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28 Aug, 2020

How to make healthy habits stick, with Dr Heather McKee

What we tend to ignore when we think of weight loss is how we are approaching and managing the process of change. As important as it is to focus on what you eat to lose weight and keep it off, it is equally crucial to consider maintaining lifestyle changes over time. We speak to Dr Heather McKee about how to make behavioural changes, and what strategies we can use to adhere to new ways of eating.

Health

How and why should we let go of a dieting mindset, instead choosing to adopt a healthier lifestyle?

The main reason is that most diets fail, 80-90% fail in the first year, and even more in the second, and as you move down the line there’s no long-term evidence of the effectiveness of dieting. What the research demonstrates is that the more restrictive your practices, the more likely you are to gain weight long term, and there’s a physiological and psychological reason for that.

The physiological reason being something called adaptive thermogenesis, which is when you lose weight, a physiological response occurs in your body and your body doesn't want to lose weight because breaking down fat is difficult for the body to do, so it releases certain hormones to slow down the weight loss reaction. And so even with all the willpower and self-restraint in the world, it can be difficult to overcome the influence of this increase in hunger hormones. Your body is smart and it will adapt by slowing down the energy you burn at rest and slowing down your metabolism to account for the deficit of food through restrictive dieting. So really you could say the physiological effect of dieting is that it makes you become hungrier and your metabolism slower over time. There are some really interesting studies on weight loss television programmes that promote drastic short-term weight loss, in that the metabolic rate of contestants since the show has actually slowed down to as little as 700 calories per day, so they're actually far more likely to gain weight longer term.

Then from a psychological point of view, we tend to focus on our weight on the scales and we let that number become everything, this is known in psychology as ‘an extrinsic motivator’, and so if that number doesn't reflect the effort we put in, we become hard on ourselves, we start to punish ourselves, even though we may have put in a good effort. The problem with extrinsic goals is that you need them to tell you the right thing - whether it’s the number of Facebook likes, or other people complimenting you, those sorts of goals only have a short lasting effect. Whereas intrinsic goals are different, they’re on the other end of the spectrum, they're more like going to the Detox Kitchen delis for lunch because it makes you feel amazing and full of energy afterwards, going for your morning walk because it makes you feel more alive and focussed, or the way you feel after a workout. ‘Intrinsic goals’ translates in Latin as ‘goods for the soul’, they are more process driven and based on the day to day, rather than a particular number. And these goals are shown to improve your wellbeing in general, your psychological well-being and your physical wellbeing, because they are much more sticky.

A goal needs to align with your values, and a number is never going to truly align with your values. Whereas if you align your goals with your values, for example if you value bringing your best self to work, or being a positive role model for your children, eating well and being healthy are common attributes that represent what people value. These are the reasons that keep you going in the trenches, these reasons don't rely on willpower or social likes, or anything else to keep you going, they’re goals that are inherent to you and part of who you are.

You’ve said before that developing self-compassion is absolutely key to making healthy habits stick, why is this?

We change more from a place of growth than a place of shame. So if we are beating ourselves with a stick because we’re not a certain number on the scales, it’s only going to hinder our long term goals.

Ultimately change is hard. We often know the ways to be healthy in body and mind, but that doesn't necessarily make it easy to change. It’s not about saying there is something I need to fix, rather it’s about saying I’m good as I am, but I choose to learn and manage better for my own reasons, because these are my valued reasons. It’s an opportunity for personal growth within yourself. That’s often why people don’t want to talk about weight loss because it feels a shameful thing or act, rather than it actually being a self-empowering act, that you actually choose to change your habits because you want things to be a little bit more in line with your values, with who you are as a person, or you want to have more energy, or you want better sleep or be a good role model for your children. There’s nothing shameful about pursuing any of those reasons.

There’s this myth that if we show ourselves self-compassion then we’re just lazy, people have this idea of it as just sitting at home watching Netflix and ordering Deliveroo. As opposed to what we know from the literature, which is that people that have more self compassion are more goal focussed, they are much more likely to eat well, to exercise more, less likely to procrastinate and more likely to stick to their long term goals.

Self-compassion allows you that platform to experiment, which is something that so many people don’t do when it comes to their health. They try to get everything perfect, and if they don’t get it perfect the first time then they think that they’ve failed. But being healthy is a lifelong pursuit, it’s not something that you just do for January, it’s something that you do for the rest of your life. And so you need to have self-compassion in order to be successful in achieving your long term goals, because you will fail, you will fail multiple times, but a compassionate person looks at failure with curiosity rather than with spite. They’re interested in looking at, saying ‘Ok what went wrong here? Did I not eat enough for lunch? Did I feel emotional at the time? What were the reasons why I gave in?’ and they look to learn from what went wrong and apply those learnings in future so the same thing doesn't happen again.

Would you agree that obesity is not caused by a lack of willpower, but is instead a product of a variety of matters including emotional distress, poverty and inequality?

Willpower is like a muscle, and so if you use it all the time, which people do on these restrictive diets, they use it all up, and then they can't keep going. Like a muscle, if you trained your left quad in the gym for hours every day for a week, by the end of the week you wouldn't be able to walk, but if you trained it in adequate amounts over time, it would get stronger, and actually your walking would get stronger. And it's the same when it comes to healthy habits, it’s not about doing everything at once, and in fact the more goals you try to achieve at once, the more likely you are to fail.

It's about deciding on what's the first step for you. Perhaps it's that you struggle with having a healthy lunch, and so the first step is actually sorting out your lunchtime, or maybe snacks are an issue for you and maybe that’s where you start. Rather than saying ok I’m never going to eat sugar again or drink alcohol again or exercise for an hour every day. It’s actually about thinking what’s a smaller step you can take. Because the beauty of small steps is that they make things easy, and so often when it comes to habit change or weight loss, we set ourselves up to fail, because we make things really hard at the start because we're super motivated at the start, but your motivation runs out over time because it's tied to your willpower.

You want to build that willpower over time, so if you can start really small, maybe one meal or one snack a day, and then over time look at what you can add in. That repetition is what builds a habit, and you help yourself find systems that can help support that longterm change as well, so it's much less likely you'll fall off the bandwagon because at the start it seems so easy it's almost too good to be true.

Lifestyle behaviours are a marathon not a sprint. If we look at toothbrushing, it’s not something you stop at 30, it’s something you work on every day. So again, rather than those external goals, we have to look at what actually are the key ingredients that you want to have in your day that actually bring you more joy and align with your values.

What practical advice can you offer for making healthy habits stick? Similarly in achieving specific goals such as weight loss.

Start with your why.

That’s your intrinsic motivation rather than extrinsic, which is for example your weight on the scales.

Avoid using willpower.

Start with the smallest or easiest goal first, think of it as a lifetime pursuit, as a marathon not a sprint. You can't achieve all your goals overnight, in fact it's something you will do for the rest of your life, just like toothbrushing.

Find joy in your healthy habits.

The habits you enjoy are the ones you are going to stick to. Often when we think about weight loss, we think about the deprivation and how hard it is going to be, but we have to take a step back and think about all the things it will actually give us in our lives, taking a more balanced view, asking ‘what does this allow me to do, who does this allow me to be, how will I feel day to day as a result of this?’.

Often I get people to make a joy list of the health behaviours they really enjoy - is it a long walk in the park, is it a delicious turmeric latte, is it outdoor swimming. Stop trying to do those habits that you don't enjoy. So many people think they have to drink wheatgrass juice every day to be healthy even if they don't like the taste, or take up trampolining because it's the latest craze when they don't enjoy it, but they're not going to stick to that. Rather you're better off taking up dancing if that's what brings you joy, and stop depriving yourself of the healthy things you actually enjoy. It doesn't have to be difficult, it can be a joyful pursuit, you can give yourself permission to enjoy being healthy.

Your environment counts.

You make on average 250 food decisions per day. I believe that you are what you see, and in the way that when we see our phone we pick it up, it's the same with food. If you are surrounded by unhealthy food it's very difficult for you to create healthy habits. Look at what you have out and what's at eye-line when you open your cupboards and fridge. Is it big juicy tomatoes or is it cake. Really think about the food environment you expose yourself to. Similarly if you're going for lunch and you're really hungry and you go into a shop that sells lots of sweets, it's much more likely that you are going to give in because you're hungry. If you're in the office and someone brings in a birthday cake and it's sitting on the table, every time you walk past you have to make a decision about whether you're going to engage or not, and eventually your willpower is going to break down and you're going to give in to temptation. It’s very hard to change your habits in an environment that is unsupportive of change.

Now especially as so many people are working from home, consider what are the things that support you, and what are the things that don't. For example I have my yoga mat lying out in my living room with recovery balls, I leave them out as a visual reminder to do my physio exercises. I literally have to trip over my habit to do it! Equally if I had a piece of cake there, eventually I'd eat it. Think about what would make it easier and support you to do your healthy habits.

A nice example of a visual cue is a veg box. It’s beautiful, it comes with all these different coloured fruit and veg, it's very pleasing to the eye, and every time you see it it cues you to think ‘I need to eat more fruit and veg’. It's also a visual representation of ‘I care about myself, I'm investing in my health’, and this is a visual representation of that.

How do we as individuals challenge unhelpful thinking and respond to our emotions with reason, as opposed to with food?

This is certainly something a lot of people have been struggling with during lockdown, more and more people have found themselves comfort eating. First we need to examine the cue. It could be that the cake is in your environment or it could be an emotional cue, and we need to use mindfulness to be aware of that cue. I often get people to do a temptation tracker to look at when they are most tempted throughout the day and why, which can give a really interesting insight into their emotions, goals and the patterns in their behaviour. People tend to think their temptations are unique but there are definitely trends, it’s reported that people are most tempted at 3.30 and 8.30pm. There’s a reason why people are most tempted throughout the day. It might be they didn't eat enough for lunch, or it's when we have heightened emotions in the day.

After you've established the cue, the next thing is understanding what the reward is. All too often when it comes to changing our habits we focus on the solutions, e.g. giving up sugar, rather than the driver of the behaviour. So is it that you’re upset, or are you bored. Actually through examining the patterns in your habits you can help determine what the underlying reward is that you're craving. Maybe you're finding yourself going out and having a chocolate bar because you actually need a break from work, and actually what you really need to do is give yourself a chance to recover. Or maybe you're eating unhealthy snacks because you're stressed, and maybe you actually need to look at what's the driver of that stress and are you using other coping mechanisms to deal with that stress. Once you understand ‘ok it is stress that is causing this’ then you can start to look at your routine and think about what else you can do to directly address those behaviours. And it might not stop you having those chocolate biscuits at 4pm every day, but over time it will really help you manage better.

You can experiment too, so for example if you do find yourself having a biscuit at 4pm every day, you can try snacking on something healthier at that time, or go for a walk or meditate at that time. It’s not about getting rid of the foods you like, but understanding what is a physiological hunger and what's an emotional hunger, because you will never cure an emotional hunger with food, you won't cure it until you understand what is driving that emotion, and address that emotion.

Remember again to start small, with the easiest tangle first. I always talk about habits like a tangled knot, so giving up sugar is like having a massive knot in front of you, and rather than pull at the middle (we always try and do the hardest part first), it’s easier to start with the easier tangles and unravel those slowly, and eventually the habit knot will be untangled, but we need to start small and gain momentum.

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Based on over 10 years of research into healthy habits, as well as extensive 1:1 client work, Heather has distilled the key findings from research and practice on what it takes to make healthy habits stick. If you want to stop relying on willpower and restriction. If you want to create healthy habits you actually enjoy, then this is the course for you. Launching to a limited number of participants in September 2020 The Bite-Sized Habit course is focused on giving you the skills, knowledge and confidence to create the healthy lifestyle you've dreamed of. You can join the waitlist here: https://www.drheathermckee.co....

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