As a physician, I have mixed feelings about the popular reality television show "The Biggest Loser." On one hand, some of my patients are surely inspired by seeing severely overweight people, many of them suffering chronic weight-related health problems, make various positive lifestyle changes and rapidly lose weight. Unfortunately, others may assume that eating meals prepared by professional nutritionists and getting one-on-one coaching from a celebrity personal trainer are fundamental to the contestants' successes. Since most people don't have access to such help, they may conclude that it's not worth trying to fix all their unhealthy habits.
That, however, would be the wrong conclusion to draw.
Even off the airwaves, programs designed to change health-related habits are often intensive and expensive. For example, participants in the Diabetes Prevention Program, a classic federal study, received 16 sessions of individual education from master's degree-level lifestyle coaches, followed by meetings at least every two months for the next 3 years. The study paid the coaches' salaries, but if participants had been footing the bill themselves, the cost would have been $2,300 each.
My patients aren't reality show contestants or participants in all-expenses-paid studies. So I have generally advised them to tackle one behavior at a time, rather than trying to do it all at once. Instead of advising a patient to simultaneously try to quit smoking, cut down on calories, and start a daily walking program, for example, I would advise her to focus on the single change that seemed the most doable, and to postpone the others until that first change was well established. For most people, I thought, making many changes at once would be too hard to handle.
But recent studies have challenged my thinking. In a study published in the Journal of Family Practice, Stewart Alexander and colleagues at Duke University Medical Center recorded visits that 461 overweight or obese patients made to their primary care physicians. The researchers determined if a physician had provided specific advice regarding weight loss, nutrition, physical activity, or some combination. Patients who received all three types of advice during the same visit were the most likely to decrease their fat intake and lose weight. Surprisingly, patients who received only physical activity advice were more likely to gain weight than patients who received no advice at all.
In another study, published in the Archives of Internal Medicine, researchers examined the effect of an intervention to promote multiple health-related behaviors in black couples aged 35 to 50 years. Participants were randomly assigned either to receive 8 counseling sessions on physical activity, healthy diet, cancer screenings, and alcohol use or to get advice on reducing sexually transmitted disease risk. A year later, those who had received combined lifestyle counseling were 40 percent more likely than those in the other group to report meeting national guidelines for fruit and vegetable consumption and physical activity. Cancer screening rates rose in the first group, too.
How can you make these discoveries work for you? One way is to take advantage of a proven program that will soon be widely available via YMCAs nationwide. A 2008 study found that group classes led by YMCA employees reduced participants' body weight and cholesterol levels at rates comparable to those in the Diabetes Prevention Program—at a cost of only $300 per person. With funding from last year's health reform law, YMCAs have begun offering this program at sizable discounts to members and non-members, and in some cases it may be covered by health insurance. (If the YMCA program isn't right for you, my fellow U.S. News health blogger Chelsea Bush has suggests 5 cheap alternatives to hiring a personal trainer.)
For me, the take-home message from the recent research is that all of us can change multiple health-related behaviors at once, as long as we receive structured support from health professionals and peers. And although it probably isn't enough for you to spend a few minutes reviewing lifestyle changes with your family doctor, he or she should now be able to refer you to an effective, affordable group program where you can find strength in numbers.