A New understanding of Obesity and how to treat it with Behavioural interventions…

Posted: February 12, 2011 in Uncategorized

Next month’s issue of the *Swiss Journal of Psychology* (vol 70, #1,
March) includes an article: “FIT — Do Something Different: A New
Behavioral Program for Sustained Weight Loss.”

The authors are Ben Fletcher , Jill Hanson, Nadine Page, & Karen Pine.

Here’s how the article begins:

[begin excerpt]

Even as more and more diets become available, obesity rates continue to
rise, which has led some to conclude that “there is little support for
the notion that diets lead to lasting weight loss” (Mann et al., 2007,
p. 220). Repeated dieting has also been shown to have a negative impact
on immunocompetence (Shade et al., 2004) and mortality (Sorensen,
Rissanen, Korkeila, & Kaprio, 2005) and to produce cognitive impairments
(D’Anci, Watts, Kanarek, & Taylor, 2009).

Many researchers have shifted the focus from dieting to emphasizing
lifestyle or behavioral modification as a viable, more effective, and
safer approach to weight loss (Dansinger & Schaefer, 2006; Wardle,
2005). The challenge, however, has been to identify which aspects of
behavior to target since current behavioral programs seem to produce
modest results at best, even when well conceived and well resourced. For
example, the large-scale TAAG study targeted schools and community
agencies and 8,727 participating adolescent girls and was informed by
the best available models and previous practice and social marketing
over a 2-year intervention. The intervention produced no reduction in
BMI or associated markers, with only a 1.6 minute/day difference in
activity levels on one of the cohort-control comparisons (in which it
seemed the control group had an unusually low score compared to the
other controls) (Webber et al., 2008).

To be effective in weight reduction, behavioral approaches must tackle
the causal characteristics that are amenable to change. Willpower or
intention is a likely candidate, yet people have limited willpower, and
this is known to weaken the more it is called upon (Baumeister,
Heatherton, & Tice, 1994), probably because it relies on glucose as a
limited energy source (Gailliot et al., 2007). Equally, the link between
weight control intentions and food choice is very weak (Wardle,
Griffith, Johnson, & Rapoport, 2000), and good intentions are not in
themselves sufficient to bring about behavioral change (Webb & Sheeran,
2006). Behavioral programs that rely too heavily on participants’
willpower and active intention are therefore likely to fail in the
longer term. Diet and exercise regimes are maintained for a short time
at best, but people simply do not have the willpower to make every day a
diet day. For sustained success, it is argued, the answer may lie in a
behavioral approach that avoids overreliance on willpower (Dansinger &
Schaefer, 2006). Recent research highlighting the role of genetic
factors in weight regulation and obesity (e.g., Blakemore & Froguel,
2008; Hofker & Wijmenga, 2009) and in food intake (Wardle, Llewellyn,
Sanderson, & Plomin, 2009) further amplify the need to target core
psychological mechanisms to deal with the growing obesity problem.

A key finding from our previous research is that overweight people have
low behavioral flexibility (Fletcher, Hanson, & Jones, 2004; Hanson,
2008). In other words, their range of behaviors across situations is
limited. Behavioral flexibility can be reliably measured using FIT tools
(Fletcher & Stead, 2000) and has been found to correlate negatively with
BMI in a sample of over 1,000 people. In essence, heavier people are
more habitual and constrained in the way they behave. A recent study of
obese schoolboys also reported an association between BMI and clinical
tests of cognitive flexibility (Cserjesi, Molnar, Luminet, & Lenart,
2007): Boys with higher BMI were more likely to persist with ineffective
strategies when solving problems.

If behavioral and cognitive flexibility is negatively related to weight,
then we propose a novel hypothesis: increasing it should lead to a
reduction in weight. An intervention designed to increase flexibility is
the FIT-Do Something Different (FIT-DSD) program. By doing something
different on a daily basis individuals are challenged to break existing
habits and increase their behavioral flexibility. This may help to break
distal habits that other behavioral approaches do not target, yet that
nevertheless play a key role in maintaining unhealthy behaviors. It is
known, for example, that changing the context of behavior can help break
habits (Wood, Tam, & Guerrero Witt, 2005). Recent neuroscience research
has also shown that doing something new over a period of several weeks
can result in marked gray matter growth and white matter architecture
changes in the adult brain (Draganski et al., 2004; Scholz, Klein,
Behrens, & Johansen-Berg, 2009). Doing something different may have the
potential to lay down new learning pathways as well as disrupting
negative habitual ones.

This approach also avoids the need for sustained willpower and may
provide the impetus for positive change by altering the daily habits
that trigger overeating and the broader changes needed for positive
health engagement generally. There is some evidence that positive, habit-
based approaches can lead to weight loss in the longer term if they
target the proximal habits related to eating and exercise (Lally,
Chipperfield, & Wardle, 2008), although no research has so far looked at
the effects of tackling more distal habits. Therefore, this research
evaluates the efficacy of the FIT-DSD program as a tool for purposeful
sustained weight loss. Study 1 is a pilot study comparing two behavioral
interventions, the FIT-DSD program and a narrative control group whose
daily task did not target behavioral habits. Based on the hypothesized
relationship between behavioral flexibility and BMI, participants
following the FIT-DSD program were expected to lose weight during the
intervention period and to continue to lose weight post-
postintervention. No specific predictions were made regarding the weight
losses of narrative control group participants, although all wanted to
lose weight. The purpose of this control was to establish whether the
active ingredient of the FIT-DSD intervention was the hypothesized
expansion in behavioral flexibility. This would be supported by a weight
loss advantage in the FIT-DSD group over the narrative control group. If
both groups show weight loss to the same degree (and both were wanting
to lose weight), this would be more easily attributed to other, more
general demand characteristics present in both conditions. Behavioral
flexibility is important in many life contexts, and the studies may also
help to examine whether this novel approach could have broader
applications for well-being generally.

[end excerpt]

Another excerpt: “In Study 1, the FIT-DSD program was compared with a
control condition where participants engaged in daily tasks not expected
to influence behavioral flexibility. Study 2 used an active or
quasicontrol group in which half the participants were also on food
diets. Measures in both studies were taken pre-, post-, and post-
postintervention. In Study 1, FIT-DSD participants showed greater weight
loss that continued post-postintervention. In Study 2, all participants
on the FIT-DSD program lost weight, weight loss continued post-
postintervention, and participants who were also dieting lost no
additional weight. A dose relationship was observed between increases in
behavioral flexibility scores and weight loss, and this relationship was
mediated by calorie intake. Corresponding reductions in BMI were also

Another excerpt: “Why should changing comparatively small behaviors help
people lose weight when other multimodal programs fail? We suggest that
the FIT-DSD program acts on mechanisms different than those that are
usually the focus of weight loss and weight maintenance programs. First,
by doing something different on a daily basis, the participants expanded
their behavioral repertoire and modified some of their usual habits.
Habits do not exist in isolation; they form an interconnected web (Neal,
Wood, & Quinn, 2006). The FIT-DSD program may have weakened the web of
habits so that participants’ daily pattern of behavior was less likely
to contain triggers that led them to overeat. The behaviors that
participants modified on a daily basis (e.g., interacting differently
with a person, having a no-TV day, taking an alternative route to work)
required little sustained willpower and led to a measurably greater
sense of well-being. Because their attention was directed toward their
behavior rather than toward their food intake, they did not fall victim
to the food cravings previous work has shown dieters experience
(Fletcher, Pine, Woodbridge, & Nash, 2007). Nor are they likely to
suffer from the behavioral rebound that can occur as a result of trying
to suppress thoughts about food (Erskine, 2008).”

The author note provides the following contact information:
Ben Fletcher
School of Psychology
University of Hertfordshire
College Lane, Hatfield
Hertfordshire, AL10 9AB


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