What Happens to your "Good Intentions"?
Tuesday, August 16, 2011 at 8:20AM 
The most recent data on calorie intake shows that Americans’ average calorie intake has increased by 571-calories per day between 1977 and 2006.[1] Over this same period obesity increased dramatically from 15% to 34% of American adults. Why exactly are we seeing this dramatic rise in obesity now, after thousands of years of leaner humans being the norm? It’s not because of changes in our genetics, or physiological changes in appetite regulation (which would mean we’re genetically mutating at some fantastic rate). The popular topic of hormones (leptin, ghrelin, etc.) and “hypothalamic regulation of feeding” suffer from the same underlying problem (have these systems changed in 30 years?) and ignore the fact that nowadays humans simply choose to eat—without consideration of whether they are hungry or not.
But again, why? This change in human behavior is largely the result of food being available 24/7 almost everywhere, along with it having gradually become culturally acceptable to snack anywhere anytime. Overeating is even considered “manly,” and high-volume eating has become “sport” with competitive eating contests on who can eat the most (you name it)! Furthermore, perceptions of “normal” weights have continued to rise along with our national girth. People on the lower end of the normal-healthy BMI range are now considered by many to be “too thin.”*
The overweight and obesity we have today is simply the result of these social, cultural, and environmental changes that together exert a “pressure” on individuals—to eat more, and eat more often. A pressure that historically had not existed. The challenge humans had for thousands of years was to find enough food to eat. Today we have the opposite problem—the challenge is to say “no” to endless opportunities to eat (in the absence of physiological need).
Basically we respond to the stimulus of appealing food, by eating it, despite our weight loss and health goals. Immediate gratification trumps good intentions.
Unfortunately this is how our brain wiring interacts with modern culture and environment, and it's a recipe for weight gain. When overeating is not balanced by an equal amount of undereating bodyweights creep up over time. And so here we are. So what do we do? Is there any way to win this uphill battle?
Fortunately we do know some strategies that get good results. For instance, just this past week there was a press release saying that, “obesity counseling should focus on neurobehavioral processes." The three processes identified are: food reward, inhibitory control and time discounting. While this is being described as a new view, or understanding, of what underlies eating behavior, that is not the case. Behavioral psychology/medicine long ago described what this recent article is describing as "new," but it does underscore where we need more focus.[2,3,4]
Behavioral reinforcement theory tells us that the closer (in time) the reinforcement is to the stimulus the more strongly it reinforces the behavior.[2,3] In this case, eating (the appealing food you run across) would appear to be a self-reinforcing behavior because the reinforcement (pleasure) is immediate.
On the flip side when would you get reinforcement for avoiding eating the appealing food you run across? Ah, herein lays the challenge. When you are focused on the scale dropping, the reinforcement for that is delayed to say the least! This is the problem in a nutshell.
Key point: Immediate reinforcement trumps delayed reinforcement. As reinforcement theory tells us, in shaping behavior change “reinforced behavior will be repeated, and behavior that is not reinforced is less likely to be repeated."
Note, however, that “weight loss” is NOT a behavior! Weight loss rather is the result of consistently engaging in a set of healthy behaviors that create the outcome of weight loss. Therefor, in order to get positive traction and success, you need to reinforce the behaviors that create the outcome of weight loss.
You’ll increase your chances of success with weight loss (and maintenance) geometrically by employing two behavioral strategies:
Success Tool #1: Record keeping has long been correlated with successful weight loss (and maintenance). It’s incredibly hard to find opportunities for behavioral reinforcement of healthy behaviors. Record keeping however, provides a treasure trove of those opportunities! It’s very satisfying (reinforcing) to see that you have met an objective. That objective may be any number of (ideally but not always) measurable behaviors that create the outcome of weight loss including: 5 servings of fruits and vegetables, walked 10,000 steps, drank 8 glasses of water, you ended the day at or below your calorie goal, etc.
Success Tool #2: As I’ve discussed previously, stimulus (cue) control works because by avoiding constant battles you win the war! Stimulus control consists of both removing problem-trigger-foods from your home environment, and adding the healthy foods that you want to eat more of. It also includes bringing healthy stuff with you (lunch, snacks, and water) so that you are not at the mercy of what the outside world has available (in your face, all the time).
These critical behavioral strategies, have been underplayed or ignored by many weight loss professionals, likely due to the false notion that people should (a moral judgment?) be able to learn how to NOT eat appealing food in their environment. That judgement however sets people up for failure because it ignors brain wiring. Another misconception among some professionals is that removing trigger foods from one’s environment amounts to “deprivation.” Deprivation in this case is a subjective and false judgment (that I liken to adolescent-thinking), and can be dealt with quite effectively through cognitive restructuring (a topic that requires another blog in itself).
For the record, the point of stimulus control is not that you would never eat a trigger food. It’s just that you take control— i.e. you leave the ice cream at the ice cream shop and go out for it whenever you want. Trust me; you’ll eat a lot less ice cream than when you bring it home by the half-gallon!
Given the calorie-laden environment we traverse daily, weight management may always be challenging for many of us. By employing stimulus control and using record keeping to provide reinforcement for healthy behaviors you will provide yourself a substantial foundation to build your success on. And remember, healthy behaviors become habits too. So someday you will look back and wonder what the big deal was!
Best,
-Dorene
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What is your question or comment? Comment here, or email me: dorene@beyonddiets.com.
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Would your food log look like a crime scene?
*The "normal" BMI category is 18.5- to 24.9. However if you are female the lowest mortality weights fall between a 19 and 21 BMI, and for males they fall between a 20 and 22 BMI. That's because the higher third of the normal category (23- to 24.9) is already assoiciated with higher mortality rates from type 2 diabetes and cardiovascular disease.
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[1] Energy Density, Portion Size, and Eating Occasions: Contributions to Increased Energy Intake in the United States, 1977-2006.
[2] The Behavioral Economics of Dieting. FoodTechnology July 2011;65(7):pg.16.
[3] Elementary Principles of Behavior, 4th Edition by Malott and Trojan.
[4] Could Behavioral Economics Help Improve Diet Quality for Nutrition Assistance Program Participants?
Reader Comments (2)
Love this blog. Just yesterday I was at Kinko's to have some color copies made and, as I was waiting with my dietetic intern, I noticed that the under-counter space was filled with candy and snacks. I asked her, "Do I need to have a snack when I come to Kinko's?" Crazy!
Hi Neva, thanks! Exactly the problem. I'm old enough to remember when food was mainly available only at home, the grocery store, or at restaurants! We didn't tend to eat between meals, and we ate a regular breakfast, lunch and dinner. Remember gas stations when they only had a vending machine for pop or candy bars? Today gas stations are all "convenience" stores. And so it goes. The sad (and scary) thing, is that we now have 30% of children obese. Surgery, nor pills will solve this problem (they don't address the cause). Behavioral strategies (along with diet and exercise) do work. What would really help is a cultural shift back to the pre-seventies structure and common sense around feeding ourselves!