Health Behavior Change and Multiple Health Behavior Change

health behavior change failureKyle has been overweight for several years. He has tried to lose weight by changing his diet and increasing his exercise several times, but never succeeded to maintain both areas of health behavior change.

Kyle’s experience is common: Many people have made goals (or New Year’s resolutions) to eat better and exercise that were never successful at maintaining them over time. Gym memberships go up around New Years and then drop in just a month or two as people give up their goals of health behavior change.

Health Behaviors are Related. Part of the issue is that health behaviors are related.  Research has shown that physical activity and attention to healthy diet are positively associated.  This means that increasing physical activity should support efforts to eat better. Unfortunately, it also means that failing to maintain one is likely to adversely impact efforts to maintain the other.

But, the problem of health behavior change is deeper than this.

Health Behavior Patterns. My research with the Patterns of Adapting to Health (PATH Type) Inventory has shown that health-related behaviors like healthy eating and physical activity are “predicted” by many other health-related behaviors.  For example, attention to healthy diet is significantly associated with an internal locus of control in health decisions, higher health literacy, regular involvement in family health decisions, a natural lack of confidence in health care professionals, an existing proactive focus on health, high levels of physical activity, and a tendency to avoid medical care due to the cost. While some of these associations are not surprising, things like not trusting medical providers and avoiding care because of the cost are not obvious predictors of a natural attention to healthy diet.

Maintaining levels of increased physical activity also depends on the right mix of many other health-related behaviors.  According to my research with the Patterns of Adapting to Health (PATH Type) Inventory, high levels of physical activity are significantly associated with a strong proactive health focus, high health literacy, a tendency to maintain health practices learned in childhood, confidence in the competence of medical providers, a tendency to not be involved in family health decisions, existing attention to healthy diet, and a willingness to compare health treatment options.  As above, the strength of the global associations between the health-related behaviors described and high levels of physical activity means that efforts to change a behavior must include a rearranging of multiple behavioral associations within the person.

Maintaining Health Behavior Change. Maintaining specific health behavior change is strongly influenced by the presence of many other health behaviors. Marty’s concerns about health care costs are strongly associated with his avoidance of seeking care from a doctor, relying on others to make healthcare decisions for him (external LOC), and health information seeking motivated by a need to find low cost treatment options.  The association of different health-related behaviors within Marty means that efforts to change specific health-related behaviors like seeking care or being more involved in health decisions will be either be supported or resisted by other health behaviors that exist within the individual.

Health Behavioral Signature. Prior research has proposed that individuals have a health behavioral signature; that is, a pattern of responding in the same way to health-related situations or contexts.  When presented with fruit or cupcakes Kyle typically picks cupcakes; when feeling ill or sick Kyle rarely seeks care and lives with the symptoms; when his child gets sick Kyle leaves the health care decisions to his sister; Kyle avoids situations that require physical activity.   This is another reason why efforts to change one or two health-related behaviors typically fail.  Goal-directed adaptive responses to changing contexts are typically activated outside the awareness of the person. This nonconscious activation of habits and behavioral repertoires by local contextual cues is a critical mechanism supporting the stability of an individual’s health behavioral signature and a powerful dynamic resisting behavior change.  Changing one or two behaviors are resisted by the configuration of many other goal-directed and habitual behaviors that form an adaptive whole.

Conclusion. Successful long-term health behavior change is likely to only follow a successful reorganization of the configuration of multiple health behaviors that exist within the individual.  This is why successful long-term health behavior change is an outcome of successful multiple health behavior change.