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SOCIAL UNDERMINING OF HEALTHY EATING AND EXERCISE BEHAVIORS

Stanforth, Dixie M.S.; Mackert, Michael Ph.D.

ACSM's Health & Fitness Journal: May-June 2009 - Volume 13 - Issue 3 - p 14-19
doi: 10.1249/FIT.0b013e3181a1b79a
FEATURES

LEARNING OBJECTIVE • To learn how others may influence healthy eating and exercise choices and common behavioral responses to negative input. Increased understanding of this phenomenon will enable fitness professionals to engage clients in effective interactions to raise awareness and develop preventive measures for specific situations.

This article explores the negative influence of others on exercise and eating behaviors to determine if there are differences between those who perceive undermining compared to those who do not.

Dixie Stanforth, M.S., is a lecturer in the Department of Kinesiology and Health Education at The University of Texas at Austin and a Ph.D. student in the Department of Advertising, specializing in Health Communication. Her research interests include identifying strategies to bring about meaningful behavior change in fitness and health outcomes.

Michael Mackert, Ph.D., is an assistant professor in the Department of Advertising at The University of Texas at Austin. His research focuses primarily on the strategies that can be used in traditional and new digital media to provide health education to low health literate audiences.

"Come on, have a little bit - I made it just for you!" "Why don't you skip your workout today and join us for happy hour - you exercise too much anyway!" How often do others attempt to undermine you or your client's healthy eating and/or exercise choices? What are typical responses to this type of behavioral sabotage? Does the response differ based on your relationship to the saboteur? Are there certain characteristics of those who are able to withstand this form of social pressure compared with others who succumb? Do undermining interactions lead to negative health outcomes, such as weight gain or perhaps increased stress?

Research involving social issues that impact weight loss or the ability to maintain a healthy weight is a growing segment of the multidisciplinary search for ways to reduce the prevalence of obesity. Most Americans are losing the weight battle, whether from poor diet or physical inactivity, and it seems that this trend will only continue. Controlling energy intake along with regular exercise is considered foundational to weight control, yet demographic data clearly document the exponential increase in obesity over time (3). Some authors suggest that the obesity epidemic stems from very small imbalances in energy intake and output and use the term "energy gap" to describe this energetic difference, which most often leads to weight gain. Hill et al. (9) have estimated that modifying energy balance by just 100 kcal per day (through any combination of reducing intake or increasing expenditure) has the potential to prevent weight gain in 90% of the adult population. The key point is that small changes matter, and there are a multitude of factors affecting eating and exercise choices for most individuals. In a recent commentary, Hill (8) outlines the scope of changes necessary to sustain even small behavioral changes for most individuals. These considerations are comprehensive and include the development of marketing and public policies regarding food and physical inactivity, such as the use of public service announcements designed to combat obesity. Other recommendations include the creation of community environments conducive to supporting these changes and a better understanding of the sociocultural belief structures that shape individual and collective behaviors.

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Recent attempts to identify factors influencing long-term weight loss and maintenance success are promising and may provide ways to further enhance the long-term outcomes for those desiring to lose weight. One area that has received modest attention is the influence of others on the ability to maintain healthy behaviors, such as exercising and eating well. Using support partners has been shown to enhance maintenance of weight loss (5,11), yet the literature is not entirely consistent (6), and one meta-analysis reports only a small immediate effect for involving a spouse in weight loss (5). However, the potential for significant others to affect weight gain, physical activity, and eating behaviors has been established to varying degrees within families, spouses, and friends/support partners. For example, one study points out that most of the research involving social support occurs only during the weight-loss phase, rather than maintenance (14). They compared weight loss participants among a cohort recruited either alone or with friends, who were subsequently grouped to receive a standard behavioral treatment (SBT) or the SBT combined with a strong social support intervention. The participants recruited with friends lost 33% more weight after 10 months compared with those recruited alone, and 66% maintained full weight loss during follow-up compared with 24% for the SBT group. In addition, 95% of the "friend" group that also received SBT completed the 10-month study compared with 76% in the other group, leading the authors to conclude that social support will significantly influence the ability to lose weight and maintain that weight loss.

Support from significant others has usually been evaluated from a positive perspective, with most studies determining whether others are helpful in weight loss and maintenance efforts. One area that has received comparatively little attention is the impact of others who might, purposefully or not, attempt to undermine healthy lifestyle choices. Related work exists in other fields, such as the investigation of the relationship between social undermining and substance abuse and mental disorders (12), yet this phenomenon is largely unexplored in the study of eating and exercise behaviors. Exercisers are a substantial minority in the United States, and these individuals must live, work, and socialize with others who do not share this same commitment. Their sedentary friends may suggest happy hour in place of a workout or skipping the gym to go to a movie and potentially apply emotional pressure when rebuffed. Similarly, those trying to establish or maintain healthy eating habits face numerous situations where they experience either active or passive undermining - it's the donuts in the break room, the supersize option to save money, and the "just this once" dessert treat that a friend wants to share.

The goal of this study was to determine whether those who exercise and/or regularly make healthy eating choices believe that others with whom they interact engage in attempts to undermine these behaviors. The project was designed to first measure if this perception exists among a large generalizable sample of adults. Second, the goal was to identify the salience of this perception in an attempt to better understand why some individuals successfully establish and maintain healthy behaviors, whereas others do not.

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STUDY DESIGN

Survey participants were randomly selected from the Virtual Consumer Research Group Panel in the Department of Advertising at The University of Texas at Austin, where panelists are recruited from around the world through collaborative agreements with high traffic Web sites and online marketing efforts. Participants are randomly selected and invited to participate in specific research studies: 6,923 individuals received this survey, and 1,270 completed the survey within the 2-week response period. The final sample (n = 1,109) included more females (75.6%) than males (24.4%), with an average age of 45.7 years for males and 41.3 years for females. About half (50.9%) of the survey respondents indicated that they were regular exercisers, with most participating in cardiovascular (95.8%) and/or resistance training (61.4%). Most of these respondents meet or exceed the American College of Sports Medicine guidelines for developing and maintaining cardiovascular fitness (1), with 63.6% aerobically exercising 4 or more days each week and 54.9% performing resistance training at least 2 days per week. Many of the respondents were long-term exercisers: 30.1% had been exercising 5 years or longer. By comparison, 25.2% had been exercising 6 months or less.

All respondents were asked about weight loss history (previous attempts, success, and weight satisfaction) and a variety of eating behaviors. These included ratings of how carefully respondents "watch what they eat" or "choose healthy foods," with about half of the sample reporting that they regularly monitor food choices. Participants also were asked about specific habits, such as frequency of fast-food consumption (13.1% eat fast food at least several times per week), number of meals per day (40.7% eat two or less per day), and sodas per day (20.5% drink more than three per day). The concept of undermining was presented to respondents through examples related to exercise such as "It won't kill you to skip your workout for a day" and "You'd rather exercise than be with me." Similar examples, such as "Come on, just have a few bites" and "I made it just for you" were provided as examples of undermining healthy eating efforts.

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HOW COMMON IS UNDERMINING?

Of the respondents who exercise, 26.9% reported experiencing exercise undermining. There were no significant differences in perceived undermining based on the length of time subjects had been committed to an exercise program, although those who had been regular exercisers 5 years or longer reported the highest rate of undermining (27.6%). Slightly more respondents reported undermined eating (28.8%) compared with undermined exercise, and 55.3% of those who report exercise undermining also perceive similar undermining attempts with eating.

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WHO ARE THE PERCEIVED UNDERMINERS?

Participants were asked to rate the degree of undermining pressure applied by five relational groups for exercise behaviors, ranging from 1 (no pressure) to 7 (significant pressure). As expected, the strength of undermining pressure increased with relational connectedness. Although there were some slight gender differences, all respondents rated the strength of exercise undermining pressure as greatest from friends, significant others, and family members. Eating undermining told a similar story, with family members, significant others, and friends again rating the highest in terms of applying pressure.

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HOW DO PEOPLE RESPOND TO UNDERMINING ATTEMPTS?

Judging by how these individuals reported responding to undermining, it seems that others are not particularly effective in causing behavioral change. The most common response to exercise undermining was simply to ignore it (63.8%), followed by explaining one's self (40.8%), and changing the subject (20.4%). Only a small minority (10.5%) reported "giving in" to others undermining their exercise by changing workout plans.

For eating behaviors, ignoring the undermining attempt was again the most common response (39.8%), although this response occurred much less frequently compared with exercise undermining situations. Explaining one's self (35.1%) and changing the subject (18.5%) also were prevalent responses to eating undermining. Succumbing to eating undermining pressure, however, occurred much more frequently (30.4%), pointing to a difference between "giving in" to social pressure to join others in unhealthy eating choices, compared with "giving up" a scheduled workout.

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WHAT IS THE IMPACT OF UNDERMINING?

One strategy for assessing the impact of undermining is to compare body mass index (BMI) values between those who are undermined and those who are not. Mean BMI for the entire sample was 28.0 ± 6.9 kg/m2, with both males (27.9 ± 5.8 kg/m2) and females (28.0 ± 7.3 kg/m2) categorized as overweight (25.0-29.9 kg/m2). Exercisers had significantly lower BMI values than nonexercisers (26.4 ± 5.9 kg/m2 vs. 29.6 ± 7.5 kg/m2), although undermined exercisers (26.5 ± 6.2 kg/m2) were not different from those not reporting undermining (26.4 ± 5.8 kg/m2). There were no significant differences between those reporting eating undermining (28.4 ± 7.5 kg/m2) and those who did not (27.8 ± 6.7 kg/m2). It is not clear whether the similarity in BMI between groups is caused by a true lack of undermining impact or simply reflects the need for improved measurement of undermining, as discussed in directions for future research.

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Individuals often use diet and/or exercise to facilitate weight loss, so a variety of weight-related behaviors based on undermining status were also evaluated, and several trends are worth noting. The frequency of those attempting to lose weight in the total sample (62.8%) is similar to other population-based research (4). Undermining does seem to have an effect because a higher percentage of those who perceive exercise (68.9%) or eating undermining (69.4%) are trying to lose weight. In addition, a greater percentage of those who report exercise undermining also report previous attempts at weight loss (84.8%). The greatest difference occurred in weight satisfaction, with a greater percentage of exercisers satisfied with their body weight whether they were undermined (34.8%) or not (35.8%). Comparatively, a much higher percentage of those whose eating was undermined were not satisfied with their weight (76.9%); this could be caused by undermining efforts increasing the attention people place on their weight and eating decisions, but more research is necessary to explore this relationship Other eating habits, such as the frequency of making healthy choices, eating breakfast, fast food or sodas, showed only slight differences based on reported undermining. Only the number of meals consumed each day approached significance, with those who were undermined eating more frequently.

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LIMITATIONS OF THE STUDY

The limitations of this study must be considered before drawing conclusions from this work and considering future directions for research. Limitations include a lack of gender balance and racial diversity in the sample population (88.1% white), reliance on self-reported behaviors, and the potential for respondent confusion regarding relational terminology. Potential problems with self-reported data, such as underreporting caloric intake, have been well documented in the literature, particularly in regard to eating behaviors (10). In addition, the use of self-reported height and weight to calculate BMI is controversial and may lead to overestimating or underestimating actual BMI from inaccurate information (2,13). The use of the term family, in addition to significant others within the relational groups, may have elicited inaccurate responses to some items. The ongoing qualitative analysis should bring clarity in this area. Consider all results with these limitations in mind.

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WHAT IT MEANS: IS THERE AN UNDERMINING EFFECT?

Substantial proportions of this sample reported undermining of their exercise (26.9%) and healthy eating behaviors (28.8%), although higher values had been anticipated based on anecdotal evidence and informal conversations with fitness researchers and professionals. This was a first attempt to assess the frequency of undermining in a large-scale randomized sample, and refined measures in future research could indeed reveal higher rates of eating and exercise undermining.

How people respond to undermining is very interesting, particularly the differences between eating and exercise undermining. The fact that more than 30% of these individuals change healthy eating behaviors and "give in," whereas only about 10% "give up" exercise plans warrants further exploration to determine potential explanations for this disparity. It is also important to note that most of the reported undermining occurred within close personal relationships, suggesting that there are multiple opportunities for underminers to promote poor choices. In addition, more than half of those who perceive undermining with exercise also report undermined eating, indicating that there may be a heightened awareness or responsiveness in some individuals.

The results of this study demonstrate that undermining is not a rare phenomenon and merits further investigation. Does undermining lack behavioral influence as the result of some difference between positive and negative social support on health behaviors? Alternatively, will further investigation uncover a role between undermining and more negative health outcomes? For example, the "energy gap" hypothesis previously mentioned (8) contends that as little as 100 calories per day in positive energy balance will lead to significant weight gain over time. One hundred calories does not represent much food (just one large apple or 10 potato chips), and often a splurge involves larger portions of calorically dense foods. Because about one third of this sample reported eating undermining, it becomes easy to see how one could consume much more than an additional 100 calories during an undermining interaction. Further research should examine which individuals are most vulnerable to undermining efforts and the traits of those who successfully resist undermining pressure.

Researchers and fitness professionals have invested significant effort to discover how they might leverage positive social support to improve health behaviors. Others have demonstrated the effects of positive social support on healthy behaviors (14) and how obesity can spread through social networks (7). This current research project has uncovered a "dark side" of social influence on health behaviors, where others attempt to negatively influence exercise and eating behaviors. Improving our understanding of eating and/or exercise undermining as a potential negative influence on behavior and health outcomes should be part of our effort to help clients set and achieve personal health and fitness goals. Moving our understanding beyond shared anecdotal experiences, such as the post-holiday dinner pressure to finish Aunt Mabel's pecan pie, should help generate momentum toward enabling fitness professionals to identify preventive strategies to prepare clients to meet the challenges inherent in undermining situations. Continued work on the undermining of health behaviors should clarify its role and contribute to improved interventions that account for both the positive and negative impacts of social support on healthy eating and exercise behaviors.

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CONDENSED VERSION AND BOTTOM LINE

Those who regularly make healthy eating and exercise choices interact with others who do not support or encourage those behaviors and may even attempt to actively undermine those behaviors. More individuals give in to behavioral sabotage in eating situations compared with exercise, a rate of compliance suggestive of either different response mechanisms or simply the increased amount of social engagement in eating situations. Helping clients determine if social undermining of either eating or exercise behaviors is impacting their ability to reach health or fitness goals and working together to develop positive countermeasures may enhance client success.

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References

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Keywords:

Behavior Sabotage; Body Mass Index; Health Behaviors; Social Influence; Support

© 2009 American College of Sports Medicine