Why existing behavior change programs aren’t sustainable

Kelly Bryant

When it comes to sustainable behavior change, the healthcare industry has a retention problem. Poor medication adherence accounts for 10-25% of hospital admissions, and pharmaceutical brands lose 38% of their sales due to non-adherence. A 2007 study showed less than 50% retention in a web-based weight loss program, and a population-wide stage-based change intervention targeting cancer prevention found less than 30% of participants in the action or maintenance stages after 2 years.

Stroke, heart disease, and diabetes are largely lifestyle diseases, and in the United States they cost a combined $560 billion per year. All three are associated with being overweight or obese. As the rate of obesity continues to rise, so to does the cost of chronic disease, meaning that behavior change programs targeting weight loss could be our best shot at reducing healthcare costs long-term.

However, behavior change is a long and complex process. The American healthcare industry, which excels at medical research and cutting-edge treatments, doesn’t yet understand how to see people through the ups and downs of behavior change. This is especially problematic in weight loss programs, as they’re not only plagued by the usual adherence issues — like forgetfulness, inaccessibility, and cost — but additionally by the inevitability of weight loss plateaus and their emotional toll.

Plateaus, or a period of successive weigh-ins without weight loss (despite adherence to the program), are a natural part of any weight loss journey. According to our data, of 50,000 people who successfully lost 10 lbs., 88% hit a plateau — and not just one plateau, but an average of three. Of course, those with chronic or prechronic lifestyle diseases often have more than 10 lbs. to lose. Our numbers show that the amount of weight the participant loses and the number of plateaus they hit are positively correlated — in other words, the plateaus don’t stop after the first 10 lbs.

plateaus-15These weight plateaus are largely a result of the body’s natural metabolic response to weight loss. It is perfectly normal to see dramatic results in the first week, followed by a slower period of weight loss, and eventually a plateau. Despite the fact that this cycle is perfectly normal, but patients don’t see it that way. A slew of psychological factors may impact how a user responds to a plateau, including frustration tolerance, self-efficacy, and the patient’s locus of control, according to Andreas Michaelides, PhD, Noom’s Chief of Psychology.

probability plateau-15Our data show that the best predictor of breaking a plateau is continuing to persevere through it; every day participants continue to interact with Noom, the likelihood of a plateau ending increases. Of course, this seems obvious at first glance. But as a patient experiencing it, breaking a plateau seems impossible. “In the midst of a plateau, the immediate evidence supports that right now you’re failing, and people are more likely to go with the immediate evidence,” says Dr. Michaelides. For patients who’ve dieted and failed repeatedly in the past, their assumption is that they will fail again.

Empowering patients to carry on through these hurdles requires a personalized and nuanced approach, which existing solutions lack. Next week we’ll dive into the potential solutions behavior change programs could adopt in order to engage patients through plateaus.