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Small Changes for Health: Not So Fast

Changing habits is not easy, so why not start small?

wildpixel / iStock
Source: wildpixel / iStock

Small changes to establish new, healthier, habits. Seems like a simple concept, one that most of us can see the wisdom of. Many organizations have endorsed the small change concept, including the U.S. Surgeon General (in 2008), the American Diabetes Association, the American Heart Association, and the American Cancer Society.1

Is it simple? If so, why hasn’t it been embraced by so many trying to “lose weight and exercise more,” and why don’t doctors work with their patients to adopt this concept?

These questions have complex answers.

First, a definition of habit: “Any regularly repeated behavior that requires little or no thought and is learned rather than innate. A habit … is developed through reinforcement and repetition.”2

Why Small Change Works

Many behavior models point out that people have three innate psychological needs—competence, autonomy, and relatedness.3

Succeeding at a small habit change like eating a piece of fruit with lunch every day or adding 500 more steps during the day can be a win for all three of these needs.

Small change allows people to accomplish change because it is easy to do. The task is repeated for two to three weeks to allow comfort with the habit to occur before moving on to the next change. This process can continue for a period of months or longer, depending on the amount of change desired. As one success builds on another, aspirations and intentions may expand.

Adoption of even a few healthier habits can be beneficial. There is a great deal of research indicating that minor changes to healthier behaviors can result in positive health outcomes. Once people see and feel these outcomes, they may become encouraged to build on them.

During the process, a major key to success is to have people choose the habit they want to work on. They need to feel that the habit is something that they can accomplish easily every day.4 When people decide on the small habit they want to change, it is then a choice and has not been imposed. So often, interventions presented in research have been imposed. And so often, those interventions do not have staying power.

Small change can lead to the elimination of the “on or off” switch that is so common for diet and exercise. So many people feel that they are either “on” a diet or “off” of it. They are either going to the gym or have dropped off for now. The accomplishment of a smaller change can lead to an understanding that “diet” can mean making a switch to eating more vegetables, and “exercise” can mean taking more steps during the day.

When your own new choices become habitual, it can lead to regarding yourself as your own resource for making health decisions. Developing autonomy and intrinsic motivation are stronger predictors of sustainability than extrinsic factors.5

Barriers to the Small Change Approach

Being able to develop healthier habits can butt up against our own physiology. We know that often food is manufactured to improve mouth appeal, activate reward centers in the brain, be convenient, and fun. We also know that our bodies downregulate many functions when they are habitually sedentary, making it difficult to “find the energy” to get moving.

In spite of many campaigns to get people to eat five servings of fruit or vegetables per day, only 10 percent of Americans actually do so on a regular basis.6 It appears that in some cases there is a lack of affordability and accessibility. But, there is also still a gap in understanding the health benefits of eating more plants.

Creating awareness of our current habits is key to switching a few to healthier ones. As Chip and Dan Heath mentioned in their book, Switch: How to Change Things When Change is Hard, we are very fond of our habits. In addition, many of them are unconscious.7 First we have to become aware of what our habits are, then realize that they are just habits that can be changed, and then have a strategy to make changes.

Other potential barriers:

  • How can change, even small ones, be presented to a person who has a fixed view of themselves, their desires, and their health?
  • How do you stop some people from hanging on to a perceived need for instant gratification?
  • How do you counter the tendency to grab on to fantasies and unrealistic expectations when it comes to setting goals?

What’s the Answer?

Unfortunately, doctors often do not have the time or expertise to walk a patient through the mental shifts needed to be comfortable with accumulating small changes for a permanent switch to better health. But doctors do not have to be the only ones carrying the torch for small change.

Awareness of the success potential of the small change approach can be disseminated via research, media, coaches, trainers, dieticians, physicians, and even the food and fitness industries. Initiatives, education, and work in the trenches can all combine to make this a reality for more people. This has already started to happen and will continue as more successes come rolling in. There is a lot of work to do, but the future holds promise.


1. Hill JO. Can a small-changes approach help address the obesity epidemic? A Report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. The American Journal of Clinical Nutrition 2009;89(2):477-84.


3. Ryan RM., Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 2000;55(1):68-78.

4. Lally P, Chipperfield A, and Wardle J. Healthy habits: efficacy of simple advice on weight control based on a habit-formation model. International Journal of Obesity 2008;32:700-707.

5. Gardner B, Rebar A. Habit formation and behavior change. Oxford Research Encyclopedia of Psychology 2019.

6. Lee-Kwan SH, Moore LV, Blanck, HM, Harris DM, Galuska D. Morbidity and Mortality Weekly Report, Center for Disease Control and Prevention. 2017;66(45):1241-1247.

7. Heath C, Heath D. Switch: How to Change Things When Change is Hard. Broadway Books 2010.

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