Lifestyle change: “I know what to do, I just need to do it…but how?”

I hear this nearly every day in my primary care clinic. Many of my patients are overweight or obese, which mirrors the national trend: two out of three adults in the US are overweight or obese. Many of these folks suffer from medical issues such as low back, hip, knee, and foot pain; asthma; obstructive sleep apnea; fatty liver; type 2 diabetes; high blood pressure; high cholesterol; or depression. We know that these conditions often improve with weight loss. So, I often recommend weight loss as a first step in treatment, and the usual approach is through lifestyle change.

Lifestyle change programs for weight loss have been extensively studied, and across the board, those that incorporate diet and exercise are very effective — if people can stick to the program.

And that is exactly my patients’ lament. They know they’re suffering, they know that weight loss can help, and they know all about diet and exercise, but many have trouble sticking to the program. Why is this, and what can I do to help?

A recent study examined what things hinder or help people to stick to a lifestyle change program. The authors scoured the research literature for high-quality studies. What’s really important about the studies included is that they did not look at actual weight loss, only at lifestyle change success or failure.

Research found that these steps can help you live more healthfully

  • Set realistic expectations and focus on health, not the scale. When you have a lot of weight to lose and the pounds are coming off slowly, it’s hard to stay motivated. At the same time, people who weren’t expecting to lose a lot of weight tended to be more successful. In addition, harboring negative attitudes and assumptions about obesity, and feeling embarrassed about one’s weight, were associated with quitting. We can benefit when we let go of self-judgment and focus on our overall health, as well as develop smaller, more realistic goals.
  • Study your mood and food. Stress, depression, anger, poor coping skills, using food as a reward, and seeking comfort in food can derail a person’s commitment to eating more healthfully. Treating underlying psychological problems and learning how to better manage stress can be essential to our success. Doctors who don’t address these issues are doing their patients a disservice. There are many approaches to improving behavioral health barriers, and a plan should be tailored to the individual.
  • Put the oxygen mask on yourself first. Attention to the needs of family above self and pressures from home or work were also associated with quitting a program. I’m highlighting this because it’s the number one thing I hear from my patients: they have responsibilities at home and/or at work, and they have “no time for me.” Listen: when you’re on an airplane, the flight attendant gives that spiel, “If you’re traveling with children, and the oxygen masks come down, put the mask on yourself first.” Why? Because if you’re going unconscious, you can’t help anyone. It can sound like a cliché but it’s a fact. If you’re not taking good care of yourself, you can’t take good care of others. When we’re taking the time to prepare healthier meals or get some exercise, it doesn’t just benefit you, it benefits every person you care about and your ability to do your job, whatever it is.
  • Even though you ain’t got money. Economic issues were cited as a barrier, as was lack of knowledge about nutrition and physical activity. Many of us believe that eating healthy costs a lot of money, or that we need expensive equipment or a gym membership in order to exercise. Education and experimentation with cheaper fresh, frozen, and canned produce, as well as a home exercise plan, can help dispel those myths. Produce in the refrigerator aisle is often flash-frozen at the peak of freshness, and a lot less expensive. At our house, we buy pounds of frozen mixed berries, chopped greens, and cubed squash at the local bulk grocery chain. Workouts like running, walking, hiking, or Rocky-style calisthenics can be enjoyed for free. Or, you can exercise at home using a mat, or a simple manual exercise bike.

Willpower isn’t the problem

While lifestyle changes including diet and exercise can work, many people struggle to stick to a program, and it’s not for lack of willpower. Many factors can get in the way, but with a little work you can figure out what those are. Your doctor can help you figure out ways to overcome the barriers to healthy living. Tell your doctor what’s working or not working for you. Ask about resources, possibly including life coaches, therapists, and/or nutritionists, who can help you be successful with your lifestyle change program.


National Institute of Diabetes and Digestive and Kidney Diseases, Overweight and Obesity Statistics.

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, August 2014.

Lifestyle interventions for weight loss in adults with severe obesity: a systematic review. Clinical Obesity, October 2016.

Management of obesity. The Lancet, February 2016.

Obesity as a Risk Factor for Low Back Pain: A Meta-Analysis. Clinical Spine Surgery, November 2016.

Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis. British Journal of Sports Medicine, May 2017.

Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature. Surgery for Obesity and Related Diseases, January 2017.

Foot pain severity is associated with the ratio of visceral to subcutaneous fat mass, fat-mass index and depression in women. Rheumatology International, May 2017.

Co-morbidities in severe asthma: Clinical impact and management. Respirology, March 2017.

Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses. Obesity Surgery, July 2015.

Effect of Weight Loss, Diet, Exercise, and Bariatric Surgery on Nonalcoholic Fatty Liver Disease. Clinics in Liver Disease, May 2016.

Treatment of metabolic syndrome. Expert Review of Cardiovascular Therapy, March 2004.

Overweight and Obesity Associated with Higher Depression Prevalence in Adults: A Systematic Review and Meta-Analysis. Journal of the American College of Nutrition, April 2017.

Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clinical Obesity, March 2017.


  1. Donna

    Dear Alan White: They’re finding now that some specific gut-bacteria actually cause weight gain. They have done the experiments with rats and mice; and taken stool transplants from obese mice & given them to skinny mice and found that they, too, became obese. It’s NOT a CHARACTER FLAW! So, put that in your skinny-little-25-push-up-attitude. No one WANTS to be fat! And most of us have done everything that we could NOT to be, but still are. We’re slighted, condemned, and criticized – and NOW we’re told that a cold-virus as well as certain gut flora mentioned above – can also cause a person to become overweight. So MAYBE it’s not just PIGGING-OUT and SLOTH that makes one OBESE! it seems that we’re getting to the bottom of the problem, finally!!! Thank Goodness! They also know that certain Skinny mice have more brown fat than Obese mice who have more white fat. Brown fat is more thermogenic and burns more calories keeping those mice skinny, whereas the mice with more white fat are, – fatter. That is a hereditary issue one is born with. So, one can’t take all the credit for being the “right” size and shape!!! Maybe it’s not WHAT ‘you’re’ doing right, but rather what “family gifts” you received that keep you looking “slim and nifty,” albeit severely judgmental.

  2. Alan White

    Ho hum. Another bureaucratic scheme layered on top of another bureaucratic scheme, ad infinitum and ad nauseam. Obesity (fat people more properly) cost taxpayers billions of dollars each year. We need a federal law making it a requirement that any applicant for any state driver’s license be capable of 25 push ups, 50 sit ups, and a 12 minute (or less) time in running a mile.

    • Graeme Harrison

      Alan White, instead of your eugenics approach (wipe out the less-thin), how about a ‘fleet average’ benchmark for all fast-food outlets – that they have to serve at least one-third of their meals as salads, with lean/grilled chicken or fish added… without the 16oz soda drink ‘meal upgrade’.

      Then let them work out how to not so aggressively bundle sugared water with every meal, or greasy burgers as their mainstay. The meal upgrade that could be allowed is sliced (ie ready to eat) fruit with Sodastream-style carbonated water (nil calories).

      Then start naming and shaming those chains that are not meeting the benchmark. I live overseas, but just spent another month in the USA and was shocked by how the sugar-loading of all foods and drinks continues unabated.

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