How to better motivate weight loss
How many of you out there have gone to the doctor's office for a checkup and were told that you needed to lose weight? If you're over a certain age and American, probably a lot of you. Of those who have had that experience (or a similar one), how many of you actually were sufficiently motivated by what the doctor told you to do that you actually went out and did something about it. A much smaller number, I'm sure.
The question of how someone can motivate someone else to change their behavior in a positive way is an important one. Doctors are forever telling their patients to lose weight or to stop smoking and dentists are always telling their patients to floss, but typically their change-motivating intervention stops there, and as we all know, though we believe the doctor or the dentist and know that we should make these changes, we typically don't. It is simply hard to change habits, even when they are bad for us. If we had some sort of program we could participate in that showed us how to make desired changes and which provided a trainer to yell at us when we fail to act in appropriate ways more of us would make those changes, probably. But for the most part, such programs don't exist in our areas, are too expense, or too much of a bother. We know that the motivation for making change has to come from inside, but we don't typically know how to muster it.
British health psychologist Christopher Armitage has a study in the most recent Journal of Consulting and Clinical Psychology (February 2006 Vol. 74, No. 1,141-151) called "Evidence That Implementation Intentions Promote Transitions Between the Stages of Change" that looks at ways that doctors and other people with a vested interest in motivating healthy change can better give directions to their charges so that those directions are in fact motivating. The article is dense and harder to read than is strictly necessary (in typical research journal fashion), but the results are worth commenting on.
Armitage essentially took a group of 554 British insurance company employees interested in losing weight and sent each a "dietary habits" questionnaire. Though all participants were advised of the benefits of a low fat diet for weight loss, one randomly chosen group of them (the experimental group) received an additional instruction at the end of their questionnaire:
"We want you to plan to eat a low-fat diet during the next month. You are free to choose how you will do this, but we want you to formulate your plans in as much detail as possible. Please pay particular attention to the situations in which you will implement these plans."
This last question was designed to get the experimental group to form in their minds a set of "implementation intentions". An intention is nothing more or less than a statement that someone might make saying they will do something in the future. When a doctor or dentist gets on your case to lose weight, they are helping you to form what is known as a Behavioral Intention; they want you to say to yourself, "I intend to lose weight". Behavioral intentions are all find and good, but they do not help people to know how to lose weight. Regular behavioral intentions help people to know what they intend to do. An implementation intention answers a slightly different question: How will you do that thing?
By giving the implementation intention instruction, Armitage was asking study participants to say what they would do in order to achieve the goal of weight loss. Armitage was looking for participants to write down things like "I'll reach for a piece of fruit when I go to the kitchen for a snack". He was asking them to make a plan for how they'll accomplish their weight loss, rather than simply demanding that it occur. Most people know what they need to do differently in order to lose weight anyway; they just don't end up choosing to do those things.
As it turns out, study participants who received the implementation instruction were measurably more motivated to lose weight a month later than those who did not receive the instruction. Motivation was measured by assessing in what stage of change participants were in with regard to weight loss both before and after the questionnaires were given out. Only 13% of control subjects (who did not get the implementation instruction) made progress towards weight loss, compared with 27% of those who did get the implementation instruction. Think about it - just asking people to plan out how they will do something positive for themselves roughly doubled the amount of people who actually went on to do that thing.
This sort of thing is a work in progress, with this particular study being just a small slice of a larger vision. But this is clearly promising work too! The implication is that if we can convince doctors to provide an implementation intention instruction along with their "lose weight or else" messages (which would not take them very long to do – and a nurse could do it anyway), they will succeed in motivating their patients about 100% better than they currently do. And that would probably translate into more weight lost, fewer cigarettes smoked, and more teeth flossed.