Changing Our Behavior So Clients Can Change Theirs

Sherry Pagoto, PhD, is an associate professor of medicine at the University of Massachusetts Medical School, co-founder of the UMass Center for mHealth and Social Media, a licensed clinical psychologist, and an expert in behavioral counseling for obesity. She has had a federally funded research program on obesity and cancer prevention for 14 years and has published 146 papers on these topics. Pagoto has been recognized with several awards, including the Society of Behavioral Medicine Early Career Investigator Award in 2006, the Western Michigan University Distinguished Alumni Award in 2011 and the Obesity Society Pioneer in mHealth/eHealth Award in 2014.

She is an active voice on social media, having been named a top 100 digital health influencer on Twitter in 2015 and 2016, and a frequent blogger for Psychology Today and U.S. News and World Report. She started #plankaday, a fun core-exercise challenge on Twitter that has engaged 11,000+ participants. And she is an avid runner; she has completed 14 half marathons, and she plans to run her third full marathon this fall.

ACE: In your day-to-day life, how do you see the impact of the obesity epidemic in the lives of your clients, friends and family, or just people you pass on the street?

Sherry Pagoto: We all know that obesity can increase risk for various chronic diseases, but one of the more immediate consequences is how much obesity can limit one’s engagement in pleasurable life activities. As people gain weight, they sometimes pull back from recreational activities like hiking or playing outside with the kids, as well as social activities like parties and reunions, for fear of being judged or feeling embarrassed. This withdrawal from enjoyable activities can lead to depression, anxiety and social isolation, not to mention more time spent sedentary. Professionals who assist clients with weight management should address the emotional impacts and help clients of any size stay engaged in pleasurable life activities.

ACE: What misconceptions—if any—do you believe fitness professionals have about people who may be struggling with their weight? And why is it important for fitness professionals to overcome those misconceptions before they can truly help clients meet their goals?

Sherry Pagoto: The biggest misconception is that obesity is an issue of personal responsibility. Because behavioral modification strategies can help with weight loss, the assumption is that people are simply choosing not to engage in them. The truth is that first, many people aren’t aware of effective behavioral modification strategies and end up using ineffective strategies, like fad diets; and second, employing behavioral modification strategies isn’t necessarily easy. Neurobiological factors affect appetite, cravings, how much we enjoy certain foods and even how much we enjoy exercise. Some people are wired to have bigger challenges when modifying behavior. If someone is struggling, it doesn’t necessarily mean the person isn’t trying or doesn’t care.

ACE: What information do you feel we need to start communicating to aspiring fitness professionals so they can effectively connect with people who are overweight or obese?

Sherry Pagoto: Fitness professionals (and healthcare professionals, for that matter!) will benefit from learning more about any language or action of theirs that might convey weight bias or send the message that they think a client isn’t trying or isn’t motivated. We all have unconscious biases, so the challenge isn’t deciding whether we have them or not, but rather knowing how to identify and change them.

One approach is to check in with each client by occasionally asking, “Is there anything I have done or said that makes you feel misunderstood, judged or patronized?” This opens up an important dialogue and builds trust, and I’m quite sure you’ll be the only person who has ever been bold and open-minded enough to ask your clients that question.

ACE: How do you feel your life experience and your work in the field of behavioral psychology have helped you better communicate how to reach people affected by obesity?

Sherry Pagoto: In clinical psychology training, a first step in helping someone change is to attempt to understand the context of the person’s behavior. To change behavior, we need to change the contextual factors driving it. Applying this principle to obesity, we don’t focus on “obesity” per se but rather the behaviors associated with weight gain and the biological and environmental contextual factors that drive those behaviors. Then we are less inclined to throw “diets” at the problem, and instead we focus on strategies that help people gain control over these contextual “drivers” of behavior.

As a result, a special diet would be useful only if it thwarted a biological driver of appetite by reducing hunger or cravings, and if adherence to the diet was not stymied by environmental factors (e.g., it’s challenging to find or prepare appropriate foods, or inappropriate foods are still desirable and highly accessible). Pretty much all diets fail one or both of these criteria, which means we need to expand the scope of contextual drivers addressed in treatment.

ACE: What advice would you give to people who may not know where to start when it comes to losing weight and changing the way they live?

Sherry Pagoto: It takes a village! I would advise people to get an experienced weight loss counselor or coach, find a supportive community of others who have similar goals (social media is a great place to find this!), and engage your significant other, family members and/or like-minded friends. I have found that people who have a nice combination of expert and personal support get the help they need when they need it.