Burn the boats: Why you’re going to fail. Or not.

I’ve been studying and reading health research for decades, and this post is just a bit of my biased gestalt on the state of affairs on obesity, obesity research and the new hope that arises within a TON of people every January.

The preponderance of obesity research indicates that most of you will fail at achieving your goal of weight loss this year; and that of those of you who succeed at achieving the goal within this particular year will ultimately fail because the data generally shows that the weight comes back, resulting in a net effect of zero. What we don’t fully understand still, is why this failure happens; and I’m not sure that we’re going to truly unearth it anytime soon enough to make a difference in your resolution this year.

The evidence, in short, is incredibly depressing.

However, this is one of those situations in which I think anecdotal evidence has a powerful and important role to play because it provides a very vivid counterpoint to the darkness of sample-based research evidence on predicting your future. What’s even more interesting about these anecdotes is finding the common themes within these narratives that highlight the elements of success, many of which cannot be replicated in a study or even reliably sampled because they cannot be truly measured.

Success in weight loss or any self-improvement goal depends mainly on the ability of a person to adhere to a new behaviour. Quitting smoking is a good, simple example (albeit of a very difficult task): You succeed at quitting smoking by engaging in behaviours that do not involve smoking. Do or do not, there is no try. Taking a drag on a cigarette means you’ve relapsed and are no longer an ex-smoker.

Weight loss is not as simple of a goal. It can involve multiple behaviours, many of which involve changing substantial portions of one’s day from both a time and a performance perspective. For instance, beginning to exercise is a behaviour that requires time investment. That means exercise has to DISPLACE another activity that you’ve grown accustomed to doing. Eating less or eliminating certain foods means the performance of eating changes. And then on top of it all, there’s the social dimension of weight loss, which can mean displacing perfectly enjoyable activities that not only provide nutrition/caloric value but also contribute substantially to our sense of well-being and belonging (e.g. a weekly pub night, or after-work drinks and appetizers, or Sunday dinner with parents.)

The most common theme I’ve discovered (and this is, in and of itself, just opinion and anecdote) from watching patients attempt to enact lifestyle changes and reading stories of people who have had overwhelming success, however, comes down to something perhaps equally as unpleasant as making a lifestyle change that you’ve failed at in the past: pain, and sometimes, fear. Unfortunately, this is, thus far, a fairly immeasurable quality, so making causal associations between pain/fear and dietary success is fairly difficult, though, with the right research team, not impossible.

When it comes to adherence to new behaviours, (and I’m not sure this has even been studied at all yet, in the way that I’m going to state it), is the introduction of a situation in which the pain of staying in the same place (or moving backwards) becomes so great that success is the only option. I have personally witnessed (though with limited verifiability) patients who, after suffering a serious hand injury that would affect their ability to earn a living, stopped smoking the day of the injury. These were people who had tried to quit in the past unsuccessfully and years later, are still smoke-free, even though the danger of affecting their hand function by smoking is pretty much gone.

In medical school, we’re taught to try to find reasons for patients to change their lifestyle. Sometimes, it’s an injury or a new diagnosis. Sometimes, it’s being around for their loved ones. In most circumstances, it’s the pain of the situation, or the pain of the fear that ultimately moves people to action.

Personally, I think that the reason why most people fail at their goals is because it’s really not that painful to fail. If you fail, you’ll get over it. Your waist size doesn’t change, or it might even get a little bigger, but on the whole, your life is pretty good. There is a famous story of Alexander the Great, who upon landing on the shores of Persia, ordered his men to burn the boats, thereby removing all realistic hope of retreat. If your income was contingent on your ability to stay at a certain BMI, regardless of your beliefs about the BMI and whether you are an “outlier” or not, you’d get there and stay there. You would find a way to stay there. You might bitch and complain about it, but given the option of unemployment or BMI, my guess is most people would pick BMI. In a way, it’s no different than doing your job. If you don’t do your job, you get fired. Come hell or high water, when crunch time comes, you’ll find a way to get that job done because you know the personal stakes are high.

Finding that intolerable state is what motivates successful change. Eventually, you may come to enjoy the new life you’ve created. I can’t think of a single ex-smoker who regrets quitting smoking. I can’t think of a single person who, after successfully losing weight and keeping it off, regrets making sweeping changes to the way they live. They tell me that the process of quitting/changing really sucked, but that they would never trade their old life for their new one. One patient of one of my mentors, after quitting smoking, kept putting the money he spent on cigarettes in a large jar. A few years later he bought a massively expensive sports car (I can’t remember the make/model), which he enjoys far more than any cigarette he ever smoked (or so he tells me.) It doesn’t mean you have to live a painful life forever. But enacting change without consequence of failure, I think, is embarking on a journey to which there is always a convenient exit.

So, as unpleasant as it is to contemplate, my challenge to those of you serious enough to take it, is to find that pain. If that means making your life intolerable to failure, then perhaps that’s not a bad approach. Find ways to put yourself in situations where getting out is more painful than staying in.

It’s 2012. Find your pain. Burn the boats.

For slightly more positive tips on lifestyle changes, here are some my previous posts, or you can click the “lifestyle change” tag in the cloud on the right:

Death by sand: When do the fine details really matter?
Defending yourself against decision overload
The Information Diet
Fitness, nutrition and a Peruvian fruit stall