Forming habits and improving self-regulatory skills help people lose weight

by Nathalie Kliemann and Becca Beeken

Obesity is a growing public health concern. Individuals with obesity (Body Mass Index ≥30) are at increased risk for a range of diseases including cardiovascular diseases and a number of cancers. There is therefore a need to find effective ways to help individuals with obesity to lose weight. Evidence from recent studies suggests that brief interventions based on habit theory may be a novel approach. Interventions based on habit theory encourage people to repeat certain behaviours in a consistent context (in the same place or at the same time of day). This helps to make the behaviours more automatic (do them without really thinking about them) over time. These interventions also encourage people to set goals, plan when they will perform their behaviours, and monitor how they are getting on during the habit formation process. This can improve people’s ability to control their behaviours or their ability to ‘self-regulate’. Self-regulation refers to the ability to control behaviours, attention and thoughts to achieve a goal (e.g. avoid eating chocolate to lose weight).

Our research group at University College London developed a habit-based weight loss intervention, called 10 Top Tips (10TT), with the charities Cancer Research UK and Weight Concern. The 10TT are a set of everyday healthy eating and activity behaviours that are described in a leaflet alongside advice for turning the behaviours into habits. The leaflet recommends making specific plans, repeating the behaviours in a consistent context, and monitoring performance daily using a log book.

The leaflet was tested in a randomised controlled trial in primary care. Patients with obesity from 14 GPs across England were invited to take part. Those who consented were randomly allocated to 1 of 2 groups. Individuals in one group were given the 10TT by a practice nurse in an appointment at their GP surgery. The other groups were referred to the usual care offered by their GP.  Initial results of this trial demonstrated that patients who received the 10TT intervention lost almost one kilo more than those receiving usual care. Furthermore, patients who received 10TT reported the behaviours had become more automatic over three months. This suggests that 10TT was more effective at establishing new habits by the end of the intervention period. In the present study, we aimed to understand the effect of 10TT on self-regulatory skills and whether changes in self-regulatory skills and automaticity explained why the intervention helped people to lose weight over three months.

In our latest research we found that over three months patients who were given 10TT reported greater increases in self-regulatory skills than those who received usual care. Changes in self-regulatory skills and automaticity over 3 months appeared to, at least partially, explain how the intervention helped people to lose weight. Participants who monitored their behaviours for longer, recorded their weight more often, and made more plans, experienced the greatest changes. This findings support the proposition that self-regulatory training and habit formation are important features of weight loss interventions.

We hope the results of our research will improve our understanding of how interventions based on habit theory work. These findings could guide the development of more effective habit-based weight loss interventions to help people to lose weight.

In future studies, we aim to explore whether the effects of the 10TT intervention can be enhanced through making it easier to use the log books (e.g. through digital self-monitoring via a mobile phone app). We are also interested in whether adding self-regulatory training to help people break existing habits (as well as forming new habits) would increase weight loss.

 

Article link: Kliemann N, Vickerstaff V, Croker H, Johnson F, Nazareth I, Beeken B. The role of self-regulatory skills and automaticity on the effectiveness of a brief weight loss habit-based intervention: secondary analysis of the 10 top tips randomised trial. International Journal of Behavioural Nutrition and Physical Activity. 2017, 14:119.