From the Guidelines
Effective behavioral change is best achieved through a multi-component approach that includes setting specific, proximal, shared goals, self-monitoring, scheduled follow-up, regular feedback, increasing self-efficacy, and using motivational interviewing, as evidenced by the most recent and highest quality study 1.
Key Components of Behavioral Change
- Setting specific, proximal, shared goals in collaboration with the patient
- Establishing a strategy for self-monitoring, such as a dietary or physical activity diary or web-based or mobile applications
- Scheduling regular follow-up to assess success, reinforce progress, and set new goals as necessary
- Providing feedback on progress toward goals, including using in-person, telephone, and/or electronic feedback
- Increasing self-efficacy by using strategies such as mastery experiences, vicarious experience, physiological feedback, and verbal persuasion
- Using motivational interviewing to explore and resolve ambivalence toward changing behavior
Implementation of Behavioral Change
The approach should be tailored to the individual's needs and preferences, and may include individual or group counseling, as well as the use of electronic tools such as websites and apps for smartphones and tablets 1.
Outcomes of Behavioral Change
The success of behavioral interventions should be evaluated not solely by weight loss, but also by improvements in health, physical stamina, and quality of life (QoL) 1.
Maintenance of Behavioral Change
Behavioral interventions should continue to be offered to patients on pharmacotherapy and after bariatric surgery, to support improved habits and adherence to a healthful lifestyle, as well as for mental health and QoL benefits 1.
From the Research
Effective Behavioral Change Strategies
Effective behavioral change interventions typically contain multiple potentially active components, including behavior change techniques (BCTs) 2. The following strategies have been identified as effective in promoting behavioral change:
- Target activation, which involves heightening the accessibility of behavior-related thoughts, feelings, and goals, rather than altering their value 3
- Social support, which can be encouraged through self-guided interventions that emphasize self-monitoring and action planning 4
- Goal setting, which can be particularly effective if the goal is difficult, set publicly, and is a group goal 5
- Strategies that consider factors such as age, ethnicity, community, and technology, and derive their components from application of the health belief model, the theory of reasoned action/theory of planned behavior, transtheoretical model, and social cognitive theory 6
Key Factors Associated with Effective Behavioral Change
Several key factors have been associated with effective behavioral change, including:
- Interpersonal resources, which can predict engagement of a support person 4
- External monitoring of the behavior/outcome by others without feedback 5
- Delivery of interventions face-to-face 5
- Use of tools such as the readiness ruler and personalized action plan form to facilitate healthy behavior change 6
Methods for Identifying Effective Behavioral Change Techniques
Several methods have been used to identify effective BCTs, including:
- Experimental manipulation of BCTs
- Observational studies comparing outcomes in the presence or absence of BCTs
- Meta-analyses of BCT comparisons
- Meta-regressions evaluating effect sizes with and without specific BCTs
- Reviews of BCTs found in effective interventions 2