Using ‘Stimulus Control’ to Increase Physical Activity and Improve Diet

Stimulus control is a behavioural technique that can be used to help improve people’s diet and physical activity levels. The challenge is that it’s a technique not taught to most health and fitness practitioners.

So, in this article we’ll explain:

• What Stimulus Control is
• Why it’s important for health and fitness professionals
• How to use Stimulus Control to increase physical activity
• How to use Stimulus Control to improve eating behaviours.

What is Stimulus Control?

In Exercise Behaviour is More Important Than Just Working Out we took a look under the hood at how to build an exercise behaviour. We explained that in order to build or modify behaviours, you must understand the context within which the behaviour occurs. In short, you need to understand your ABCs.

ABCs refer to the ‘Antecedents’ that prompt or trigger the ‘Behaviour’, and the ‘Consequences’ that reinforce the behaviour, making it more likely to be repeated. Stimulus Control targets the Antecedents. The rationale is quite simple; if a problem behaviour is triggered by a certain stimulus, then removing or changing that stimulus reduces the likelihood of the behaviour occurring. Alternatively, the likelihood of healthier behaviours occurring can be increased by adding stimuli that prompt such behaviours.

Stimulus Control is one of the behaviour change techniques we use in our Weight Management programme. It is also widely used in treatments for addiction (gambling, substance abuse) and sleep disorders. For example, if I have an alcohol problem and I rent a flat next to a pub, have a mini bar in my flat, and hang out with heavy drinkers then I’m surrounded by stimuli that prompt me to drink. Moving away from the pub, removing alcohol from the house, and spending more time with friends that don’t drink, reduces the prompts for drinking. This is ‘Stimulus Control’ in action.

Why is Stimulus Control important for health and fitness practitioners?

The annual New Zealand Health Survey informs us about the health of the population and our health-related behaviours. The 2020/21 Survey, revealed that:

• 47% of adults weren’t considered ‘physically active’ (they didn’t accumulate at least 2.5 hours of physical activity per week)
• Only 30% of adults ate the recommended amount of fruit and vegetables (at least 3 daily serves of vegetables and at least 2 daily serves of fruit).

Clearly, we should move more and eat healthier foods, but in general we don’t. Our behaviour isn’t due to laziness because we tend to work longer hours than the supposed 40hr-week. Indeed, many of us do two jobs now in order to get by. In most cases, our behaviours are natural consequences of living in what public health experts refer to as an ‘obesogenic’ environment. An environment where the predominant stimuli prompt us to be sedentary and over-consume unhealthy foods.

Over the past 40-odd years, we’ve transitioned from being a physically active species, to being predominantly sedentary. Whether at work or play, much of our time is now spent in front of screens. Unfortunately, a screen-based job predicts a screen-based lifestyle. An Australian study [ref 1] found that people with sedentary jobs spent an additional 3.3 hours of their daily non-work time sitting in front of screens. This equated to 200% more ‘recreational sitting’ than people who had physically active jobs.

Sitting in front of a screen conditions you to… spend more time sitting in front of a screen.

Again, the ABCs in action. Once screen time becomes a behaviour, the behaviour permeates across our lives becoming more frequent. This wouldn’t be a problem if it wasn’t for the fact that sedentary lifestyles increase the risk of cardiovascular diseases, diabetes, obesity, colon cancer, hypertension, osteoporosis, depression, and anxiety. Indeed, even back in 2002 the WHO warned that a sedentary lifestyle was one of the leading causes of death and disability in the world.

Our reliance on screens for work, entertainment and social interaction have also made us a marketers dream. Not only is there an abundance of stimuli for unhealthy foods, but those stimuli are also deceptively manipulative. For example, a New Zealand study [ref 2] found that during COVID-19 lockdown restrictions, unhealthy food and drink brands engaged in ‘COVID washing’ via social media.

COVID washing refers to the practice of portraying a company as caring and contributing in a meaningful way to the pandemic response to mask the real objective of promoting products and choices that are detrimental to our health. “Consumption helps with coping” was one commonly used message. As well as using the #allinthistogether, Domino’s posted that “Not sure who needs to hear this, but you can order Domino’s more than once today. It’s OK”.

More screentime = more exposure to unhealthy food marketing.

The marketing strategies of the fast-food companies are extremely effective. EFTPOS data collated by the Helen Clark Foundation revealed that Aucklanders alone now consume the equivalent of:

• 89 Big Macs, or
• 399 Wicked Wings, or
• 560 slices of Domino’s pizza, for every adult, child and baby, per annum.

Because physical activity and healthy eating are our ‘bread and butter’, and the obesogenic environment isn’t likely to change anytime soon, we need to learn about, and use every technique at our disposal to help people eat healthier foods and become more active.

For fitness professionals, too often we see the gym down the road, or the ‘other’ Personal Trainer as our competition. They’re not. We’re actually competing with the chairs, sofas, and screens of our clients and fellow kiwis. These are far more influential and threatening to our success and the health of those we’re attempting to help.

Stimulus Control and Physical Activity

A Personal Trainer I worked with many years ago observed that: “At best, I spend 1-2 hours per week with my clients. That leaves 166-167 hours in the week where I’m not training them. To guarantee results, I need to have an input into what they do outside of our sessions”.

Absolutely correct. Sure, Personal Trainers design programmes for people to complete independently. But there are a number of things we can do in conjunction with that training to encourage incidental activity. Incidental activity refers to any activity that is built up in small amounts over the day, such as taking the stairs instead of a lift.

Incidental activity is more influential than most people think. For example, an intervention among office workers in Denmark found that sitting time could be reduced by 1 hour for every 8-hour workday [ref 3]. Less sitting time was accompanied by significant:

• Reductions in body fat
• Increases in fat-free mass.

Amongst other things, the intervention involved simple actions such as:

• Moving office rubbish bins away from desks (which requires people to stand and walk to the bins)
• Scheduling and implementing standing meetings
• Using sit-stand desks with reminder prompts to raise the desk regularly
• Displaying posters in the office which promote desired behaviours (use the stairs)
• Receiving email and text message reminders of desired behaviours.

When implemented and sustained, seemingly minor actions can have a significant impact.

In that light, here are a few more idea’s to increase incidental activity:

• Install and use an app that reminds you to take a break and walk around the office every hour
• Delete all ‘convenience’ phone apps that encourage sedentary behaviour (e.g., Uber eats)
• Hide/dispose of the remote control so you have to get up to change TV channels
• Give up the carpark at work or park further away from the office
• If using public transport – get off one stop earlier and set a reminder prompt to do this on your phone.

Stimulus Control and Healthy Eating

The marketing of unhealthy food has become so pervasive that most of us accept it as normal. Consequently, we download the fast-food apps without really thinking about it. We don’t object to fast-food companies sponsoring school sports. We buy our favourite sports teams merchandise and become unwitting brand ambassadors for:

• KFC (cricket and rugby league)
• Burger King (basketball)
• Cadbury (netball)
• Powerade/Steinlager (the All Blacks).

Big food is using stimulus control against us

Generally, we don’t make the connections between the stimuli that prompt behaviour, and actual behaviour. Hence, we blame people for making bad choices rather than blame those (our ‘beloved’ politicians) who have a duty to protect our collective health from the interests of companies that profit from ill-health.

Studies investigating food marketing from similar Western countries to ours, tell us that:

In high profile locations in supermarkets:

• Fruit and vegetables made up less than 1% of products
• Sugary foods and drinks made up 43% of products [ref 4].

On social media:

• The majority of online advertising is for unhealthy foods and beverages
• When compared to healthy or non-food posts, advertisements for unhealthy food were more likely to be:
  • Read for longer
  • Liked and shared
  • Result in positive ratings for the person with the post in their feed [ref 5].

On TV:

• 1% of all food advertising was for fruit and vegetables
• Fast food and takeaway advertisements appeared more than twice as often as any other type of food or drink [ref 6]
• Back in 2012 a study found that McDonald’s alone spent almost three times the amount (almost $1billion US) on advertising as all fruit, vegetable, bottled water and milk combined [ref 7].

And in a New Zealand study [ref 8] it was shown that:

• Kiwi kids were exposed to non-core (not a healthy food option) food marketing 27.3 times a day. The majority of this was for sugary drinks, fast food, confectionery, and snacks.

Food marketers understand stimulus and effect and they are currently in control

The reality is that our food environment isn’t likely to change anytime soon. We can use techniques such as Stimulus Control to minimise the negative impact this environment has. We can encourage people to:

• Delete all unhealthy food apps (no more reminders of daily specials)
• Unsubscribe/unlike all unhealthy food brands on social media (no more special deals filling up the newsfeed)
• Turn all screen’s off after a certain time of day, or during certain activities (such as dinner)
• Create a shopping list of healthy foods and only go food shopping with such a list (focuses the attention on the list rather than the unhealthy food specials)
• Avoid walking past fast-food outlets – choose an alternate route for a daily walk
• If visiting a café on a regular basis – set a phone notifier that reminds you to choose a healthier option.

A Final Word…

In The Art of War famous Chinese military general, strategist, and philosopher Sun Tzu states:

• “Know thy enemy and know yourself; in a hundred battles you will never be defeated”.

As health and fitness practitioners, our enemy is the obesogenic environment that runs counter to the health of those we work hard to help.

As humans, we need to accept that we’re more vulnerable to this environment than we think. If we accept that we’re vulnerable, and the environment is a genuine threat to our collective health, then we can start using the techniques at our disposal to counter the threat.

Stimulus Control isn’t a silver bullet, it’s one of a number of valuable techniques we can use to help level the playing field. And the playing field desperately needs leveling!

References

1. Hadgraft et al. (2014). From the office to the couch: Correlates of high workplace sitting plus high non-work screen-time. Journal of Science and Medicine in Sport. http://dx.doi.org/10.1016/j.jsams.2014.11.100
2. Gerritsen et al. (2021). The timing, nature and extent of social media marketing by unhealthy food and drinks brands during the COVID-19 pandemic in New Zealand. Frontiers in Nutrition. https://doi.org/10.3389/fnut.2021.645349
3. Danquah et al. (2016). Take a stand! – a multi-component intervention aimed at reducing sitting time among office workers-a cluster randomised trial. International Journal of Epidemiology. https://doi.org/10.1093/ije/dyw009
4. Obesity Health Alliance. (2018, November). Out of place – the extent of unhealthy foods in prime locations in supermarkets. http://obesityhealthalliance.org.uk/wp-content/uploads/2018/11/Out-of-Place-Obesity-Health-Alliance-2.pdf
5. Murphy et al. (2020). See, like, share, remember: Adolescents’ responses to unhealthy-, healthy- and non-food advertising in social media. International Journal of Environmental Research and Public Health, 17(7), 2181. https://doi.org/10.3390/ijerph17072181
6. Obesity Health Alliance. (2017). A watershed moment – why it’s prime time to protect children from junk food adverts. http://obesityhealthalliance.org.uk/wp-content/uploads/2017/11/A-Watershed-Moment-report.pdf
7. Harris et al. (2013). Fast food facts 2013: Measuring progress in nutrition and marketing to children and teens. Yale Rudd Center for Food Policy & Obesity. p1-128. http://fastfoodmarketing.org/media/FastFoodFACTS_Report.pdf
8. Signal et al. (2017). Children’s everyday exposure to food marketing: an objective analysis using wearable cameras. International Journal of Behavioural Nutrition and Physical Activity. https://doi.org/10.1186/s12966-017-0570-3