The Science of Change

“I want to learn how to eat and make longterm lifestyle change to keep the weight off once I lose it.” This is an important and insightful concern I hear. Even a highly effective weight loss program needs to address the powerful physiologic drive for weight regain in a holistic manner. Let us turn to the science of habits and neurologic pathways to do so. Today’s blog is a few “pearls” I hope you find helpful!

Treatment Adherence

Medication adherence is the extent to which a person takes a medication as prescribed.

Studies show that only 50% of adults follow treatment plans for chronic diseases. So, when a program to treat the condition of overweight/obesity attributes lack of efficacy on “non-adherence,” that is an example of weight bias in a healthcare setting that contributes to adverse health outcomes. Why? Because treatment for overweight/obesity is so much harder than taking a pill! Let’s take a closer look.

Weight Bias

Weight bias is a common phenomenon in which negative attitudes, beliefs, judgments, stereotypes, and discriminatory acts are aimed at individuals simply because of their weight. It can be internalized (by oneself) or externalized (by another person or organization). Ironically, some weight management treatment programs try to explain a lack of efficacy by a lack of adherence to a diet or exercise plan. This is an example of weight bias in healthcare causing adverse outcomes and potential harm. We need to look at change management from studies on the science of habits and change.

Gap Analysis

A gap analysis is an evaluation of the difference between the current state and the desired state. Assuming a person has already received a correct diagnosis and treatment plan for the chronic condition of overweight/obesity, there are two potential types of gap that can interfered with achieving the desired outcome: a knowledge gap and a change gap.

Knowledge Gap

A knowledge gap is a shortage of the knowledge needed to make a change. In this application, it may be the knowledge of a nutrition or exercise plan. I think the knowledge gap of nutrition or exercise is overemphasized and can lead to “diet jumping” to the latest trendy diet, such as “keto”, low carb, or “intermittent fasting” whereas it used to be HCG, low fat, and Paleo. In general, going back to basics and trusting your instincts and using what works for you is much more valuable and enduring than any purported specific diet.

Change Gap

Change gap is the gap between the desired habit and the current habit. Change management is complex and deeply rooted. Habits are behaviors that are adaptive and happen without conscious thought. In overweight/obesity, there are hormonal and physiologic causes driving habits as well, so they are not just behavioral. This discussion is limited to the science of behavior. Discussion on the physiologic underpinnings is addressed in other blogs.

Habits are Adaptive

All habits are adaptive, meaning they serve us in some way. Instead of shame or blame, let’s look at the power of habit and the science behind creating new habits.

Hyperbolic Discounting

Hyperbolic discounting is the hardwired tendency of humans to choose short-term pleasure over long term reward. This is the tendency to choose a highly palatable food that is ubiquitous in our food environment over something like vegetables (unless you prefer vegetables:). This may be why seeing a significant short term weight loss, or “jump start” is often cited as a motivator to continue on to longer term change.

Complex Ambivalence

Complex ambivalence is the even more powerful drive to choose short-term pleasure over a potential (as opposed to certain) long term reward. This may be why many people state that seeing concrete, immediate improvements in body composition, blood pressure, and blood work reinforces the changes in habit they are creating.


Providing tangible, short term rewards for effort are crucial to creating new habits. The type of meaningful reward is highly personal. It may be reduced pain, feeling proud of doing something hard, not having to take medication or wear a CPAP, or something more tangible.


Providing an effective program is the first step in creating a new neural pathway of change. To reinforce the neural pathway to change long term diet, exercise, and other habits, you need to see and experience that the change is working. If a program does not work, it is not reasonable to expect it to cause long term lifestyle change.

Silver Bullets

Beware of programs that overly emphasize a “silver bullet” to address excess weight, such as medication, surgery, or meal replacements. Effective long term weight management requires a comprehensive and holistic approach that addresses the whole person, offers all treatment options, and addresses the individual as the author of their health change and acts as a guide. This is important because medications or surgery alone leave important gaps in long term weight management. This is why I prefer to be independent of a surgical program but offers referrals for surgery, and considers anti obesity medication, but offers other options as well. Meal replacements are highly effective, but are only a tool within a comprehensive and holistic program. They can be effective at creating new habits because they overcome some of the most common initial barriers such as skipping meals, convenience and seeing results quickly.

Take Home Pearls

Whatever change you are trying to make in your life, remember the power of habit and the science of creating a new neural pathway, including seeing a short term benefit, reducing barriers, and creating rewards. This is why they say that humans are creatures of habit. Let’s use that to our advantage! Talk to me and we can unearth the keystone habit for you and utilize tools such as visible "Color My Day."

Rainier Medical Tools for Change, click here for tools and here for education modules.

“Change is not fatal, but failure to change might be.”

- John Wooden

Take Back Your Habits,

Valerie Sutherland, MD

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