Health Or Beauty – What Drives Weight Loss Success?

One of the first questions I have for a new client, when they come to me to help them achieve better fitness, weight loss, or energy, is this:

“What it is that you want to achieve in terms of your fitness?

A close second question is “Why do you want to achieve this?”

This second question always seems to inspire deeper thought. It has always seemed like an important part of the question, to me. This is because I have consistently observed among clients that the answers to these questions have great bearing on their progress toward their goals.

So it is not surprising that during the course of my regular review of the literature on all things health and fitness that a particular study drew my attention.

The Study

The study to which I refer involved gathering information from a field of subjects in 3 different categories:

1) weight loss maintainers (3 years)

2) weight loss regainers

3) stable obese – no weight loss achieved

The goal of the study was to ascertain what factors made the difference between these 3 groups.

What’s different about those who KEPT the weight off from those who regained – from those who never were able to lose weight?

The Primary Focus

This was not an attempt to be an exhaustive study. Rather, the researchers hoped to find some common element among the “maintainers” that would provide valuable feedback as to why these particular were able to more successfully maintain their weight loss than the regainers. Or the “stable obese”.

Health Or Beauty?

They uncovered some interesting – and useful – information regarding the motivation of the “maintainers” and the “regainers”.

Revealed was some interesting – and useful – information regarding the motivation of the “maintainers” and the “regainers”.

[ Ref: Int J of Obesity. 2000 Volume 24, # 8, Pages 1018-1025. The correlates of long-term weight loss: a group comparison study of obesity. J Ogden]

The Focus Of The Study Questionnaire:

In order to ascertain motivating factors for the subjects in the study, the questionnaire was developed to assess beliefs about the consequences of obesity.

The subjects rated a series of items to reflect the extent to which they believed they were consequences of obesity. That list included:

  1. medical concerns (joint problems, heart disease, stomach cancer, bowel cancer, diabetes;
  2. psychological considerations (depression, anxiety, phobias, low self-esteem, lack of confidence;
  3. motivations for weight loss relating to the following:

(a) health (be healthier, live longer)

(b) attractiveness (be more attractive, be able to wear nice clothes, feel more confident about the way I look)

(c) confidence (increase my self-esteem, like myself more, feel better about myself)

(d) symptom relief (feel less breathless, feel more energetic, feel more agile)

(e) external pressure (please my family partner, please my friends, please my doctor;

The results indicated that the weight loss maintainers reported a lower belief that [weight loss maintenance] was caused by medical factors and a greater belief that psychological changes were consequences of obesity. Further, the results indicated that they had been motivated to lose weight for reasons relating to confidence rather than pressure from others or medical reasons such as health and symptom relief. This supports previous research which has indicated a role for an individual’s model of the illness and their motivations for change.

Additional data from this study revealed some interesting what I call “variations on the theme”. This is where research analysis can get really befuddling as we realize, once again, the enormous amount of factors that have bearing on research results!

Apparently, an important factor for the “maintainers” in their success at weight loss and maintenance related to their confidence psychology. In other words, they demonstrated a high rating in terms of their belief that they could achieve success. Does “I think I can” play out in a big way here, too?

In particular, weight loss may only be both attained and maintained if obesity is perceived as a problem which can be modified and if any modifications brings changes in the short-term which are valued by the individual concerned.

What Does It All Mean?

At face value, for the purposes of this study anyway, it looks like “beauty” trumps “health” for weight loss and maintenance. At the same time, with such a powerful correlation with the “I think I can” factor at play, is it simply the personality trait of confidence that is the deciding factor? Why the stronger link between those who were confident about their ability to lose weight and maintain their loss and the desire to be more physically confident and attractive?

Ah, research! Always presents more questions than it answers!

The Health Belief Model Explained for Patients

This is the most researched and validated description of patient’s beliefs about health and related matters, and it has five main elements.

1. Our interest in our health and the degree to which we are motivated to change it varies enormously. (health motivation)

2. When considering specific health problems, we patients usually have very different ideas about how likely we are to be affected. For example, those of us who think we are at high risk of developing lung cancer are more likely to follow advice about giving up smoking than those who do not think they are at risk. (perceived vulnerability).

If we already have a health problem, then the perceived vulnerability relates to the degree to which we believe in the medical diagnosis and its possible consequences.

For example if you are unlucky enough to be diagnosed in the gastroenterology clinic as having irritable bowel syndrome and it is suggested that tension may be contributing to the condition but you are convinced that pelvic inflammatory disease not tension is the cause you are unlikely to follow the proposed management plan. We do not see ourselves as being susceptible to tension so conclude there must be another cause. Most probably pelvic inflammatory problems (PID) like one of our friends, and so the doctor must be wrong.

In this event usually we are too shy, reticent or just too afraid of being rude to tell the doctor that we don’t agree, this is a mistake.

3. We all vary in how dire we believe the consequences of contracting a particular illness would be, or of leaving it untreated. (perceived seriousness)

Heart disease or lung cancer seems a long way away to a 16 year old girl starting to smoke because of peer pressure. Her attitude may be “And anyway by the time I get to 40 they will have a cure for it won’t they?”

On the other hand, the publicity about skin cancer resulting from ozone depletion has meant that, in recent years, anxious patients have flocked to doctors with a wide range of minor skin blemishes. All of us regard cancer as very serious; some of us if we suspect it may even be too frightened to go to the doctor. Particularly sad examples of this, which unfortunately are not uncommon, are the older woman with slowly growing fungating carcinomas of the breast that they are ashamed of. Young men with testicular growths do seem to have benefited from the publicity and now seem more likely to attend than they did.

4. We all weigh up the advantages and disadvantages of taking any particular course of action, not necessarily taking all the relevant considerations into account but we make an evaluation nonetheless. (perceived costs and benefits)

This cost benefit analysis is unique to any individual and can be influenced by outsiders including doctors. However, in order to influence the equation in our favour, those factors already included by us need to be known by the doctor.

5. People’s beliefs do not already exist pre-packaged. These beliefs we end up with are prompted or created by a number of stimuli and triggers, (cues to action), such as a physical sensation, what Granny said, a TV programme or what has just happened to the man down the road.

The health belief model emphasises what we have already discussed. We are all generally engaged in a struggle to understand what is happening to us and what might happen. Different people try to resolve these dilemmas in different ways. A person’s belief system is of course unique but strongly influenced by race, culture, religion and the immediate society. A poor Chinese peasant will have a very different health understanding from a German banker, but so will people living in the same environment. There will be little similarity between the health understanding of a Geordie miner and a black Rastafarian both living in Newcastle. There are major differences between peoples in different strata’s of the same society and differences are often still considerable within the same social group.