Motivation and emotion/Book/2011/Weight loss motivation

The problem
In the 2004-05 National Health Survey 54% of Australian adults were classified as overweight or obese (62% men and 45% women). This figure grew from 4.6 million in 1989-90 to 7.4 million in 2004-05 (ABS, 2008). Issues surrounding being overweight and obese represent a worldwide concern leading to greater risk of particular medical conditions to the individual and greater costs to society and governments (WHO, 2003). There is hope, however, as we see that although at times it may seem so, this growing epidemic is not being completely ignored.

In order for individuals to prevent or reverse weight gain, short of having surgery they need to employ greater self-regulation efforts to eat less, acknowledge and monitor the influences affecting eating that come from their environment, and expend calories and fat stores by increasing their levels of physical activity (Reeve, 2009).

Consider this...
Every January the same situation comes knocking at our door step: Another Christmas has just rolled by, as has one more new year’s celebration, On the whole a series of holiday events has left behind the feeling of exhaustion, guilt regarding overindulgence and among others the thought that perhaps this is the time to change. Whether or not recognised ‘new year’s resolutions’ are made and it has been shown that a large portion of these relate to health related behaviours such as the decision to lose weight (Polivy & Herman, 2002).

What brings these resolutions to life?
At any one time, it has been estimated that between 40 to 70 percent of adults are using some sort of weight loss method (Georiadis, Biddle & Stavrou, 2006). Type the words ‘motivation’ and ‘weight loss’ into an internet search engine and expect to be bombarded with literally millions of results made up of motivational blogs, quotes, diets, plans and websites claiming they all have the secret to motivating long and lasting results. Take a quick glance at the current status of the fitness industry as it increasingly fills with greater numbers of fitness facilities,gym instructors, personal trainers specialising in weight loss, and even the recent addition of "24 hour" gyms. There is certainly no shortage of information and help available to those seeking to lose weight. It is a fact of life, however, that sometimes although people may know what needs to be done or what needs to be changed in regard to their health behaviours, the motivation to implement these behaviour changes can not be found (West et al., 2010). This chapter therefore attempts to address this issue and begin to answer one major question relevant in modern society: what is it that psychology tells us really motivates someone to initiate, achieve and maintain weight loss?

The decision to lose weight
Think about all the decisions you make in everyday life, some are relatively simply and take only a short moment such as the decision to watch a particular television program, while some involve a little more consideration such as the decision to quit your job. In regards to the decision to lose weight, the harsh reality is that in the beginning there was already a decision or perhaps a series of them that lead to the problem in the first place. People make choices in favour of unhealthy food options and sedentary lifestyles everyday however there are many factors that may motivate them to make health behaviour changes and initiate weight loss.

Health concerns appear to be a major source of motivation for those making the decision to lose weight and specific medical triggers and an individual’s concerns regarding their appearance do not follow far behind (Brink & Ferguson, 1998). Men are believed to be more likely concerned by future health, whereas women’s desires to lose weight are more likely driven by the want to improve their appearance (Cheskin & Friedman, 2001). Weight loss that is initiated in response to media triggers has in fact been shown to result in better weight loss and maintenance due to the enhanced motivation that is created by the experiencing of health threats (Gorin, Phelan, Hill & wing, 2004). Also, in the short-term extremely powerful motivation can come from incidental social benefits such as losing weight for an upcoming event however this motivation does not often carry over into the long-term because the focus is more so on fleeting moments (Cheskin & Friedman, 2001).

One particular study involving interviews prior to a weight loss intervention among overweight and obese men showed that the positive health benefits associated with weight loss was a major motivating factor initially (Hankey, Leslie & Lean, 2002). Motivating factors were however shown to differ with age and between those that are successful at weight loss and those that are not. In this particular study, younger men valued the cosmetic aspects or weight loss more whereas the health benefits became more important with age. Also, psychological factors more so than health reasons were more likely the motivation behind the weight loss efforts of those that were successful (Hankey, Leslie & Lean, 2002).

Self-Determination Theory: It needs to be done for the right reasons
To examine weight loss and maintenance two types of motivation need to be differentiated: autonomy and control (Williams, Grow, Freedman, Ryan & Deci, 1996). These are major components of the approach to motivation known as ‘self-determination theory’ that places emphasis on the inner resources for personality growth and self-regulation of behaviour that evolve in individuals as human beings (Ryan & Deci, 2000).

In regards to weight loss, self-determination theory suggests that in order to make the changes necessary for losing weight and maintaining the loss, an individual accepting the regulation for change as their own holds far greater importance than them simply complying with the demands for change (Williams et al., 1996). Simply put, if a person was only engaging in dieting and exercise behaviours due to someone else telling them they had to, successful weight loss and maintenance would not be likely to result from these controlling reasons. More positive consequences of dieting behaviours are produced by more self-determined forms of motivation than the least self-determined or controlling types (Georgiadis et al., 2006) and the basis for autonomous regulation relies on the need for values and behaviours to be internalised by an individual and then integrated with their sense of self (Williams et al., 1996).

This theory has been tested among participants in weight loss programs with positive results in favour of the benefits of autonomous motivation being evident. For example, Williams et al. (1996) hypothesised that dieters reporting stronger autonomous reasons for participation would more regularly attend meetings, lose more weight and maintain exercise regimen as well as weight loss. Support for the hypothesis was found with results showing that autonomous motivation greater predicted attendance and weight loss, as well as maintenance of this loss at a 23-month follow up. In another study, Silva et al. (2011) analysed the one year impact of a self-determination theory based intervention amongst previously overweight or obese women and showed that this type of intervention results in significant changes in behaviour relating to exercise and physical activity and changes in body weight and composition.

Self-efficacy: Beliefs about our capabilities
Self-efficacy as a concept and a theory of motivation has been linked to a range of health behaviours and has demonstrated a strong relationship with health behaviour change and maintenance across many domains (Strecher, McEvoy DeVellis, Becker & Rosenstock, 1986). In regards to weight loss it is said to be an important facilitator of successful behaviours and improved experiences of weight loss programs (Linde, Rothman, Baldwin & Jeffery, 2006). Self-efficacy refers to an individual’s judgements about their capabilities to organise and execute actions required to achieve outcomes and cope with situations based on the skills they have and the circumstances that they face (Reeve, 2009). According to the theoretical framework, behaviour change and maintenance are a function of beliefs about whether particular actions will lead to particular outcomes (outcome expectations) and a person’s beliefs about how capable they are at performing those actions that are required to achieve those outcomes (Strecher et al., 1986).

Following their investigation of various theories said to play important roles in explaining weight management, Palmeira et al. (2007) concluded that those theories involving self-efficacy were most predictive of changes in weight. More specifically, in their sample of overweight and moderately obese women, it was found that self-efficacy was the single best correlate of a reduction in weight amongst participants in the weight management program.

Teixeira et al. (2006) examined the changes in psychosocial variables related to exercise, eating and body image and assessed their ability to predict maintenance of weight loss. They found that along with eating restraint, exercise self-efficacy significantly predicted short-term weight loss. Similarly, when Linde et al. (2006) examined how the concept was related to diet and physical activity behaviours, results showed that self-efficacy for both eating and exercise behaviours assessed prior to active treatment significantly predicted monitoring behaviours during the weight loss program.

Although initial self-efficacy beliefs predicted weight loss outcomes during treatment, they failed to do so during post-treatment (Linde et al., 2006). So perhaps the benefits of one’s capability judgements are only on their own motivating in the shorter-term before other things need to be added to the mix in order for motivation to be sustained.

 It’s hard to imagine a time when having a ‘losing personality’ could possibly be a good thing: if it regards possessing the personality traits best suited to weight loss and maintenance however, then it very well could be. Although personality does not alone stand as a motivator, it can act as a moderator of the motivations and attitudes a person possesses and the ways in which various personality traits relate to weight loss efforts are increasingly being examined in psychological science (Yu, 2011). It has been shown that while some personality traits often considered to be quite positive can in fact make dieting and weight loss a lot harder, those we see as being at times damaging can be extremely helpful when it comes to attempts at dropping that extra weight (Yu, 2011). Personality traits can affect a person’s motivation to correct their dietary intake, such as by avoiding fatty foods and eating smaller portions (Sullivan, Cloninger, Przybeck & Klein, 2007) and also their motivation to engage in exercise (Yu, 2011).

People who are said to be ‘novelty seekers’ tend to be more impulsive, get bored easily and seek thrills and a need for adventure may not provide a good fit with successful weight loss (Yu, 2011). Sullivan et al. (2007) designed a study attempting to identify the differences in personality characteristics between lean and obese people and determine whether these characteristics were associated with treatment seeking and successful weight loss. They found that obese persons scored higher on novelty seeking but lower on persistence and self-directedness traits and suggested that overeating to avoid boredom may be one of the contributors to obesity. People who achieved successful initial weight loss scored lower on novelty seeking than those that were not successful (Sullivan et al., 2007), suggesting that those who get bored easily may have trouble engaging in monogamous weight loss programs and may need more exciting strategies to motivate them towards greater losses.

Neuroticism, agreeableness and optimism are other traits believed to be associated with efforts to lose weight. People who are more neurotic worry about their health and are therefore more willing to do what is necessary to meet goals and those that are less agreeable are less likely to give into the social pressures to engage in other behaviours that surround them. Therefore, generally speaking, people who are more neurotic and less agreeable are shown to achieve greater successes in their weight loss efforts (Yu, 2011). Also, being overly optimistic may cause people to think as though they detrimental health behaviours will not affect them and they will be fine no matter what they eat or how little physical activity they engage in, therefore hindering attempts at losing weight (Yu, 2011).

Goals: Looking forward can lead to proudly looking back
Having a goal can create motivation by causing people to concentrate on the discrepancy between where they are currently are and where they would like to be (Reeve, 2009). Tracking progress relative to an end goal is one way that people can maintain their motivation when striving to achieve weight loss as it has been shown that greater weight losses are achieved when goals are set (Baron & Watters, 1981).

Individuals wishing to motivate themselves can either adopt a goal focus where they identify the end goal and motivate themselves by focusing on what they have left to accomplish, or they can focus on what they have already achieved in pursuit of their goal and motivate themselves by adopting an accomplishment focus (Conlon et al., 2011). In relation to weight loss, a goal focus motivates people to work towards a target weight because until they reach that target weight they see that not enough progress has been made. On the other hand, focusing on what has already been accomplished highlights the progress and can lead to balancing the achievement of a previous target weight with progress towards a new target.

Research has shown that goal-focused weight loss participants are more highly committed to their goals than those that are accomplishment focused or don’t set goals at all (Conlon et al., 2011). This does however seem to depend on an individual’s level of commitment as a focusing attention on what is left to achieve may be more effective when those trying to lose weight are already committed to their goal. It may be that those who don’t reach the specific goal weight that they set may be discouraged from attempting to maintain weight loss (Elfhag & Rossner, 2005). When trying to lose weight initially there is great enthusiasm that comes with the pursuit of a goal however looking at what has already been achieved gives positive feedback that may result in greater motivation and higher self-efficacy that will benefit individuals in the long-term (Conlon et al., 2011). So, if people are trying to maintain their weight loss and avoid falling back into old habits for an extended period of time then placing some focus on previous accomplishments may motivate them. After all, we should never allow what we are striving for next allow us to forget or to be proud of what we have accomplished in the past.

It can be common for people to set unrealistic goals when attempting to lose weight (Elfhad & Rossner, 2005) but setting these goals and having ‘unrealistic’ expectations may not necessarily undermine successes (Linde, Jeffery, Levy, Pronk & Boyle, 2005). Failing to meet expectations for weight loss that are set in the short-term have been shown not to be associated with longer-term achievements (Fabricatore et al., 2007). Linde et al. (2005) demonstrated that amongst participants in a two year weight loss program, larger and less realistic goals can predict greater weight loss. Therefore this shows us that setting goals that are high and possibly seen as ‘unrealistic’ do not hinder successes in weight loss and they can in fact help to assist and motivate weight loss attempts.



Back to reality
Now that we've had this nice little daydream about someone giving us money everytime we reach a weight loss goal, I know exactly what you’re thinking: when in the real world is someone actually going to pay me for achieving and maintaining weight loss? My answer to you is this: although you may stumble across the rare competition or challenge in which you will receive a financial incentive or reward for losing weight, if it never happens (which is likely) don’t lose hope. These examples of research just show that incentives and rewards can be used for motivation in weight loss efforts just the same as any other area.

Commit to buying yourself a new piece of clothing each time you reach a target weight or perhaps create your own simple deposit contract in which you put money into a money box and only get back if you achieve your goals (donate it to charity if you don’t). In fact those joining a gym, hiring a personal trainer or attempting any other weight loss strategy that involves them having to pay money are already setting up a situation in which they are financially accountable for their behaviour changes so maybe this will motivate them. Try to create your own external incentives and rewards!

Take a look around for just a short while and it is easy to see how in everyday situations, particular things can reinforce our behaviour and receiving external rewards for our achievements can give us pleasure and a sense of gain. Therefore it seems the logical question here is: if motivation can come from within, can people trying to lose and maintain weight also be motivated extrinsically by such things as incentives and rewards? Generally within programs designed to help participants lose weight, the aim is to modify the antecedents and consequences of eating and exercise in order to then create changes in these behaviours (Jeffery et al, 1993). So, how is weight loss and maintenance improved when a more direct approach is taken to modifying what comes before and after diet and exercise?

Jeffery, Wing, Thorson & Burton (1998), conducted research examining two different strategies aimed at enhancing adherence to exercise within an 18-month weight loss program. A personal trainer that scheduled, cued and participated in exercise sessions was used to strengthen the antecedents of physical activity and financial incentives based on attendance at sessions were used to heighten the consequences. Results showed that used on their own both personal trainers and incentives doubled attendance at sessions and when they were combined the attendance of participants was approximately tripled (Jeffery et al., 1998). This increased attendance however did not result in long-term weight loss but still shows that incentives are possibly a motivating factor in the short-term for people trying to increase their physical activity levels which could create habits that could send them on their way to making further health changes and achieving weight loss.

In another study of financial incentives in particular, Volpp et al. (2008) designed two approaches for losing weight applied from behavioural economists and tested them over a 16-week period. In the first intervention, participants played a lottery and then if they achieved or lost more than the target weight they received the winnings. The second intervention involved the participants investing their own money and if they failed to achieve the target weight loss they lost the money (deposit contract). Overall, participants who received either incentive-based intervention lost significantly more weight than those that received neither and results showed that while only 10.5% of the control participants met the target, approximately half in each the deposit contract and lottery group did (47.4% and 52.6% respectively).

While the findings of the above mentioned two studies didn’t translate into the longer-term there is still hope since other investigations have found differing results. For example, Mahoney, Moura & Wade (1973) showed that not only did people given instructions to self-reward themselves a portion of their deposit contingent achieve greater weight loss after four weeks of treatment, they also showed greater improvement at a four-month follow up. So, self-rewarding behaviours during weight loss efforts may indeed be useful for motivation in longer-term situations of weight control and maintenance.

Summary
Generally speaking, individuals wishing to lose weight need to decrease their overall food intake while increasing their physical activity levels. This certainly isn’t confidential information or any form of secret, however despite the fact that people often know what behaviour changes need to be made in order to improve their health we all know how hard it is sometimes to find the motivation to make these changes. This chapter therefore tried to address this issue and has outlined just some of the motivating factors involved in the initiation, achievement and maintenance of weight loss.

In summary, the initial decision to lose weight is most commonly driven by factors relating to future health benefits, specific medical triggers, appearance concerns and sometimes transient social events. Factors that help to motivate people through successful weight loss and maintenance include autonomous motivation and components of self-determination theory (autonomy and control), an individual’s self-efficacy, goal setting, extrinsic regulators of behaviour, such as incentives and rewards, and even an individual’s personality characteristics (neuroticism and agreeableness).  So based on what psychological science tells us here are some tips for those looking for motivation in reducing their weight or maintaining behaviour changes:
 * Own your decision and ensure that you are doing it for autonomous reasons rather than controlling ones
 * Set goals according to the SMART-TIME formula
 * Create incentives and reward yourself when you achieve these goals
 * Know yourself and your personality so you can prepare for your weaknesses in your strategies
 * Beware of what your good at and where your weaknesses lie and believe in your capabilities while always trying to improve on your downfalls