Changing the Error of Our Ways

BioPsychoSocial Health CategoryWe all have bad habits. I don’t sleep nearly enough, and by mid-afternoon I’m a basket case without an infusion of chocolate. I know I should probably sleep more and avoid sweets; in fact, I’ve known this for several years, but I’ve never felt motivated to change my ways. This human tendency has beleaguered health care professionals for ages: how do we motivate individuals to change their behaviors? Two recent studies may give us some ideas.

A recent study published in the Annals of Behavioral Medicine found that smokers who received anti-tobacco messages via their PDAs were more likely to try to quit smoking. In this study, one group received frequent messages about the adverse health consequences of smoking, while the control group received frequent messages about general stress or money concerns. In the end, 53% of those receiving anti-tobacco messages attempted to quit smoking, versus 19% in the control group. In addition, those receiving the anti-tobacco messages expressed significantly more worry about their smoking habits than those who did not. The researchers concluded that in order to get an individual to quit smoking, the key was to get the smoker worried about the health consequences of tobacco use.

TelephoneHowever, another recent study found that dieters were more likely to succeed with their weight loss if they had more frequent telephone contact with nutritionists. A study published in the Annals of Internal Medicine found that obese individuals who were trying to lose weight had more success with high-frequency telephone contact or high-frequency face to face visits with nutritionists than those who had neither. They did not include a group that had high-frequency contact with researchers regarding general stress or money concerns. The article does not mention what precisely was addressed during contact with the study participants other than “lifestyle counseling”, nor does it assess how concerned the study group was about the effect of obesity on their health. The researchers in this study concluded that the frequent contact may have played a key role in the study group’s success.

In both the smoking and the weight loss studies, success was due, at least in part, to frequent contact that addressed the behavior that needed changing. In the first study, the researchers concluded that it was “worry” that motivated the smokers to quit, and certainly those who received the anti-tobacco messages did indicate an increased level of concern about their habit. However, was it truly worry that motivated the change, or was it the frequent reminder about the behavior at issue? Would similar effects be seen in dieters if they received frequent reminders about the negative effects of obesity and a sedentary lifestyle on their overall health? Could it be that the frequent nudges about the undesired behavior, rather than “worry”, is the crucial factor to spur behavioral changes?

Given that between 50 and 75 percent of medical conditions are due to behavioral factors, learning how to motivate change could play a huge role in improving our health. I hope to see more studies that address precisely these issues.


Magnan, R., Köblitz, A., Zielke, D., & McCaul, K. (2009). The Effects of Warning Smokers on Perceived Risk, Worry, and Motivation to Quit Annals of Behavioral Medicine, 37 (1), 46-57 DOI: 10.1007/s12160-009-9085-8

Andres G. Digenio, James P. Mancuso, Robert A. Gerber, Roman V. Dvorak. Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients: A Randomized Trial. Annals of Internal Medicine, Volume 150, Number 4 (February 2009), pp. 255-262.

T. A. McNamee, MD

T. A. McNamee, MD, is an associate professor and internal medicine residency program director at Sanford School of Medicine of the University of South Dakota.
See All Posts By The Author