Changing Behaviour

I recently read an article which talked about changing behaviour on a large-scale population level, i.e., the social world that we live in. However, what I think is vitally as important, if not more, is to change the behaviour of healthcare professionals. Allowing them to have an integrated and evidence-based approach that understands the complexity of obesity and also realises that obesity is not solely the fault of the individual. 

Excerpts from this article:

“”However, changing this process is very difficult and can take several decades to change the level of culture, unconscious bias, also policy, legislation and practice changes which have to happen on a large scale. Behavioural science is also a rapidly evolving field which could be used in the obesity environment. 

A simple analogy:

Smoking?

It may be quite a simple analogy, but what we need to do is to try and individualise a person living with obesity. The UK’s tobacco control strategy would be a good idea because if you think about it, the person is affected by tobacco in lots of different ways, as is the person living with obesity. And also, we don’t turn around to a person who’s smoking and say “It’s all your fault.” 

Yes, they do bear some individual responsibility however there are other factors that make quitting smoking a very difficult ask to do. However, our healthcare professionals are very compassionate towards this and people are very willing to help. So again, we look at the complexities of obesity and how difficult it is to change behaviours. A way to do this within the social perspective, again similar to tobacco, we need to look at advertising bans, point-of-sale restrictions and that would be for those unhealthy options which we all know very well. We need to look at limiting the availability or visibility of those unhealthy options as was done with tobacco. 

Initially this was regarded as a ‘Nanny State’ and now it’s deemed as normal and that is the reason why there should be no qualms enacting that type of legislation for the unhealthy foods promoted by the food industry. Psychologically speaking, by reducing the opportunity to eat these unhealthy foods, it also reduces the activation of motivational processes or habitual behaviour i.e., when standing at the till, you generally grab something that’s there. However, if it’s not there, or if there’s a healthier option, you would turn into a habit of grabbing that, and that was the same with cigarettes. The minute they’re out of eyesight, your brain forgets about that initial temptation, similar to fast food and takeaway. 

We should also be looking at the social and contextual factors that exist within the promotion of positive actions, for example, price promotions on healthy options; making vegetables far cheaper than potatoes and starch. You must also understand, from the analogy of smoking, that you have a shared positive rationale for stopping smoking because it also affects other people; your family, friends and co-workers from second-hand smoke. 

Now that the non-smoking has become the “new norm” and the harm of smoking has been accepted, it begs to say that people living with obesity would look to the compounding effect of taking this seriously. But what we must remember is that all these types of changes do not change behaviour in themselves, but work on imposing restrictions and interventions in a large-scale population whilst requiring capabilities and motivations. This is where some of the individual responsibility does take place. 

So again, we look at the types of interventions that can be delivered by healthcare professionals. It is difficult because the clinical guidelines that are currently available do not provide clear evidence-based intervention strategies and how to deliver them, either at an individual or population level. 

There are charities and associations who distribute this information in a clear and concise way however, within the actual medical education system there seems to be a death of this. For example, it’s important to guide choice rather than give prescriptive advice, so moving from a ‘telling’ to an ‘asking’ approach. For instance, from a ‘telling’ perspective: “Why don’t you try to… move more?” To ‘asking’: “What do you want to achieve?” 

Telling: “Don’t worry about what you look like”, to ‘asking’: “What is stopping you from doing your activities?” So there again, we’re looking at problem solving for the individual but still incorporating the healthcare professional. 

Telling: “Have you thought about joining a gym?” Asking: “What do you think you can do differently in your day to make some change?” This looks at action. 

Telling: “Why don’t you give yourself a reward and buy a new top when you lose 5 kilos?” Asking: “How will you reward yourself for success?” So again, the behaviour change technique which is self-reward and self-compassion which is highly lacking within people living with obesity. 

What could also inspire culture change and asking what the person living with obesity would like to do that they used to do when they were less obese. 

Especially for men, it’s really difficult to talk to them and generally they don’t enjoy the environment of slimming clubs etc. There are various training programmes out there such as Football Fans training programmes and Man VS Fat.

 It is really important for you as a HCP, to read up on these as a self-educated idea, on how to actually individualise treatments, and if it’s not football, then perhaps another sport.