Current Approaches to Behavior Change

Written By Ray Hyatt

Current Approaches to Behavior Change

Every few years a new answer to weight loss arrives with the promise that this time, change will be easy. The cabbage soup diet. The low-fat decade. The low-carb decade. Weight-loss surgery. And now a weekly injection.

Each of these can move the scale. The harder question, and the one that matters most to your health, is what happens a year or five years later. The science of behavior change has a fairly consistent answer: lasting results come from the habits, skills and environment you build, not from the tool that started the weight loss. That is true whether you are dieting, recovering from surgery, or taking a GLP-1 medication such as semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound).

This post looks at what we have learned from past quick fixes, what the research says about the new medications, and why knowledgeable coaching is one of the best investments you can make alongside them.

Lesson one: fad diets take weight off, then it comes back

Most fad diets work in the short term because almost any strict rule cuts calories. The trouble is that strict rules are hard to live with, and the weight tends to return once the rules end.

A well-known meta-analysis of US weight-loss studies (Anderson et al., 2001) found that people kept about two-thirds of their lost weight after one year. By five years, they had kept only about a fifth of it. The diet was not the problem so much as what came after it: nothing had changed in the daily routines, cues and environment that drove eating in the first place.

Behavior-change research explains why. Knowing what to eat rarely changes behavior on its own. Much of what we eat runs on habit, triggered by context: the time of day, the kitchen, stress after work. A diet that relies on willpower is fighting those habits every day. Change that lasts builds new habits instead.

Lesson two: even surgery can't do the work alone

Weight-loss (bariatric) surgery is one of the most effective treatments for severe obesity, and for many people it is life-changing. It is also a clear example of a powerful tool that still depends on behavior.

A 2019 scoping review (Kaouk et al.) found that patients typically lose 20–30% of their body weight in the first one to two years. After that, weight regain is common: on average, people regain about 7% of their body weight from their lowest point over ten years, and roughly one in four begin regaining after the first year.

The factors linked to regain were mostly behavioral and modifiable:

  • Grazing, binge eating, night eating and loss-of-control eating

  • Higher-calorie, lower-quality diets, including sugary drinks and alcohol

  • Low physical activity

  • Depression, anxiety and stress

  • Not having a plan for when behavior challenges show up

  • Dropping out of follow-up care with their nutritionists and coaches

Patients who kept up their follow-up support did better over the long term. The surgery changed their anatomy; it did not change their routines, their coping strategies or their environment. That part still had to be learned.

The GLP-1 era: a remarkable tool, not a finished plan

GLP-1 medications have genuinely changed obesity care. They quiet appetite and "food noise" in a way no diet can, and the weight loss in clinical trials has been substantial. But the research also shows what happens when the medication stops and nothing else has changed:

  • Semaglutide (STEP 1 extension, Wilding et al., 2022). Participants lost about 17% of their body weight over 68 weeks. One year after stopping, they had regained roughly two-thirds of it.

  • Tirzepatide (SURMOUNT-4). Among people switched to placebo after 36 weeks of treatment, 82% regained more than a quarter of the weight they had lost within a year. Those who regained the most also lost more of their gains in blood pressure, cholesterol and blood sugar (Horn et al., 2025).

It is worth remembering that the pivotal trials delivered these drugs alongside lifestyle counseling. The medication was never meant to work alone.

In 2025, four leading organizations (the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society) issued a joint advisory on supporting people on GLP-1 therapy. Its priorities include:

  • Enough protein, plus strength training, to protect muscle and bone while weight comes off

  • Managing nausea and other digestive side effects, and avoiding nutrient gaps on a reduced appetite

  • Nutrient-dense, minimally processed eating patterns tailored to the person

  • Support for activity, sleep, stress and social connection

  • Planning for maintenance, including what happens if the dose is reduced or stopped

The advisory also noted a hard truth: most people prescribed these medications do not receive adequate nutritional counseling or behavioral support.

What the science says actually lasts

The science of behavior change has matured a great deal over the past decade. A few principles now have strong, consistent support:

  1. Diagnose before you prescribe. The leading framework in the field, COM-B, says behavior changes when a person has the capability (skills, knowledge), the opportunity (time, access, support) and the motivation to act. Lasting change starts by creating a tailored and sustainable plan along with a with a knowledgeable coach.

  2. Build habits, not willpower. Habits are behaviors triggered automatically by a cue, like the morning coffee or the drive home. Research on habit formation finds it takes about two months on average, with a wide range from a few weeks to most of a year. The popular "21 days" has no scientific basis. With your personal plan missing a single day does not derail the process.

  3. Choose your own goals. People form habits more strongly when they pick the behavior themselves, and motivation that comes from within predicts long-term maintenance far better than guilt or pressure.

  4. Turn intentions into if-then plans. Roughly half of people who intend to change don't follow through. Simple plans such as "If it's 6 p.m. on a weekday, I'll walk for 20 minutes before dinner" substantially improve the odds.

  5. Track and get feedback. Self-monitoring with feedback is one of the most reliably effective techniques across diet, activity and weight studies.

  6. Change the environment. Making healthy choices easier and unhealthy ones a little harder works better than reminders alone.

  7. Use life transitions. A new job, a move, a diagnosis or starting a new medication disrupts old routines and opens a window for new ones.

  8. Plan for maintenance and lapses. Keeping change going has different drivers than starting it and needs its own plan.

There is really no quick fix. Each approach in this list produces modest effects on its own. Combining several well-matched techniques, delivered skillfully over months, is what produces meaningful change. My own coach once told me that I would be successful if I stuck to my plan 90% of the time. What I did the other 10% wouldn't derail my progress.

Why knowledgeable coaching matters

If lasting change depends on habits, skills and environment, someone has to help build them. That is the gap a skilled health and wellness coach fills.

The evidence supports it. The Diabetes Prevention Program, still the landmark trial in this field, found that an intensive lifestyle program cut progression to type 2 diabetes by 58%, compared with 31% for medication (Knowler et al., 2002). Its core ingredients were goal setting, self-monitoring, problem solving and frequent, structured contact. Reviews of health coaching find consistent benefits for weight, physical activity, blood sugar and confidence, especially when coaching is structured, sustained over months and uses proven techniques such as motivational interviewing (Sforzo et al., 2018). Apps and digital tools help too, but most lose their users within weeks; adding a human coach improves both engagement and results.

For someone using or considering a GLP-1 medication, a knowledgeable coach can help you:

  • Eat well on a smaller appetite, prioritizing protein and nutrient-dense foods so the weight you lose is fat, not muscle

  • Build strength with a realistic resistance-training routine

  • Manage side effects with practical strategies around meal size, timing and hydration.

  • Use the GLP-1 window and Plan for the long term. While the medication quiets cravings, it is an ideal time to build new routines that do not depend on fighting hunger or using medication. Your GLP-1 stopping plan.

  • Handle setbacks without shame, which research shows drives avoidance rather than progress. Remember the 90/10 advice.

Knowledgeable is the key word. A good coach works from evidence, supports your autonomy rather than lecturing, and knows when to send you back to your physician. Coaching complements medical care, it does not replace it.

The bottom line

Fad diets, surgery and GLP-1 medications share one lesson: a tool can start the change, but your daily habits and behaviors decide whether it lasts. The good news is that habits can be learned and unlearned, behavior can be modified and changed, and you do not have to do it alone.

The Thadeus Wellness Program is a 12-week, one-on-one coaching program built on the behavior-change principles in this post. Whether you are already on a GLP-1 medication, thinking about starting one, or looking for a path that doesn't depend on a quick fix, we will work together with you to build routines that fit your life and hold up over time.

Our Fall Special is limited to the first 10 clients who sign up before December 31, 2026. Learn more about the program and reach out to schedule a FREE 30-min Zoom conversation.

This post is for general education and is not medical advice. Talk with your healthcare provider before starting, changing or stopping any medication.

Sources

Ray Hyatt https://thadeuswellness.com
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