Long-term behavior change is key to creating healthy habits, research shows

Can policymakers promote healthier eating and exercise habits using the same techniques they did to dramatically thin the ranks of smokers? The latest research from the USC Marshall School of Business suggests they can.

In “Healthy Through Habit: Interventions for Initiating and Maintaining Health Behavior Change,” Wendy Wood, Provost Professor of Psychology and Business, and David T. Neal at Duke University demonstrate that public interventions to change health behaviors have largely failed to establish long-term healthy habits. Wood has appointments at USC Marshall and the USC Dornsife College of Letters, Arts and Sciences.

Changing our bad eating and exercise habits requires a full-on behavioral intervention, along the lines of anti-smoking campaigns such as the Great American Smokeout, being observed today, which encourages smokers to make a plan to quit.

“People reduced smoking because the environment changed for smokers,” Wood said.

“The government didn’t just give us information and leave it up to us. It instituted smoking bans and raised taxes on cigarettes. Similar steps are needed for health risks like lack of exercise and unhealthy food.”

In “Healthy Through Habit,” Wood and Neal unpack the behavioral science of health-habit interventions. Long-term behavior change is key to breaking unhealthy habits and creating healthy ones, the research shows.

The article was published in Volume 2 of Behavioral Science & Policy, a new international, peer-reviewed journal using behavioral research to inform public policy.

The authors analyzed some of the best-known and highly cited studies claiming long-term change of health behaviors. They assessed the success of health interventions and provided guidelines for improvement.

“Unfortunately, we’re not doing well at all,” Wood said.

Most interventions fail because they fall short of forming habits that sustain healthy behavior.

Three steps

Forming health habits requires three steps, according to the researchers: behavior repetition, stable cues and uncertain rewards.

• Repetition. Some behaviors take few repetitions to become ingrained, whereas others, like a new gym routine, can require five to six weeks. “Habits involve learning through doing,” Wood said.
• Stable clues that trigger habit formation. For example, successful public information campaigns have linked replacing smoke alarm batteries to changing the clock for daylight savings.
• Positive rewards … some of the time. “Behavior change interventions should give rewards in the way a slot machine does — at uncertain intervals but often enough to sufficiently motivate people to perform the target healthy behavior,” Wood said.

Breaking bad habits

But even with healthy new habits, you still need to break the unhealthy ones. According to Wood and Neal, there are three key ways to reduce the impact of bad cues:

• Cue disruption: Moving, a new job or having a child provide a window of opportunity to institute new, healthy changes.
• Change the environment: To curb smoking, public policy banned smoking in offices and restaurants. Similar bans on unhealthy foods, especially in schools, could be equally powerful. Taxes on sugared sodas are similar to government taxes on cigarettes.
• Vigilant monitoring is the strategy people are most likely to use to control unwanted habits.

“By thinking, ‘Don’t do it,’ and monitoring carefully for slipups, participants in several studies were more effective at curbing bad habits such as eating junk food, smoking and drinking too much,” the researchers wrote.

Here’s the takeaway

Like smoking bans and cigarette taxes, public policies will need to create eating and exercise contexts that promote health, she said.

“Forming healthy habits depends on the context in which we live,” Wood said. “Europeans are thinner than Americans, not because they are more committed to their health or have more willpower, but because of their lifestyle.”

Europeans walk more and eat smaller portions at meals, with fewer in-between snacks, she said.

By breaking down the steps to breaking bad habits and forming healthy ones, Wood hopes that her article will provide the impetus to policymakers to change current environments to facilitate healthy eating and promote exercise.