By Dr Wendy Lawrence PhD CPsychol AFBPsS, Associate Professor of Health Psychology, MRC Lifecourse Epidemiology Unit, University of Southampton
“Overweight and obese adults report low levels of physical activity, high TV viewing and poor sleep duration. These behaviours seem to cluster and collectively expose individuals to greater risk of obesity. Multiple lifestyle behaviours should be targeted in future interventions.”
‘Wow!’ I hear you all gasping. A breakthrough in obesity research! This conclusion appears in a recent article in the International Journal of Behavioral Nutrition and Physical Activity. This paper reports on data from the UK Biobank cohort of >500,000 participants, and demonstrates the value attributed to analyses of huge data sets whether or not they offer any additional insight. So where is the input from health psychology research as to why such behaviours cluster, and perhaps more importantly how we might target multiple lifestyle behaviours as suggested by the authors – clinical exercise physiologists, public health and health promotion specialists, and health technology and prevention experts from Newcastle, UK and Sydney, Australia?
As a health psychologist I have a broad understanding of the health behaviour change theories and models we have at our disposal, and have worked on the development of the Taxonomy of Behaviour Change Techniques. Developing behaviour change interventions within a theoretical framework that best fits with our target behaviour, population and context is what we do. We know that change is difficult, we know that even “successful” interventions tend to have small effect sizes, and we know that it is not just about targeting lifestyle behaviours. Individuals make choices based on a wide range of factors; change does not happen in isolation, outside of a social and environmental context. How many of you have tried to change something? How successful were you? For how long?
As the DHP’s Practitioner Lead and lead for the delivery and development of “Healthy Conversation Skills”, I know a little about the challenges and frustrations facing our healthcare workforce as they work to combat obesity. They are perfectly positioned to support behaviour change; they have regular contact with people and a range of resources and services to draw upon. However, they frequently have limited experience of, or training in, skills to support behaviour change. I have been fortunate in recent years to be able to work with many of these practitioners to provide them with such skills, and to see how receptive and excited they are to add these to their tool kit for tackling health issues like obesity. It has been immensely satisfying to witness increases in confidence in their ability to empower patients to identify first steps to change, to support them to set goals and make plans to achieve these, and to utilise a range of behaviour change techniques to make such changes more likely to happen and be sustained. And I’m not the only health psychologist working in this way.
So wouldn’t it be helpful if, rather than making sweeping statements about targeting multiple lifestyle behaviours, authors instead sought out their local health psychologist (I’ve checked … they definitely have them in Newcastle and Sydney!) and in collaboration developed more useful conclusions, with clear strategies for future interventions? In this way, health psychologists can work together with those in public health and prevention research and then perhaps these huge data sets might actually be worth more than the computers on which they’re stored.