Improving Adherence in Weight Loss Programs
Researchers from the University of Massachusetts and Rush University Medical Center (Pagoto & Appelhans, 2013) conducted a meta-analysis of randomized controlled trials that compared diets differing in macronutrient composition. They found very small and inconsistent differences in weight loss. The authors state, "The only consistent finding among the trials is that adherence - the degree to which participants continued in the program or met program goals for diet and physical activity - was most strongly associated with weight loss and improvement in disease-related outcomes."
Clinically we have seen that to improve adherence, not only in the weight loss phase but also to maintain weight loss long term, clients usually need to respond to cognitions such as the following:
- I should lose weight quickly and if I don't, it isn't working (and therefore it's not worth it so I should give up).
- If I make a mistake, I've blown it for the day so I might as well keep eating whatever I want and get back on track tomorrow.
- It's okay to eat this because just this one time won't matter.
- I've been doing well and the scale has gone down so it's okay to loosen up.
Left unaddressed, dieters invariably get off track with their eating and gain a little bit of weight. They then often become discouraged and further reduce their adherence or abandon their eating plan altogether.
Pagoto and Appelhans conclude that there needs to be an emphasis on "biological, behavioral, and environmental factors associated with adherence to lifestyle changes" in order for dieters to make progress in weight management. While these factors are essential to address, we have found that the changes dieters make are usually short term unless they simultaneously address their dysfunctional cognitions. In addition to other cognitive and behavioral skills, they need to identify the specific thoughts they're likely to have in any given situation that could lead to non-adherence and they need to practice strong responses daily in order to be able to respond effectively to their thoughts when a challenging situation arises. If they do not, diet adherence will continue to be problematic and short-lived.
JAMA. 2013;310(7):687-688. doi:10.1001/jama.2013.8601