Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

I’ve always taught people to make major changes in their diets right away, rather than going through a lengthy phasing in of changes, sometimes called the “baby steps” approach. The argument for making a few changes at a time is that people are less likely to feel overwhelmed, and may feel like they can master changes better if tackled one or two at a time. The downside of this approach, in my opinion, is that the “bad” food often remains in the house, tempting people to continue to eat it; incremental change can be hard to measure (what does “less” or “more” mean?); and often the initial changes made are not enough to result in weight loss or health improvement, which can make it more difficult to stay motivated to continue.

Since most health improvement and weight loss programs fail for most people, our thinking is that if a strategy is used by “the others” it may be best to exclude it from our repertoire. Lots of coaches and programs use a “baby steps” approach, so it’s one we’ve avoided.

There is some evidence to support our stance that one big change works better. Alcoholics don’t gradually withdraw from alcohol, for example – they are taught to quit. And while smokers are often told to gradually withdraw from smoking, a new study says they’d be better off just quitting abruptly.

The study involved 697 smokers, 355 of which were assigned to an abrupt cessation group, and 342 who were assigned to a gradual cessation group. Participants in the abrupt cessation group each chose a date 2 weeks in advance on which they would quit smoking. The gradual cessation participants reduced their smoking 50% by the end of week one, another 25% by the end of week two, and then stopped smoking entirely.

Participants in both groups were provided with behavioral support from nurses, and both groups used nicotine replacement patches before and after quitting. Those in the abrupt cessation group were taught to anticipate times and situations in which they would be tempted to smoke and they developed strategies for avoiding relapse.

At week four, 39.2% of the gradual cessation smokers were still abstinent, while 49% of the abrupt cessation smokers were still abstinent. The gap narrowed some at six months, but abrupt-cessation participants were still more likely to be abstinent (22%) vs gradual-cessation participants (15.5%).

The participants’ preference for quitting method seemed to matter. When asked, those who preferred quitting gradually were significantly less likely to be abstinent (38.3%) vs those who preferred abrupt withdrawal (52.2%). This held true regardless of which group the participants were assigned to. While the researchers did not comment on this, my opinion is that people who are motivated to make changes are usually more willing to commit to being “all in” than those who want things to be different but are not yet fully committed to working toward their goal.

The authors concluded, “We found clear evidence that quitting abruptly was superior in the short and longer term…Participants who preferred to quit gradually were less likely to achieve abstinence, regardless of how they were allocated to quit.”

So we’ll continue to show people how to make one big change in their dietary pattern, which leads to big changes in their health and better long-term compliance.

Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. “Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial.” Ann Intern Med. [Epub ahead of print 15 March 2016] doi:10.7326/M14-2805