Here’s some hopeful news for people who are struggling to adopt a more healthful lifestyle:
A new study has found that people who made two simple behavioral changes — eating more fruits and vegetables and cutting the amount of time they spend in front of a TV or computer screen — were more likely to experience another potentially healthful change (eating less food with saturated fat). Furthermore, they were highly likely to maintain those new habits months later.
“Many people, particularly health professionals, are often extremely pessimistic about whether people can change their health behaviors,” said Bonnie Spring, the study’s lead author and professor of preventive medicine at Northwestern University, in a phone interview Tuesday. As a result, doctors tend to prescribe medications rather than counsel their patients about making lifestyle changes.
“This study shows that it really is possible for people to make quite large changes in health behaviors and to maintain them pretty well,” Spring said.
Ditching unhealthful lifestyle habits is often overwhelming, in large part because “no one ever comes with just one unhealthy behavior,” said Spring. “They tend to come bundled.”
Spring and her colleagues decided to see if simplifying the intervention process — asking people to focus on just one eating and one physical activity behavior — would lead to better results. For their study, which was published Monday in the journal Archives of Internal Medicine, they recruited 204 adults, aged 21 to 60, and randomly assigned them to one of four treatment groups.
Group 1 was advised to increase their fruit and veggie intake and their physical activity. Group 2 was told to focus on decreasing both their dietary fat and their sedentary leisure (like watching TV). Group 3 was assigned the task of eating less dietary fat while increasing their physical activity. And group 4 was instructed to eat more fruits and veggies while spending less time being sedentary.
For three weeks, all the participants entered their daily data into a PalmPilot (the study was conducted before smart phones took over mobile technology). The data was uploaded to a real-live coach, who communicated with each participant by either e-mail or telephone. Participants were also told they could earn $175 if they met their goals during the three-week treatment period.
After that initial three weeks, patients could earn $30 to $80 per month if they sent data three days a month for five more months — but this time they didn’t have to maintain the lifestyle changes in order to get paid. In other words, the monetary incentive was taken away.
All the groups showed improvements in the tasks they were assigned. But the group that was told to eat more fruits and veggies and get off the couch tended to show the greatest health gains not only in its targeted categories, but also in a third one: eating less saturated fat. They not only tripled their daily servings of fruits and veggies (from one to three servings, on average) and spent an average of 90 minutes less each day being sedentary, they also decreased their fat consumption to levels comparable to those in the group that was advised to do so.
None of the other treatment groups showed such broad improvements in lifestyle changes.
Furthermore, the eat-more-fruits-and-veggies-and-spend-less-time-on-the-couch group also had the greatest percentage of participants (86 percent) who reported that they were maintaining the healthy lifestyle changes at the end of the study’s follow-up period.
“I think they were pleasantly surprised,” said Spring.
Uncoupling the cues
Why did that particular combination of behavioral changes work the best?
“We think that the reason that the saturated fat intake came along for the ride when people cut down their TV watching is that those two activities tend to be paired,” said Spring. In other words, turning on the TV acts as a cue for people to munch their way through a bag of potato chips or cookies or other high-fat snack. So, if you aren’t in front of the TV (or computer), you’re less likely to consume the extra food.
But that wasn’t the only factor involved. “Our observation is that there is something quite empowering when people increase their fruits and vegetables,” said Spring. “It increased their confidence that they could make all the other changes.”
Footnote: Not all health experts believe that saturated fat consumption is as strong a contributing factor in America’s poor health as previously believed. These experts point to carbohydrates, particularly sugar, as playing a much greater role in the current obesity epidemic, with all its associated illnesses. High-fat snack foods, however, are often high in carbohydrates, too. So breaking the pairing of TV and eating may help reduce consumption of unhealthy carbs as well.