Habit – the Real Key to Long-Term Weight Loss Success

habit-2Most diet programs involve dramatic lifestyle overhauls, massive shifts in behavior, and rigid dietary prescriptions that require a great deal of effort and attention on the part of the user to implement and maintain.  Willpower, they say. Stay focused on your goal (a lean physique, a specific weight or body fat percentage, etc) and WORK HARD, they say. You can do it! You can win the war with your body! It’s just a matter of focus, willpower, self control.

We all know how well most diet programs work out in the end, though.

My Own Habits

Five years ago I had an epiphany of sorts. I realized that my body was the result of my lifestyle habits. The way I ate, the way I moved, the way I slept, the way I dealt with stress…all these things worked together to produce the body I had at the time. My body, and my health, were a product of thousands of small, seemingly inconsequential behaviors (both conscious and unconscious) I engaged in on a day to day level. Trying to undertake massive behavioral changes all at once, as I had done so often as I tried fad diet after fad diet, rarely worked in the long term, as those massive behavioral changes gradually gave way to the ingrained habits that had established themselves over the course of decades.

I shifted my focus. Instead of focusing on an aesthetic goal and trying to force my body to that goal, I decided to focus on those small, seemingly inconsequential habits that formed the vast majority of my day to day activity. I identified the habits, the nearly subconscious behaviors that I fell back on automatically, that shaped the body and health I had at the time. And once those habits were identified, I identified new habits that could replace them, and I focused on shaping those new habits, slowly and methodically. The end goal wasn’t ‘weight loss’. The end goal was a new habit, a nearly subconscious behavior that I would fall back on automatically in my day to day life. I believed that with new habits and new behaviors, my body and health would change. I was right.

The Science

Research has established that what we term ‘self control’, or willpower, is a finite resource (1). As a person exerts conscious control over their behavior, they use up and eventually exhaust their reserves of self-control, at which point they revert to habits, which don’t require the use of self-control, as they are largely automated responses to stimulus (2). The more self-control a person exerts, the faster they deplete their self-control reserves, and the more they fall back on habits as they fatigue. So the more dramatic and extreme a diet plan is, the more likely the dieter is to exhaust their self-control reserves and relapse back into established, ingrained habits.

Researchers from the University of Southern California examined the role of habit in goal achievement through a series of studies (3). Their results confirmed that people fall back on habits, both good and bad (or ‘goal-congruent’ and ‘goal-incongruent’) when their reserves of self control are depleted:

In general, the present results suggest that habits are a regulatory mechanism that can enable people to engage in goal adherent action. Across all of the five studies we report, habits worked to compensate for low levels of self-control. Participants were especially likely to fall back on their habits when willpower was low, either because it had been reduced through prior self-control efforts or because it was chronically limited. This reliance on habits promoted goals when the habitual behaviors were goal-congruent, but was detrimental to goal pursuit when habits were goal-incongruent.

The last sentence is the money. ‘Good’ habits promote goal achievement, ‘bad’ habits inhibit it. The goal itself is almost incidental. For the best results, focus on those habits, because at the end of the day, those habits are gonna be largely what determines your progress.

What Does it Look Like in Real Life?

This concept is great in the abstract. Applying it to real life is trickier. My big ah-ha moment came when I shifted my thinking from ‘I want to have a lean healthy body’ to ‘I want to be exercising regularly, eating a nutritious, calorie appropriate diet, and getting adequate sleep consistently, because those are the things that will produce a lean healthy body.” How to get there from where I was was the big question mark. Ultimately, I ended up applying a lot of the behavior modification techniques I’d learned from my years of pit bull training to my own behavior.

I applied shaping techniques to my own behavior. Shaping involves breaking a desired behavior down into small, successive steps. In animal training, any behavior that is similar to the desired behavior is reinforced, and continued reinforcement can ‘lead’ the animal closer and closer to the desired behavior. With practice, the behavior becomes more and more automatic – it becomes a habit that requires no conscious effort.

I had a lot of behaviors I wanted to change. But I had tried making dramatic lifestyle changes before, and it required so much effort, so much ‘willpower’, that I reverted to old habits quickly. This time I decided to focus on much smaller changes, to ‘shape’ new lifestyle habits one at a time, to practice each new behavior until it was automatic, so that when I was tired or stressed out and reverted to habit, it would be GOOD habits I reverted to.

I started with exercise. I knew that reputable public health organizations recommend 30-60 minutes of exercise a day, 5-6 times a week, for best health outcomes, and up to 90 minutes a day for weight loss. But I also knew there was no way I was going to be able to jump straight into that kind of exercise volume when my HABIT was to be sedentary. As soon as I ran against a road block, I would fall back on my habits. So I broke it down. My initial goal was to 15-20 minutes at the gym, 3 days a week. At first, my goal was to swim for those 15-20 minutes, but in the beginning, even that was difficult. So I made it even simpler. All I expected of myself was to get there. There were many days that I got there, and sat in the jacuzzi, or chatted with the front desk staff, or even surfed the internet. But I got there. I was establishing a habit of getting there. Most of the time, once I was there I did something active, but in the beginning, getting there was my expectation, and having a manageable expectation made it more likely for me to follow through, and the more I followed through, the more automatic the behavior became. After a few months, I realized that I was scheduling my trips to the gym into my week without thinking about it. It had become a normal part of my life. It had become a habit. In the months and years since, I have increased the volume and intensity and frequency of my workouts so that now I easily meet the minimum public health recommendations. But had I not established that habit of making time, that habit of fitting it in, I wouldn’t have gotten past the initial stage. I would very likely still be sedentary.

My eating habits were another behavior I wanted to change. After decades of fad diets, I was worn out with kitchen overhauls. This time around I made a simple change – more vegetables – and practiced it until it was easy. And when I was including more vegetables in my day to day without stressing out about it, I added in some calorie tracking. And when that was easy, I started tracking protein too. And over time, my eating habits shifted, so that now I am able to put together a balanced, calorie appropriate, protein sufficient meal without needing to really think about it. I just know what to eat and how much, because I slowly, methodically changed my habits and practiced them until they were automatic. I no longer need to track my calories or protein, because I used tracking to create new habits that I can now rely on.

Sleep and stress management are other behaviors I’ve changed. I focused on one small change at a time, and practiced it until it was habit. I started turning off electronics a little earlier in the evening. I started making sure I was done drinking coffee by late morning. I stopped listening to the news in my car, because I realized it was making me anxious. And lots of other small changes.

Now when I’m tired or stressed out, I don’t need to think about these things, they are habits. I can fall back on these healthy behaviors and focus my mental energy on more pressing things, because I took the time to slowly, methodically change the habitual behaviors that form the bulk of my day to day life. And the result has been an improvement in my health, weight loss that I’ve been able to maintain with minimal effort, and a whole lot more mental energy to devote to things like my family and my career and my blog. Because the behaviors that I engage in automatically are, by and large, healthy behaviors. I’m not perfect. I’m still working on some things. But I’ve learned that humans are creatures of habit, and we have the power to change those habits. And those habits are what really make us who we are.

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Just starting out? My First 100 Days Beginner’s Program is specifically designed to promote the habit of making time for exercise. Check it out!

 

 

Neck and Shoulder Pain, the Bane of the Computer Age

I’m putting on my Massage Therapist hat today and going a little off topic. I want to discuss a topic that affects almost everyone I know: neck and shoulder pain associated with habitual computer use.

Many people dealing with this don’t realize that the computer is the source of their issue. Typically, I’ll have people speculate that it’s from exercise, or sleeping position, or an old injury, but more often than not it’s from spending 12+ hours a day hunched over in one position:

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Or:

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Chronic neck and shoulder pain has a pretty profound impact on quality of life. The BEST treatment, of course, is quitting your job and spending the rest of your life lounging on a tropical beach. If that’s not a feasible option, there are some things we can do to manage it.

Sleep

I’m discussing sleep first, because for the vast majority of people, simply getting adequate sleep will be the most beneficial change they can make. Adequate sleep allows the muscles to relax so the body can repair. Perhaps more importantly, inadequate sleep can compromise the serotonin system’s ability to support pain inhibition with natural opioids (1). Getting adequate sleep normalizes neuroendocrine function and supports homeostasis (2). There’s evidence that duration and quality of sleep can have a strong impact on the experience of pain (3). 7-8 hours a night of restful sleep seems to be ideal for most people, although some can get by with less and a few need more. We tend to dismiss the importance of sleep, but it’s probably one of the simplest and most profound changes we can make to improve our quality of life. William Dement has a fantastic book about the connection between sleep and pain (and other aspects of health): The Promise of Sleep: the Vital Connection Between Health, Happiness, and a Good Night’s Sleep

Exercise

Simply getting up out of your chair several times a day will bring relief! But there are specific exercises you can do as well. In a 2008 study, participants engaging in a simple strength training protocol experienced a 75% decrease in neck and shoulder pain over 10 weeks. The protocol involved 5 exercises, performed for 20 minutes 3 times a week. The exercises were the dumbbell shrug, bent over row, lateral raise, upright row and reverse fly. All of these can be done with light to moderate dumbbells or resistance bands. In fact, you can keep a set of dumbbells at your desk at work and do these exercises during down time, that’s how simple they are. Harvard Medical School has a great description of the study and the exercise protocol here.

Stretching

Take a few moments each day to give your neck and shoulder muscles a good stretch. The Mayo Clinic provides a few in this tutorial video, here are some more from E-How Health. If you’re looking for something more in depth, the Mayo Clinic created this guide to dealing with back pain for Gaiam. It includes exercises and stretching as well as nutrition and home care tips.

Massage

Studies show that massage can improve functionality and the experience of pain (4), at least in the short term. Massage won’t bring permanent relief unless you are able to stop doing that which is causing the pain (which is usually not realistic, as most of us must use computers in our jobs), but it will bring temporary relief, and regular massage can help manage the pain and stiffness from computer use. There are even self massage techniques you can utilize, and several very effective self massage tools, including the Thera Cane (my favorite) and Trigger Point Balls.

Ergonomics

Setting up your work station so that you are in a more natural position can be very helpful. If you habitually work on a laptop, use it at a table or desk rather than on your lap. UC Berkeley provides some simple tips for setting up an ergonomically correct workstation here. There are a wealth of products designed to create more ergonomically correct work stations, from tablet stands to ergonomic mice to lumbar support. You spend hours on end at this station, take some time to make sure it’s set up to minimize pain and stress on your body.

Most importantly, I think, is simple mindfullness. Our bodies don’t do well when we don’t move, so be aware of how long you’ve been sitting in one position and make an effort to increase your physical activity during the day. We spend a tremendous amount of time and energy thinking about what we eat and how we exercise, but something as simple as how we sit at our desks can have a really profound impact on our quality of life. It doesn’t take heroic measures to change though, just a few simple tweaks can make a huge difference. And as an added bonus, several of the things that I’ve discussed here not only improve neck and shoulder pain, they also improve overall health and support the maintenance of a healthy weight!

Relax The Back

Inactivity and Metabolic Health V

It’s time for another installment in my Inactivity and Metabolic Health Series! For your consideration today is the small but interesting study from the Washington University School of Medicine in St. Louis, Missouri:

Improvement in Glucose Tolerance After 1 Wk of Exercise in Patients With Mild NIDDM

There were only 10 middle aged men in this study. While it’s true that studies this small can’t automatically be extrapolated to apply to everyone, what I’m trying to show people through this series is that each small study serves as a data point in a broader constellation of evidence. There is quite a vast body of evidence that inactivity is a primary driver of metabolic dysfunction, and even though no single study can ever be taken of irrefutable evidence of anything, when dozens, hundreds or even thousands of studies all show similar results across population groups, one must sit up and take notice. You can prove pretty much anything if a single study is your litmus test (broccoli will kill you! I saw a study!). What does the weight of evidence say, though?

On to the study. 7 of the men in this study had mild NIDDM (non-insulin dependant diabetes mellitus) and 3 had impaired glucose tolerance (ie, they hadn’t been diagnosed with NIDDM yet but had the precursors). They were instructed not to change their diets over the course of the study, and kept food logs that were analyzed by a dietician to ensure that study results weren’t confounded by diet changes. They were given an initial Oral Glucose Tolerance Test, a physical exam (including blood lipid panel), and a maximal treadmill exercise test before study onset to establish baseline values.

The subjects engaged in a 7 day exercise program consisting of 50-60 minutes on a treadmill or ergometer, working at 60-70% of their maximum heart rate. On the 8th day they were given a second OGTT and exam. On the 9th day they were given a second treadmill test.

Results

VO2 max, body fat percentage and weight all remained unchanged after the 7-day exercise program, so those factors did not confound the results. There was a 36% decrease in plasma glucose, a 32% decrease in plasma insulin concentrations, and a 32% decrease in triglycerides.

What is notable here is that the subjects’ insulin response to a glucose load (from the OGTT) was significantly lower than it had been before the study. What this means: their bodies released less insulin in response to the same amount of sugar after exercising for 7 days. This is significant to the Great Sugar Narrative that holds that sugar is the driver of insulin production and release. Clearly exercise is a pertinent factor here that is ignored by the sugar-causes-diabetes contingent. Exercise can mitigate the insulin response to sugar.

Plasma glucose also decreased, even with a decreased insulin response, which indicates that the cells ability to respond to insulin also improved. From the study:

“The results of this study show that regularly performed vigorous exercise can result in a significant improvement in glucose tolerance in some patients with mild NIDDM. This improvement occurred despite a significantly smaller increase in plasma insulin levels. it appears that the improvement in glucose tolerance was due to a decrease in resistance to insulin.”

Also of note: triglycerides decreased 32% with no change in diet.

Bottom line: exercise reduces insulin response AND makes the body more sensitive to the action of insulin. Exercise does lots of other groovy things too.

Keep moving.

Inactivity and Metabolic Health II

You can view all of the posts in this series here.

Today’s post is PCOS specific, a subject I take special interest in as I lived with symptoms of PCOS for nearly 25 years before putting the pieces together and taking the steps necessary to overcome my symptoms. (You can read about my experience with PCOS here.)

PCOS is a metabolic disorder with a strong insulin resistance component. Many women with PCOS eventually develop diabetes as well. Addressing the insulin resistance is key.

Metabolic and cardiopulmonary effects of detraining after a structured exercise training programme in young PCOS women.

In this study, 64 young, overweight women with established PCOS were divided into 2 groups: one recieved 24 weeks of exercise training, the other recieved 12 weeks of exercise training followed by 12 weeks of de-training (they stopped exercising). Metabolic parameters were assessed at baseline, at 12 weeks, and again at 24 weeks.

At the 12 weeks assessment, both groups showed significant improvements in insulin sensitivity and glucose levels, lipid profile, and cardiovascular health. At the 24 weeks assessment, the first group (24 weeks of training) showed even greater improvements, and the second group (12 weeks training, 12 weeks detraining) showed no improvement over the baseline assessment. They lost all the gains they had made during the first 12 weeks of training.

The moral of the story here is that regular exercise is key. In my personal experience, type and intensity of exercise is far less important than consistency. It matters less what you do, just do something, and keep doing it.

My Pissed Off Low-Carb Rant

 

I’m not a scientist, I’m a lowly little Personal Trainer and Massage Therapist. I don’t perform studies (other than my N of 1 ones), I don’t write research papers, I don’t have a degree in anything health related.

What I do do is read a lot. Blogs (I’ve got a few of them listed in my blogroll), news articles, and most importantly, science. I try to find and read as many sides of an issue as possible.

And one thing I have, that a lot of people don’t, is an ability to think critically.

There’s a Diet War going on out there. One faction would have you believe that primitive man spent most of his time lolling about the savannah, working on his tan, only getting up off his ass long enough to throw a spear at a passing buffalo, then sitting back down to gorge himself and get back to the serious business of lazing about. Sounds pretty idyllic. Sign me up! Oh yeah, and that buffalo was made out of bacon.

Building on this belief system, they argue that modern humans are therefore primed for a life of blogging and bacon eating. It’s the true path to optimal health! See, our bodies are made to sit and eat fat, so when we eat carbohydrates, everything goes haywire. Insulin resistance, diabetes, obesity, cancer, DEATH.

‘Course, there’s all that pesky scientific data that suggests that increasing physical activity improves metabolic function (don’t believe me? Google ‘exercise and insulin resistance’, or check out my pinterest board on the topic). How can that be, if the body’s natural state is lolling about the savannah? If our bodies are designed to sit, why would moving improve metabolic function?

Do you REALLY believe primitive man spent most of his time on his ass? I don’t, not for a minute. I believe primitive man spent most of his time on the move. I believe the human body’s natural state is one of almost constant motion. When we move, we metabolize carbohydrate just fine. In fact, science holds carbohydrate is the brain and muscles’ preferred fuel (yep, I’m aware of the studies that suggest otherwise. Guess what? So far, they’re outliers). ‘Course, if we’re not moving, carbs can cause problems. But is eliminating carbs the answer? Only if you believe our bodies are designed to sit all day. If you believe that our bodies are designed to move, then eliminating carbs is a band-aid. A band-aid that might allow you to sit on your ass a few more years before disease sets in, but that ultimately doesn’t address the CAUSE of the disease: exercise deficiency. That’s right folks, I’m calling it like I see it: Metabolic Dysfunction is a disease of exercise deficiency, not of carb intolerance.

“But modern lifestyles make adequate exercise nearly impossible!” they claim. Bullshit. I have kids, a job, a household to manage, and a social life, and I am able to include adequate exercise into my daily routine. I also manage to maintain a blog! Yes, you too can blog AND exercise.

“But only young people and endurance athletes can eat carbs safely!” they counter. Bullshit, again. I’m 40. I exercise 30 minutes a day on average.

“But…but…some of us are so damaged by obesity and the Standard American Diet that we simply can’t ever eat carbs again!”. Bullshit, times 3. I was obese for 3 decades. At 35, I had a whole laundry list of metabolic issues: PCOS, high blood pressure, blood sugar regulation control problems, low HDL, and obesity (not to mention depression, panic attacks, migraines, hair loss, cyctic breasts and acne and much, much more). I reversed it ALL while eating carbs.

Ask yourself: which is more likely the natural state of the human body:
a. sitting and eating only one or two macronutrients, to the exclusion of thousands of edible energy sources
b. moving and eating whatever is easiest to find (which, where I live, would be mostly plants, with some rodents, insects and perhaps an occasional bit of larger game thrown in to supplement)

I choose b, and live accordingly (minus the rodents and insects). And you’ve seen my pictures. I suspect I look a lot more like the mythical Grok(ette) than most basement dwelling, bacon eating bloggers.