Success & Failure

It’s Complicated: Embracing or Avoiding Failure in Obesity

A new viewpoint in the current issue of JAMA suggests that how we embrace or avoid failure in pursuing health-related changes has a direct impact on motivation.

Shreya Kangovi and David Asch caution that self-monitoring aspects for health promotion has some disadvantages. When the number on the scale for those attempting weight loss, or on the glucometer for those monitoring their diabetes it not at target, this may discourage rather than increase focus on the behavior change. But Kangovi and Asch make the case that reframing setbacks can increase the success of health promotion efforts.

Downsides of Self-Monitoring

The authors reflect that self-monitoring can have negative effects. They share data showing quality of life can decrease as a result. The viewpoint further unpacks what looks like lost motivation by reaching into the behavioral science literature on how individuals deal with failure.

They state that there are two types of reactions, emotional (how do I feel about the failure) and cognitive (what caused the failure). If failure seems inevitable, avoidance of self-monitoring is a common outcome. If failure seems to be controllable, an individual may course correct and proceed even with mild regret. The authors suggest that attribution retraining can help reframe and help to dampen the negative emotions associated with setbacks, and in doing so preserve motivation.

How does this relate to people living with obesity? Regular self-weighing is one of the behaviors that leads to long-term success for those who reach clinically significant levels of weight loss. For many others, lack of progress in weight management may feel like failure. And that may be the reason some people don’t step on the scale in the first place. What else might be going on? Looking through the lens of emotions and cognitions around failure is only partially telling the story.

Biological Factors

As a matter of fact, Ochner and colleagues point to the biological mechanisms that promote weight regain in people with obesity. Those mechanisms include increases in hunger hormones and cues for food and decreases in hormones that promote fullness. These mechanisms feed into individuals interpreting their efforts to lose weight as “failure” that may trend toward self-blame.

Self-Monitoring and the Quantified Self

Pagoto and colleagues reflect on the key lessons learned as technology and devices are becoming more common in supporting behavior change, including weight loss. Acceptance strategies help individuals cope with discomfort. They are useful in reframing difficulties that are as a normal part of change. Such strategies help people expect difficulties. Ensuring that acceptance strategies are part of health promotion efforts can increase an individual’s distress tolerance.

Current self-monitoring technology for behavior change faces another issue. Often, it ignores the moments when someone is experiencing the greatest challenges. For example, food cravings, hunger, or stressful situations may send someone into older patterns for coping in the moment. Technology that supports individuals during both routine and stressful times will be key to supporting individuals on their change journey.

Supporting people in making behavioral changes must address interpretations of failure and self-blame. Support must also account for the biological realities of weight regain. More and more, technology supports behavior change. So building in mechanisms to address distress will be an important evolution in health promotion efforts going forward.

Click here for viewpoint by Kangovi and Asch. For the paper by Ochner, click here and for the blog by Pagoto, click here.

Today’s guest post comes from two good friends. Trina Histon, PhD, is a health psychologist who has worked in prevention, wellness, and obesity for over 20 years. Adam Tsai, MD, MSCE, is an internist and board-certified obesity medicine physician.

Success & Failure, photograph © Kaho Lam / flickr

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May 1, 2018

2 Responses to “It’s Complicated: Embracing or Avoiding Failure in Obesity”

  1. May 01, 2018 at 5:54 pm, Susan said:

    It’s interesting that the authors automatically assume that failure to lose weight is due to the individual failing to follow their diet rather than the biological struggle many of us face. ‘Course correction’ doesn’t work if you’ve faithfully stayed the course only to see the numbers stall or worse yet climb. Having been on so many diets over a lifetime (none stuck), I’ve learned that the worse thing I can do is get on the scale everyday. Seeing incremental changes either way is disheartening when you’re hungry or have a headache from insufficient food. There is a lot of research out there that tells us that our bodies have set points and as we age, trying to reset that body weight point is near impossible to do and even more difficult to maintain. Been there – experiencing that for decades. So please – let’s not assume everyone who’s overweight or failing at a diet is guilty of falling off the diet or cheating – or can’t control what they put in their mouth. That’s insulting. Our bodies call the shots and there are some hurdles we mere humans cannot leap.

    • May 01, 2018 at 6:40 pm, Ted said:

      Funny that you came away with that conclusion, Susan.

      I got something very different from the emphasis on biological factors in the post, Susan. I know that you can find many people who make the assumption you’re pointing to. But Trina and Adam do not.

      You are indeed correct that biological factors are very important.