While we all know we should workout, eat healthy, etc etc *insert eye roll here* actually doing it and sticking with it is a different story.
Why, we ask?
...what helps us stick with our New Year’s resolutions and our best intentions to lose weight so we achieve our goals?
...what do you need to know when you begin (again) so you’re successful (this time)?
...and, whether you’re trying to discern what you need to help you or are the one running different programs, owning a gym/studio, and coaching clients -- what leads to individuals committing, reaching goals, and ultimately getting what they want?
Because while we all know exercise and healthy eating are highly recommended to lose weight initially and maintain weight loss in the long term, poor exercise and nutrition program adherence is rampant.
A 15-week evidence-based weight loss method of diet OR diet + exercise program produces a weight loss of about 11 kg, with 6.6 kg and 8.6 kg maintained loss after one year respectively… but that doesn’t happen if we don’t stick with the method.
And adhering to weight loss interventions is difficult for many people.
So if that’s you, you’re not alone!
In fact, 50% of obese men and 58% of obese women in the US are actively trying to lose weight according to data from the 1998 National Health Interview Survey. And one can only assume that number has gone up in recent years.
The most common reported weight loss methods are;
Calorie restriction alone
Eating less fat
But despite our best efforts, the prevalence of obesity has remained high.
Let’s be honest; weight is complex. It’s impacted by diverse genetic, environmental, cultural, and socioeconomic factors.
Unfortunately, the chances of returning to a normal weight for someone who is already obese are extremely low; 1 in 210 chance for men and a 1 in 124 chance for women. That’s a less than 0.5% success rate for men and a 0.8% success rate for women!
But there IS hope. And studies have proven it.
A sustained weight loss is possible, even for those who are obese. (Just look at G!)
A study of 4034 adults with obesity in the US found that 40% lost >5% of their body weight in the past year and 20% lost >10%. And even though a 5% reduction in body weight doesn’t seem like a big number it’s enough to improve health outcomes.
One doesn’t need to lose a substantial amount of weight to see health benefits.
So why is adherence to weight loss interventions important?
It’s important to understand what behaviours lead to success so we can develop more initiatives and systems that support people’s success.
Adherence is defined as completion of a program, or, in certain cases, was assessed by the level of consistency of sticking to the intervention of interest.
And in any health behaviour, nonadherence is a problem.
The World Health Organization identified nonadherence as a problem of “striking magnitude”.
A meta-analysis of 80 studies on weight loss interventions found a mean attrition rate of 31% and a meta-analysis of 45 randomized controlled trials of nonsurgical weight loss interventions in obese adults found that 28.4% of participants dropped out of the study prior to the maintenance phase and that many of these dropouts were due to not meeting adherence criteria or weight loss criteria during the study phase.
We can create life-changing programs, but if no one does them then it doesn’t matter how life-changing they are.
What positively influences adherence in a program?
Of course, you need to make sure the workout and diet plan you’re on is actually effective for the goals you want to reach, but when it comes to sticking to them there are a couple of ways you can set yourself up for success.
A review of 4 studies revealed that interventions using telecommunication and the integration of exercise into activities of daily living demonstrate significantly better adherence when delivering exercise at home.
A meta-analysis of 18 randomized controlled trials found that diet and exercise programs combined were clearly superior in their results compared to diet or exercise programs alone. (More on that later!)
A meta-analysis of 29 studies looking at long-term (5 years) weight loss maintenance among those who participated in structured weight loss programs found that the average individual maintained at least 3 kg of weight loss and at least a 3% reduction of initial body weight. Those who lost more weight prior to starting the programs were more likely to keep weight off and those who exercise more were able to better maintain their weight loss than those who did not.
A systematic review of adherence results and factors showed that an overall adherence rate for weight loss programs was 60.5%. Interventions lasting <12 months had a mean adherence rate of 69.9% while interventions lasting ≥ 12 months had a mean adherence rate of 53%.
What actually impacts you sticking to it?
There are 3 main variables found to impact adherence;
Supervised attendance programs had higher adherence rates than those with no supervision
Interventions that offered social support had higher adherence than those without social support
Dietary intervention alone had higher adherence than exercise programs alone
The other factors linked to higher adherence are;
The factors that are linked to lower adherence are;
Lower socioeconomic status (education and income)
Dissatisfaction with the program or weight loss results
Without ignoring those factors, let’s talk about the application of those three bigger variables.
How much does social support impact success?
Interventions that included social support improved adherence rates by 29% compared to those interventions that did not include social support.
Self-monitoring programs had the lowest adherence rate (41.5%) and supervised interventions had the highest adherence rate (68.6%).
When attendance was monitored participants were more adherent compared to programs that used self-monitoring interventions, diet interventions, or physical activity interventions without supervision or attendance tracking.
High adherence rates were observed for interventions that incorporated aspects of social support.
...why is social support so impactful?
Social support is an important determinant in overall health.
In fact, Public Health Agency of Canada has listed social support as the 2nd most important determinant of health. Those with social supports in place even have a reduced risk of premature mortality.
Social support can range from group sessions to peer coaches to social support contracts to “buddy” programs.
And social support (whether through family, friends, peers, providers, or professionals) is important for successful behavioural change.
For example, one study found that those who received guided support for weight loss were 37% more likely to maintain weight loss than those who participated in self-directed strategies!
Weight loss interventions that allow friends and families to get onboard help weight loss and weight loss maintenance (95% completed treatment and 66% maintained their weight loss in full) compared to doing it alone. It results in a stronger commitment to a plan and has been shown to improve weight loss results.
It’s important to incorporate aspects of social support into weight loss interventions and to provide social support when participants have none!
And in today’s day and age social support can be delivered using existing social networks, professional support and expertise, and also with technology.
Social networking sites and apps can help individuals meet others in a non-judgmental environment to share goals and challenges, find encouragement and tools, get answers to specific health-related questions, and share their success stories which in turn can motivate others to achieve similar goals. This support translates good intentions into specific actions which can lead to accomplishing health-related goals.
Okay, I get social support. What about accountability?
Programs supervising and monitoring attendance improved adherence rates by 65% compared to self-monitoring programs and had the highest adherence rates overall.
...why is accountability so impactful?
Likely because being more accountable for your behaviour leads to sticking to it.
Working without guidance can be discouraging and, at times, dangerous.
Increasing knowledge transfer through access to an expert supervisor helps improve self-efficacy and allows clients to access the provider’s knowledge and feedback.
Furthermore, a good relationship between supervisors and participants can increase adherence to additional health advice.
Diet vs exercise vs both diet and exercise
Better adherence to dietary interventions alone has been found compared to exercise interventions alone and both.
...why do people adhere to diet plans vs exercise or diet + exercise?
One study theorized that because participants saw more weight loss from diets than from exercise interventions in the beginning, they stuck with it because of the quick results.
But, it’s been found that the most effective long-term success is with dietary and exercise programming together.
Let’s get physical
Physical activity is important to overall health and overall weight loss maintenance and should be encouraged as a part of weight loss intervention along with dietary change.
The motivations for sport participation compared to exercise are different.
Exercise is typically performed by those with extrinsic motives; attracting those focused on appearance and weight, and stress management.
While sport typically attracts those with intrinsic motives; such as enjoyment and challenge.
But whether it’s exercise or sport you do for physical activity it’s intrinsic motivation that leads to adherence and, in turn, results.
What about financial incentives?
If someone paid you to complete a program, would you do it?
We often think “uh, yes!” but studies have shown that financial incentives result in no significant difference in adherence rates.
Instead, intrinsic motivation and seeing results have been found to be most powerful in terms of why people stick with something and see success long-term.
The Adherence Conclusion
It’s not possible to lose weight without actually adhering to weight loss protocols; such as exercise and dietary interventions.
But in weight loss interventions nonadherence rates are usually high.
Simply put, a substantial proportion of people do not adhere to weight loss intervention.
But it’s not so simple... it’s wishful thinking to imagine that there’s a single solution to reverse the rising prevalence of obesity observed globally.
A comprehensive approach is needed to address this complex issue.
What we do know is this though;
Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.
This is the key to designing and implementing more effective interventions and to educate and empower individuals to set themselves up for success.
With better adherence, people who are overweight or obese can lose more weight and help keep it off in the long term.
And, while we often look at reducing disease risk and containing costs to healthcare, when asked why people habitually eat healthy and/or exercise they often answer, “It makes me feel good.”
This human element, and feeling, must never be forgotten.