Move Over “Eat Less, Move More”- Behavioral Phenotypes for Weight Loss

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The standard advice for weight loss has often been the pithy “eat less, move more.” This advice doesn’t prove very helpful to people engaged in a weight loss journey. Given the newer data on BMI and risk of mortality from COVID-19, are there better ways to frame what works for weight loss?

This year, Robert Kushner published a paper in Obesity detailing a new way to sub-type Obesity, known as behavioral phenotyping. When you see your doctor, they usually conduct an account of the presenting illness. Weight history is useful in guiding treatment, but there’s little agreement on conducting them optimally. In the USA, the Obesity Society convened a task force to frame the primary evidence-based elements in taking a weight history as part of a clinical examination.

The task force determined four domains of psychological and behavioral variables associated with weight change: cognitive, psychological, personality, and behavioral.

Cognitive – people who have experienced weight changes can often engage in dichotomous thinking, or all or nothing thinking in laypersons terms. You might have heard someone framing their food intake that day as good or bad; this is an example of dichotomous thinking in action and is most often associated with weight gain. Conscientiousness is also a cognitive variable related to exerting control over their direct impulses; this and vigilance is associated with weight loss.

Psychological – includes dissatisfaction with weight achieved and adverse childhood experiences like trauma, leading to weight gain. Self-efficacy, and self-regulation, relate to the degree to which one believes one can engage in the necessary behaviors to make changes and plan to meet long-term goals. These elements are associated with weight loss.

Personality – novelty-seeking personality often translates to impulsive behavior, which is associated with weight gain. Lower persistence and lower self-direction pertain to following a course of action despite setbacks and adapting to new situations to stay on track. Being lower on these two elements is associated with weight gain.

Behavioral – adherence, and self-monitoring is associated with weight loss; how well you can stick to a plan and monitor progress are hallmarks for success. Dietary restraint, that being limiting the overall amount of food eaten or what is consumed is associated with weight gain. That may seem counter-intuitive, but it is essential not to be so rigid that success is so narrowly defined given weight loss is a long journey.

Knowing these domains can help us better match a plan for success at an individual level. Newer approaches have done away with calorie counting and lean into a healthier overall dietary pattern. Popular programs also cover more of the psychological and physiological aspects of weight loss to have a more in-depth view of their process. The time has come to sub-type obesity and better match a person with obesity with a plan that reflects their optimal success approach.

Thanks for reading – Trina
(Opinions are my own)


Kushner, R. F., Batsis, J. A., Butsch, W. S., Davis, N., Golden, A., Halperin, F., Kidambi, S., Machineni, S., Novick, M., Port, A., Rubino, D. M., Saunders, K. H., Shapiro Manning, L., Soleymani, T., & Kahan, S. (2020). Weight History in Clinical Practice: The State of the Science and Future Directions. Obesity28(1), 9-17.

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