Weight loss, as propagated on countless reality television shows, podcasts, and news articles, should be easy: Burn more calories than you ingest. In real life, that simple formula feels more theoretical than practical, yet there is one X factor that Ginger Winston, MD, associate professor of medicine at the George Washington University (GW) School of Medicine and Health Sciences, has been exploring: the impact of personal support systems.
“My research focuses on behavioral interventions aimed at reducing the prevalence of obesity,” she says, adding that in Washington, D.C., roughly 22 percent of the population is obese, but nationwide, that number expands to 39 percent. “I [place] a particular emphasis on the role of social networks, for example, friends, family, coworkers, in promoting weight loss.”
She can trace her initiation into obesity-based research to a general medicine fellowship at Columbia University, where she focused on cardiovascular disease. “It was at that time that I started to develop an interest in obesity because I could see how the increase in the prevalence … was linked to the increase in prevalence of diabetes and cardiovascular disease,” she says.
From there, she went to Cornell University, where, with the help of an investigative research supplement, Winston studied the influence of friends and family on eating and exercise behaviors among African-American and Hispanic adults in Harlem and the South Bronx in New York City. “That work just increased my interest,” she recalls. “We were able to see that participants in our study who had network members who were helpful with their eating and exercise goals actually lost more weight compared with those who had network members who undermined their goals. And that brought me to the work I do now.”
The field isn’t necessarily new, she adds; there has been research into social networks over the years. But the results on efficacy have been mixed. “That may be because sometimes family and friends can be helpful, and sometimes they can undermine what our behavior goals might be,” she explains.
Being supportive can be as easy as offering a few words of encouragement, or it may require more engagement, such as joining in on exercise or not bringing unhealthy food into the home. Exercise support is “a big one that people find helpful, when the network member says, ‘Yes, I want to walk with you,’ or ‘I want to join you at the gym,’ ” Winston says. “It may also be simply avoiding things that are not helpful that … helps people stick with their behavior change.”
Behavior changes, she adds, aren’t one size fits all, either. At the GW weight management practice, Winston, along with two other physicians, designs plans based on each patient’s specific barriers to healthy eating and exercise.
“For example, people may have challenges with eating related to stress, or they might find themselves eating throughout the course of the day and snacking when they’re at work and not hungry and not really realize they’re doing that,” she says. “Everyone is a little bit different, so what I recommend is first trying to isolate what a particular person’s eating challenges might be, and then [continuing] from there.” Her general advice includes being present while eating — in other words, turning off the television, closing the book, flipping over the cellphone — planning meals, avoiding unhealthy snacking, and reducing stress. For those with families, her more recent research has shown that including children in behavioral interventions may have a positive effect.
“Within the child support group, adherence with eating behavior changes increased as the frequency of child support increased, so there was some evidence that the more often the children were engaging in their supportive behavior, the more often the parents were engaging in their positive behavior change,” she said. “Another interesting finding, which we didn’t expect, was the adults in our study who lost more weight [also] reported less chaos and disorganization in their home environment.”
Often, Winston adds, researchers tend to focus on just the individual, and not necessarily the social network and home. Keeping in mind the level of organization in a patient’s home life could help in tailoring behavioral interventions. It could also be an element in her next research project.
“[We] will hopefully take a look at having the household family be a support agent for adults trying to make behavior change to lose weight,” she says.