Rewriting the Rules for Health-Related Changes

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Often when people are looking to make lifestyle changes to improve their health, it comes down to losing some weight and exercising more. These are two lifestyle changes that can have large impacts. (Quitting smoking is another big one, but that won’t be covered here specifically.)

Unfortunately, when a decision is made to make these changes, there is a mindset of compliance to some external set of rules. The models currently available often frame the changes as necessary, even part of an undesirable condition that needs to be fixed. Then the skills required to make the change are taught by an external expert, who outlines a program to follow.

Following the Rules Can Go Wrong

In this scenario, what happens to personal choice, volition, and learning for personal growth? Attempting to adhere to a controlled program flies in the face of being able to set up behavioral change that will lead to the fulfillment of three basic human needs. Fulfillment of these three needs leads to personal growth and well-being. As laid out by Deci and Ryan (2000), they are autonomy, competence, and relatedness.

Specifically, when autonomy is the focus of one’s actions, that action becomes a personal choice, not something that is coerced. But it’s tricky. Following a prescribed program for weight loss and exercise can give a person a temporary feeling of control over the situation. There may be some early results, which can be a positive reinforcer for the program. But then something often goes wrong.

Following a program can be viewed as a means to an end, not a chance to participate in a growth process. There is no empowerment, intrinsic connection to the process, or investment in learning the complex nuances of behavior change.

In fact, Powell et al. (2007) has concluded that “the idea that a lifestyle intervention for obesity should occur for a discrete period of time, terminate, and then have lasting effects over the duration of one’s lifetime is outmoded.”

Creating the Environment for Sustainable Change

When motivation is oriented to white-knuckling it through an externally applied program, these basic human needs are not met. Following that kind of program often leads to the disappearance of motivation to continue. On the other hand, orienting motivation toward developing intrinsic goals that are integrated into each person’s personality and life circumstances has proven successful. This approach has been shown again and again to predict positive outcomes in many health-related areas, including weight loss, maintenance of weight loss, and physical activity. These changes become part of the individual’s habitual behavior.

How can we create an environment where the person is given the space to explore their own preferences when it comes to making the desired lifestyle changes?

One approach is through Motivational Interviewing (MI). This method was designed to strengthen personal motivation for change and to enhance autonomy over making the change. But MI does not exist in a vacuum. It must be combined with skill development, awareness of current habits, how to direct action, self-monitoring, and garnering social support. In short, the process is still a complex one. But, as Deci and Ryan have indicated, who is doing the steering makes all the difference.

How Does a Sustainable Change Process Play Out?

A few examples of how to redirect steering the course to the individual comes with questions like this:

• Where would you like to start?
• What are you interested in changing?
• How important is it that you take action?
• Write down 10 achievable actions.
• If you started working out tomorrow, what would need to happen?

Research around Motivational Interviewing is ongoing, sometimes with mixed results. Part of the problem is that often the exact method being used in Motivational Interviewing is not always explained, the training of who is giving the intervention is not always clear, and the optimal number of sessions is still in question. As usual, the issues are complex.

Having said that, it is apparent that making the way for internal control predicts sustained behavior change. Autonomy, competence, and relatedness are promoted. Yes, Motivational Interviewing and other similar programs are externally applied. But guidance toward a new way of approaching lifestyle changes is needed in order to combat the current and pervasive approach which focuses on compliance.