity in this country, and as is usually the case, the discussion largely focused on weight loss, with positive outcomes being measured in pounds lost. My approach, as you may be aware if you've followed Dr. Gourmet or The Goldring Center for Culinary Medicine, is a little different: I focus on improving what people eat. My positive outcomes include "How many pieces of fruit did you eat today?" and "How many servings of legumes did you eat this week?"

I've long advocated incremental dietary change rather than trying to completely change your diet all at once. In May of this year, an article in Obesity looked at the effects of making these small dietary changes as a means of long-term weight loss (2017;25(5):833-841).

The authors recruited over 400 overweight or obese Black and Hispanic men and women to participate in a 12-month weight-loss trial. Each participant was encouraged to select one of ten small change eating strategies to address a specific dietary challenge they faced. The ten possible changes included such strategies as "drink water instead of sweetened beverages," "make half the main meal vegetables," and "eat a fruit or vegetable before snacking." The participants also set personal physical activity goals such as "walk at least 20 minutes daily" and signed a behavior contract to stick to their goals for at least 6 days of every week.

The purpose of the research was to assess whether teaching participants ways to feel more positive in general and to use self-affirmations when faced with barriers to their new goals would help the participants increase their feelings of self-efficacy, which would help them stick to their goals and result in weight loss.

Unfortunately, those positive affect/self-affirmation (PA/SA) strategies made no difference in how much weight participants lost, although those participants who experienced more stress from work or family issues who were taught the PA/SA strategies were less likely to gain weight in response to those life stressors. In their discussion, the authors note (with some disappointment) that only 9% of all participants lost at least 7% of their body weight and suggest that a more intensive PA/SA intervention may work better in helping "high-risk racial and ethnic minority populations" to make behavioral changes leading to weight loss.

What this means for you

Granted, the authors were performing a weight-loss trial, not a behavioral change trial, but the focus on weight loss to the exclusion of other changes that can have serious effect on health is short-sighted. Sure, less than 10% of all participants lost at least 7% of their body weight, but the authors state that "63% of participants lost weight overall" - and on average they lost 2.4% of their body weight. That's not nothing - and even more importantly, 68% of all participants reported sticking to their chosen small change eating strategy and 36% stuck to their physical activity goals. They may not have lost a significant amount of weight, but making small changes for the long term, such as increasing your Mediterranean Diet score by two points (say, snacking on nuts instead of Doritos and switching from white rice and pastas to brown rice and whole wheat pasta) still reduces your risk of all-cause mortality by 25%. And that's not nothing either.

First posted: December 13, 2017