Nearly 70% of adults in the United States are obese or overweight (34). Excess body weight contributes to a variety of health problems including type 2 diabetes, cancer, and coronary artery disease (6,24). These health issues cause a tremendous economic burden with some estimates of more than $200 billion dollars annually (3). There are many barriers that impede weight loss efforts. Some of these barriers include a lack of willpower, goal-incongruent emotion-driven behavior (i.e., stress and emotional eating), other people (peer pressure to eat unhealthy food, lack of accountability to someone else, lack of support), and lack of exercise (15,31,49). If the skills to overcome weight loss barriers are absent, a person may fail to achieve a weight loss effort. Failed efforts can reduce confidence for success and reduce the odds of future efforts (38).
Self-regulation describes the skills necessary to overcome barriers. An individual’s self-regulatory capacity is important for the success of behavioral interventions (26,43). Self-regulation skills aid in increasing levels of physical activity, dietary improvement, and weight loss (1,8,28,41,56). A specific type of self-regulation strategy, called implementation intentions, guides the when, where, and how a behavior will occur. Enacting new health behaviors requires conscious effort and thus may be cognitively taxing; however, implementation intentions may help create automaticity of behaviors by linking the behaviors to situational or environmental cues (14).
“Self-regulation describes the skills necessary to overcome barriers. An individual’s self-regulatory capacity is important for the success of behavioral interventions.”
For each barrier that a person identifies with specific implementation intentions or other self-regulation, strategies may be formed. An implementation intention strategy of relevance to individuals who wish to lose weight is called a coping plan. Coping plans help people identify barriers and plan ways to overcome them (43,44). Consequently, for each weight loss barrier there is a plan of action. This form of self-regulation also is associated with increased physical activity and successful weight loss maintenance (7,27,44). It is the purpose of this review article to examine commonly listed weight loss barriers including lack of support, lack of exercise, lack of willpower, and emotional eating and provide self-regulation strategies to overcome each one.
Lack of Support and Accountability
Obesity exhibits a pattern of social clustering, meaning that the probability of a person becoming obese increases if they have a friend, sibling, or spouse who became obese (4). Social support is a well-documented component to weight management (7,22,38). Social norms guide expectations about acceptable behavior that occurs in a group context (29). Individuals within a peer network can create pressure concerning healthy food choices (31,49). For example, individuals have indicated the existence of saboteurs to weight loss efforts (18,22). Conversely, individuals who receive social support and engage in weight loss interventions with friends are less likely to drop out of programs and are more likely to maintain weight loss (54). It is important to note that the efficacy of recruiting spousal support for weight loss maintenance is not conclusive (7). In addition, the type of social support may dictate the success of long-term weight loss efforts. Individuals who regain weight report receiving reminders and suggestions as a form of social support, whereas maintainers received compliments for participation in healthy behaviors (19). It is possible that the form of support that regainers received may be perceived as negative.
Identification of negative social influences on weight loss efforts would be an initial strategy if lack of support and accountability were identified as barriers (42). In a qualitative study, Metzgar et al. found that weight loss saboteurs would tempt participants with high-calorie foods and make snide remarks about healthy food choices when eating in restaurants and at social gatherings. Saboteurs made comments such as the following:
“Oh I hate when you’re on a diet, because then I can’t eat what I want”; “You don’t need to lose weight”; “You are having a salad again today?”; “I don’t know why you have to eat all that [healthy] stuff, just eat less”; “You should stop losing weight”; and “Go ahead and eat that [dessert]. You deserve that. You work hard” (31).
Practitioners should teach patients/clients to form peer-based self-help groups (38). Within these help groups or within already existing social networks, compliments should be encouraged for engaging in healthy behaviors (19). Kiernan et al. (22) recommend self-regulation strategies that include nurturing existing positive friendships, systematically examining social networks to better manage relationships involving sabotage, and/or developing friendships around healthy behaviors or entering social networks that positively support healthy lifestyles. Long-term professional support also can be a useful weight loss and maintenance strategy (38). A weight loss professional can provide accountability and support to improve or maintain vigilance toward health-related behaviors.
Lack of Exercise
Exercise is a crucial component to a healthy lifestyle; however, exercise alone may produce only modest reductions in body weight (53). Nevertheless, research reviews and meta-analytical data have concluded that diet programs that also include an exercise component are more efficient for weight loss than diet or exercise interventions alone (53,55). Exercise program design should be based upon individual preferences and enjoyment (12). These programs should foster positive affective responses that increase confidence, motivation, and intention to exercise (25,52). Confidence in one’s ability to exercise is a crucial construct to participation. Self-efficacy, the personal belief in one’s ability for a given task, is mediated by performance accomplishments, vicarious experience, verbal persuasion, and physiological states (2). Expectations of personal efficacy regulate whether coping behavior will be initiated. Personal efficacy also will determine how much effort will be spent and how long effort will continue in the face of obstacles. The stronger the self-efficacy beliefs, the longer people will persist in a task that requires effort (2). Behavior change and maintenance, in part, are determined by the perception of one’s capability to engage in the behavior (47). Individuals who hold stronger self-efficacy beliefs are more likely to meet exercise recommendations (37). Of the four sources of self-efficacy, performance accomplishments are considered the most powerful source of self-efficacy (2). Therefore, exercise programs should be enjoyable and also foster a sense of mastery.
If the experience of exercise is found to be enjoyable and a sense of confidence is experienced, a variety of self-regulation strategies may be implemented to increase adherence. Creating implementation intentions can increase the likelihood for goal-directed behavior to occur. Implementation intentions link anticipated opportunities with goal-directed responses (14). An individual may have a goal of exercising 30 minutes 3 times per week. Forming an implementation intention dictates the when and the where exercise will take place (i.e., “When I am done with work at 5:00 p.m. I will exercise at the gym”). The effect of implementation intentions on exercise behavior is mediated by the actual memory of the implementation intention (39). Predictably, the impact of implementation intentions on behavior has been shown to increase when paired with text message reminders (40). Individuals also may use decisional balance sheets (DBSs) in conjunction with implementation intentions to strengthen adherence to exercise behaviors. Although implementation intentions improve the volitional or planning aspect of physical activity, a DBS can improve motivation. A DBS requires participants to write down the anticipated gains and losses to oneself and other people who matter to the person as well as the approval and disapproval of a behavior as judged by oneself and important others (39).
Lack of Willpower: Temptations and Portion Control
Resisting urges for immediate gratification is a highly adaptive human trait that leads to long-term goal attainment. When an individual inhibits an impulse to engage in a behavior that would undo a commitment, they are expressing willpower (30). Dieters have the long-term goal of weight loss. This process will inevitably take months or years to achieve. On the other hand, dieters also have a hedonic desire to consume food, which is activated through sight and smell. When taking part in a weight loss effort, self-control is the exertion of control over food urges. It has been proposed that self-control is a limited resource and can be depleted when overriding impulses with executive function (33). Depletion of self-control on one task (i.e., emotional control over frustration at work) leads to higher perception of effort to engage in future activities that require self-control (i.e., resisting food temptations at home) and also reduced resources for future self-control (33).
“Resisting urges for immediate gratification is a highly adaptive human trait that leads to long-term goal attainment. When an individual inhibits an impulse to engage in a behavior that would undo a commitment, they are expressing willpower.”
Muraven and Baumeister (33) compared self-control with a muscle where exerting self-control causes a temporary depletion effect but long-term practice of self-control strengthens the ability to exert it in the future. However, Miles et al. (32) observed that self-control training did not improve self-control. Self-control training participants did not eat any less chocolate than those in the control group. This may not be surprising because the form of self-control training was to use one’s nondominant hand for 6 weeks. Although participants were put in a scenario where it was required to override an impulse to use the dominant hand, they did not have to override tempting urges such as chocolate consumption.
Glucose supplementation and improved motivation have been shown to attenuate self-control depletion (17). However, because of the obesogenic environment, dieting is a particularly challenging situation because temptations are numerous, making it challenging to consistently plan when self-control situations may occur. Thus, the environment can result in a chronic state of self-control depletion with little opportunity to recover (17). Although providing incentives or using strategies to increase motivation is useful, self-regulation strategies to improve self-control for certain tasks, such as avoiding temptations altogether may be the most useful self-regulation tactic. This strategy involves personal environmental modifications.
Two types of environments of relevance are the social and physical environments. The social environment includes family, friends, and peers. Both social and physical environments can dictate the extent to which a person uses willpower. For example, if individuals are surrounded by friends and family who habitually overconsume food and do not provide support, more willpower will be needed to meet dietary goals (covered in lack of support). The physical environment describes the settings where people obtain food. Availability and accessibility of food influence consumption (48). Salience of food can serve as a continuous temptation (50). Reducing proximity and visibility of unhealthy food can aid in reducing consumption, presumably through reduced incidences of temptation (51). Another self-regulation strategy would be to increase the effort with which it takes to obtain unhealthy foods (50). To reduce consumption without relying heavily on willpower, it has been suggested that individuals repackage bulk foods into smaller serving containers, reduce the convenience of tempting foods (store tempting foods out of site), and reduce glass and plate sizes (50). To further reduce temptations, individuals should wrap leftovers such as cookies or pizza in aluminum foil to decrease visibility. Leftover desserts also could be stored in the produce drawer to reduce visibility. Finally, equally convenient healthy food should be available. For example, a person may place Greek yogurt, a protein shake, or precut fruits in a visible spot in the refrigerator.
Maladaptive eating behavior often is attributed to emotional eating, external eating, and restrained eating (23,46). Emotional eating is common among obese individuals. Emotional eating occurs in response to negative emotions such as anger, depression, boredom, anxiety, and loneliness and also has a relationship with stressful life events (13). Individuals with higher body mass indexes (BMIs) report higher degrees of emotional eating, and emotional eating is associated with increases in BMI and absolute changes in body weight over time (21,23).
Emotions explain how internal cues contribute to eating behavior, whereas external eating describes how external cues influence eating behavior. External eating entails eating in response to food cues such as scent (as described in the willpower section). Restrained eating occurs through cognitive suppression of feeling such as hunger (46). This suppression can lead to a rebound effect where overeating occurs (46). Restrained eating is positively associated with higher BMI trajectories in adolescents (46). However, a causal effect of restrained eating on body mass is challenging to establish. It is possible that individuals who are overweight or obese practice restrained eating to lose weight. Thus, being overweight or obese can be a cause of restrained eating rather than restrained eating causing obesity. To support this, Keller and Siegrist (21) found that external eating and restrained eating did not predict weight fluctuations. Overall, internal cues, such as anger, depression, boredom, anxiety, loneliness, and stress, may make an individual more susceptible to overeat than external cues (10).
Research indicates a significant and positive relationship of high stress events and chronic stress with obesity, BMI, and weight gain (45). It has been speculated that to cope with stressful times and negative emotional experiences, emotional eaters gain weight through dietary disinhibition and overconsumption of high-calorie foods (21). Perceived stress also is related to lack of control over hunger, increased hunger, binge eating, and an increased drive to eat highly palatable nonnutritious foods (16). Koenders and van Strien (23) recommend that psychological treatment strategies must be developed to overcome emotional eating. In a review of the literature, Frayn and Knauper (10) highlight mindfulness training and acceptance and commitment therapy (ACT) as two interventions to aid emotional eaters.
Mindfulness is characterized by continually attending to one’s moment-by-moment experiences, thoughts, and emotions with an accepting and nonjudgmental mindset. It is the acceptance of feelings rather than trying to change them (35). In terms of emotional eating behavior, mindfulness training teaches individuals the skills to accept, rather than suppress negative feelings (36). This improved awareness can be used to reduce reactivity to negative emotional experiences that may trigger unhealthy behaviors (11). A systematic review by O’Reilly et al. (36) provides moderate support for mindfulness-based interventions to treat emotional eating. However, it is unclear if mindfulness training improves weight outcomes (11). Recent research by Daubenmier et al. failed to find statistically significant weight loss differences after a 1-year follow-up between control and mindfulness groups. However, this study did not measure changes in mindfulness (5), which is a methodological concern in determining the efficacy of mindfulness interventions on weight loss (35).
ACT is a form of therapy, with a mindfulness component, that helps individuals create a willingness to experience aversive internal experiences while promoting goal and value consistent behavior. Therefore, a self-regulation strategy in ACT is to clarify values and link behaviors to values (9). Willingness to tolerate negative internal experiences is known as experiential acceptance, which is the degree to which an individual is willing to have challenging thoughts, feelings, or sensations while engaging in behaviors that promote a valued life (20). Healthy eating and exercise are not inherently pleasurable activities. Self-control within the ACT framework entails the acceptance of these less pleasurable states (i.e., a donut is more pleasurable than an apple) to live a more valued life (9).
To identify life values, a person must indicate why a weight loss goal is important to them. A person with a weight loss goal of 30 pounds may value being adventurous. However, because of excess weight, they have not been able to do their favorite activities. Once the value of being adventurous has been identified, weight loss behaviors should be clearly linked with the weight loss goal and aversive experiences caused by the behaviors should be linked to the life value. For example, the person may find some parts of exercise not pleasurable and may desire to quit. When they feel the desire to quit, they should practice experiential acceptance. Stated otherwise, are they willing to tolerate this negative state to become the adventurous person they want to be?
Successful weight loss is dependent on overcoming barriers that may impede achievement. Some of the common barriers that individuals encounter include lacking accountability, exercise, willpower, and emotional barriers. If a person can gain the self-regulatory skills to overcome personal barriers, stagnation and perceived failure may be avoided. Individuals who are attempting to engage in weight loss efforts should identify which barriers are personally relevant to them and then create self-regulation plans to overcome high-risk situations where lapses in self-control are likely.
“If a person can gain the self-regulatory skills to overcome personal barriers, they may be able to avoid stagnation and perceived failure. Individuals who are attempting to engage in weight loss efforts should identify which barriers are personally relevant to them and then create self-regulation plans to overcome high-risk situations where lapses in self-control are likely.”
BRIDGING THE GAP
There are many barriers to weight loss that can make this goal particularly challenging. Each barrier requires a distinct skill set. Health and wellness practitioners should teach and encourage clients to use barrier-specific self-regulation strategies as highlighted in this article.
1. Anderson ES, Winett RA, Wojcik JR. Self-regulation
, self-efficacy, outcome expectations, and social support: social cognitive theory and nutrition behavior. Ann Behav Med
2. Bandura A. Self efficacy: toward a unifying theory of behavioral change. Psychol Rev
3. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ
4. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med
5. Daubenmier J, Moran PJ, Kristeller J, et al. Effects of a mindfulness-based weight loss
intervention in adults with obesity: a randomized clinical trial. Obesity (Silver Spring)
6. Dixon JB. The effect of obesity on health outcomes. Mol Cell Endocrinol
7. Elfhag K, Rössner S. Who succeeds in maintaining weight loss
? A conceptual review of factors associated with weight loss
maintenance and weight regain. Obes Rev
8. Fleig L, Pomp S, Parschau L, et al. From intentions via planning and behavior to physical exercise
habits. Psychol Sport Exerc
9. Forman EM, Butryn ML. A new look at the science of weight control: how acceptance and commitment strategies can address the challenge of self-regulation
10. Frayn M, Knauper B. Emotional eating and weight in adults: a review. Curr Psychol
. 2017; DOI 10.1007/s12144-017-9577-9.
11. Fulwiler C, Brewer JA, Sinnott S, Loucks EB. Mindfulness-based interventions for weight loss
and CVD risk management. Curr Cardiovasc Risk Rep
. 2015;9(46): pii: 46. doi: 10.1007/s12170-015-0474-1.
12. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise
for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise
. Med Sci Sports Exerc
13. Ganley R. Emotion and eating in obesity: a review of the literature. Int J Eat Disorder
14. Gollwitzer PM. Implementation intentions: strong effects of simple plans. Am Psychol
15. Green AR, Larkin M, Sullivan V. Oh stuff it! The experience and explanation of diet failure: an exploration using interpretative phenomenological analysis. J Health Psychol
16. Groesz LM, McCoy S, Carl J, et al. What is eating you? Stress and the drive to eat. Appetite
17. Hagger MS, Wood C, Stiff C, Chatzisarantis NL. Ego depletion and the strength model of self-control: a meta-analysis. Psychol Bull
18. Hindle L, Carpenter C. An exploration of the experiences and perceptions of people who have maintained weight loss
. J Hum Nutr Diet
19. Karfopoulou E, Anastasiou CA, Avgeraki E, Kosmidis MH, Yannakoulia M. The role of social support in weight loss
maintenance: results from the MedWeight study. J Behav Med
20. Katterman SN, Goldstein SP, Butryn ML, Forman EM, Lowe MR. Efficacy of an acceptance-based behavioral intervention for weight gain prevention in young adult women. J Contextual Behav Sci
21. Keller C, Siegrist M. Ambivalence toward palatable food and emotional eating predict weight fluctuations. Results of a longitudinal study with four waves. Appetite
22. Kiernan M, Moore SD, Schoffman DE, et al. Social support for healthy behaviors: scale psychometrics and prediction of weight loss
among women in a behavioral program. Obesity (Silver Spring)
23. Koenders PG, van Strien T. Emotional eating, rather than lifestyle behavior, drives weight gain in a prospective study in 1562 employees. J Occup Environ Med
24. Kopelman P. Health risks associated with overweight and obesity. Obes Rev
. 2007;8(Suppl 1):13–7.
25. Kwan BM, Bryan AD. Affective response to exercise
as a component of exercise
motivation: attitudes, norms, self-efficacy, and temporal stability of intentions. Psychol Sport Exerc
26. Lally P, Wardle J, Gardner B. Experiences of habit formation: a qualitative study. Psychol Health Med
27. Latner JD, McLeod G, O’Brien KS, Johnston L. The role of self-efficacy, coping, and lapses in weight maintenance. Eat Weight Disord
28. Luszczynska A, Sobczyk A, Abraham C. Planning to lose weight: randomized controlled trial of an implementation intention prompt to enhance weight reduction among overweight and obese women. Health Psychol
29. McDonald RI, Crandall CS. Social norms and social influence. Curr Opin Behav Sci
30. Metcalfe J, Mischel W. A hot/cool-system analysis of delay of gratification: dynamics of willpower
. Psychol Rev
31. Metzgar CJ, Preston AG, Miller DL, Nickols-Richardson SM. Facilitators and barriers to weight loss
and weight loss
maintenance: a qualitative exploration. J Hum Nutr Diet
32. Miles E, Sheeran P, Baird H, MacDonald I, Webb TL, Harris PR. Does self-control improve with practice? Evidence from a six-week training program. J Exp Psychol Gen
33. Muraven M, Baumeister RF. Self-regulation
and depletion of limited resources: does self-control resemble a muscle? Psychol Bull
34. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA
35. Olson KL, Emery CF. Mindfulness and weight loss
: a systematic review. Psychosom Med
36. O’Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-based interventions for obesity-related eating behaviors: a literature review. Obes Rev
37. Patterson MS, Umstattd Meyer MR, Beville JM. Potential predictors of college women meeting strength training recommendations: application of the integrated behavioral model. J Phys Act Health
38. Perri MG, Sears SF Jr, Clark JE. Strategies for improving maintenance of weight loss
. Toward a continuous care model of obesity management. Diabetes Care
39. Prestwich A, Lawton R, Conner M. The use of implementation intentions and the decision balance sheet in promoting exercise
behaviour. Psychol Health
40. Prestwich A, Perugini M, Hurling R. Can the effects of implementation intentions on exercise
be enhanced using text messages? Psychol Health
41. Rovniak LS, Anderson ES, Winett RA, Stephens RS. Social cognitive determinants of physical activity in young adults: a prospective structural equation analysis. Ann Behav Med
42. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise
behaviors. Prev Med
43. Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol
44. Scholz U, Sniehotta FF, Burkert S, Schwarzer R. Increasing physical exercise
levels: age-specific benefits of planning. J Aging Health
45. Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry
46. Snoek HM, Engels RC, van Strien T, Otten R. Emotional, external and restrained eating behaviour and BMI trajectories in adolescence. Appetite
47. Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q
48. Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health
49. Thomas SL, Hyde J, Karunaratne A, Kausman R, Komesaroff PA. "They all work…when you stick to them": a qualitative investigation of dieting, weight loss
, and physical exercise
, in obese individuals. Nutr J
50. Wansink B. Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annu Rev Nutr
51. Wansink B, Painter JE, Lee YK. The office candy dish: proximity’s influence on estimated and actual consumption. Int J Obes (Lond)
52. Winett RA, Williams DM, Davy BM. Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach. Br J Sports Med
53. Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc
. 1999;31(Suppl 11):S547–52.
54. Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss
and maintenance. J Consult Clin Psychol
55. Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet-plus-exercise
interventions vs. diet-only interventions for weight loss
: a meta-analysis. Obes Rev
56. Zhou G, Gan Y, Miao M, Hamilton K, Knoll N, Schwarzer R. The role of action control and action planning on fruit and vegetable consumption. Appetite