Regarding exercise outputs, our research-to-practice philosophy has been, “build the exercise habit first, then seek fitness improvements that can last a lifetime.” Of course, such a viewpoint can be antithetical to clients who want results “yesterday,” which can lead to excessive exercise or extreme diets (e.g., very low-calorie diets that can be <800 calories/day). Although both may impact fitness and excess weight, adherence is rarely achieved, as such programs are simply too challenging and aversive for most individuals beyond the very short term. Of course, some might advocate such aggressive methods and simply blame a lack of motivation and willpower when behaviors regress; however, the more astute professional understands their critical role in facilitating behavior change (and embraces it).   

Therefore, we have previously advocated for clear and sensible short-term goals where associated behaviors are supported by helping clients’ development of distinct self-regulatory skills to overcome barriers, including the following: (1) managing unproductive self-talk, (2) preparing for barriers and “slips” in planned exercise and eating behaviors, (3) controlling negative feelings and (4) tracking incremental goal progress, which leads to a sense of accomplishment (i.e., self-efficacy) that fosters persistence. We also found that adherence to even three moderate-intensity exercise sessions per week is associated with improved mood and mental health in the initial stages. Such improvements in depression and anxiety have been shown to support an increase in self-regulatory skills usage and reduced emotional eating. 

In a series of studies, we incorporated methods where exercise was used to build self-regulation and self-efficacy for controlled eating. For example, the assessed programs focused largely on increasing fruit and vegetable intake rather than on nuanced aspects of the diet that can be a point of controversy and overwhelming for adults with overweight or obesity. For exercise, we sought to simply increase cardio exercise every several weeks (even if it remained below the 150 to 300 minutes/week suggested by commonly cited physical activity guidelines).  

The findings of our research indicated that increased intake of fruits and vegetables was associated with reductions in other food groups, and sweets reduction had the most impact on short-term weight loss. In effect, increasing fruits and vegetables served as a proxy for the healthfulness of the overall diet in the tested adults with obesity.  

Because sweets were so important in weight change (and in emotional eating), we also evaluated only the fruits/vegetable change–sweets change relationship. As expected, that association was strong. However, we also found that (especially in the group where psychosocial skills empowerment was a focus), changes in program-associated improvements in self-regulation, self-efficacy and mood were key “mediators” of the fruits/vegetable–sweets intake relationship. In less-scientific terms, fruit/vegetable increase was associated with reduced sweets through changes in self-regulation, self-efficacy and mood. Another key finding was that reductions in sweets predicted weight loss over six, 12 and all the way to 24 months. Again, the program focused on self-regulation, rather than the more typical emphasis on education on exercise methods/increases and nutritional content, and demonstrated far better effects.  

We interpret this to mean that concentrating on clients’ development of self-regulation skills for both maintaining manageable amounts of exercise and increasing their fruit/vegetable consumption will be associated with enough weight loss to maintain their behavioral compliance, and greatly increase probabilities for long-term success. It also means that professionals can target what is most beneficial. Focusing clients’ attention on the means essential for fostering improved and sustained health behaviors will be a major contribution from the health coach or exercise professional.   

Looking ahead, we are analyzing the exercise-associated psychological effects for maintaining a controlled diet and weight loss over the long term, while keeping in mind the fruit/vegetable–sweets relationship. Most of the science indicates that the weight-loss phase of the initial six to nine months should be addressed in a different manner than beyond that point, when a plateau in lost weight is expected and regain nearly always occurs. We will be reporting on those findings soon and determining how they coincide with the National Institutes of Health suggestions for researching ways in which weight may be controlled over the long term, and how exercise can be used for its psychological change properties.    

To learn from Dr. Annesi and read more about his extensive research on behavior change and the relationship between exercise and weight loss, check out these recent blogs: