How to build better habits with dietitian Leif Lagesen

MS Plus acknowledges the Traditional Owners of the land this podcast has been recorded on, the Wurundjeri people of the Kulin Nation. We pay our respect to their Elders past, present and emerging.

Jess: Hi, my name is Jess and welcome to the MS Plus podcast series. People living with a disability or chronic health conditions such as MS often report having poorer general health along with higher rates of modifiable health risks and behaviours. So, things like having a poor-quality diet or smoking. And a report from 2021 revealed that a massive 38 percent of the burden of disease, which is like measuring how much all the sickness and health problems impact on people, could have been prevented just by reducing exposure to these modifiable risk factors.

So, what this means in simple terms is, if people had changed their health behaviours, like giving up smoking or improving their diet this could have stopped up to a third of health issues from negatively impacting on people. And given this, it's no wonder that people are frequently told by their health professionals about all the things that they need to change, you know, being told to lose weight or exercise more often. However, very little support or information is given to people on how to actually make these changes and build healthy habits.

And you can see just how difficult it is for people to make these changes to their lifestyles by the number of people who might take up a new exercise regime or a new diet. But very few are able to maintain this and make it a habitual long term change. So, to break down how habits are formed and the psychology behind this, I am talking with Leif Lagesen from Eucalyptus, a digital healthcare provider. Leif is an accredited practicing dietitian with dual degrees in sport and exercise and nutrition dietetics. He is highly energized by the fusion of behavioural change strategies with health technologies and his experience extends from working with national health coaching programs to clinical settings and includes various collaborations with health tech startups.

So, Leif thank you so much for speaking with me today about this really important topic

Leif: Yeah, hi Jess. Pleasure to be here first of all, and hopefully I can give the listener some practical takeaways, on building some healthy habits,

Jess: So Leif, I'll start with the basics. Why do we form habits? Why are habits so important to us and our behaviour.

Leif: Yeah, let's definitely start with a definition and how I like to think about what a habit actually is.

So, there's kind of two ways I think about it. The first I like to call habits mental shortcuts that are learned over time as we repeat a behaviour and feel a positive experience. That's sort of the first way I like to think about it. Next, I kind of generally say the definition is any regular repeated behaviour that requires little or no thought and is learned rather than innate. I think it's also important to understand that 43 percent of our daily behaviours are actually habitual. So, once it, and not only that, I mean it sounds like you can resonate with that, Jess. I can see you nodding along there.

And I know it's very true for myself, but once a habit is formed, it's resistant to change because the repeated behavioural patterns become imprinted in neural pathways. And so before we get into why we formed them, I guess just a few examples about habits and some of the ones I think about.

Actually, let me know if you find this, but when I'm driving to a destination from point A to point B. I can get to point B and think, how did I get here?

Jess: Absolutely.

Leif: That was on complete autopilot. So, another one if we are using the car as well, you're putting on a seatbelt, that's really habitual.

Do you ever think about putting a seatbelt on? I never do. It just happens.

Jess: Yeah, absolutely. Now that you pointed out, you are so right.

How often do we just drive somewhere and have no memory of getting there?

Leif: Yes, that's exactly right. And, and some of the other ones just because I knew this podcast was coming up.

One I thought about at work the other day was going into a meeting room. I seem to always sit in the same spot in our main meeting room. And not only myself, but others as well in the meeting. So that 43 percent statistic that is floated around in the evidence and the research that really rings true for me.

Jess: Yeah, wow, that’s spot on. It is interesting to think about how much is going on underneath the surface in our brains, just every day, sort of these automated processes.

Leif: That's right. It's really fascinating to learn about as well. And, and so to your question about why we form habits. So really the main reason is energy preservation.

So, what we know is you make around 35, 000 decisions every day, every single day that you probably don't even realize. If we have to consciously think about those, we would absolutely be mentally drained or completely exhausted. So why we form habits is because it is a natural process and contributes to energy preservation.

So, your brain does not have to consciously think about your habitual behaviours. And it's therefore liberated to consider other things.

Jess: Wow. It's no wonder our brains need a way to get through the day making that many decisions. So how do we form habits?

Are there certain things that need to happen for a habit to be formed?

Leif: Great question. That's a really good question, actually. And if anyone listening to this, so if the listener doesn't take anything else away, I think this is a really key thing to think about. So how we form habits is there's actually a loop. It's called the habit loop and there's three ingredients to the habit loop. It's actually quite simple once you understand how it works, but the three key ingredients. The cue or the trigger, I'll use those words interchangeably. The cue or the trigger, the routine or the habit or action itself and the reward that comes with doing the behaviour.

So just to repeat, three parts of the habit loop. The cue or the trigger, the routine, or the action itself and a reward. And I should definitely break this down a little bit further with some examples. Starting with the cue, so as I said, it's the trigger for the action that you take. And basically it's everything that surrounds you when you undertake a behaviour. So, it could be the bit of place you're in, the time of day. Your emotional or social situation or a proceeding action. So, that's the cue. An example of a cue that I could think about in my daily life, I think and hopefully this resonates with a lot of people listening is making my morning cup of coffee.

So, when I go downstairs, the first thing I do is go into the kitchen. As soon as I go into the kitchen it's a right hand turn to the coffee machine on complete autopilot. So, stepping into the kitchen must be my cue to start making a coffee, which is the action. So, then the routine or the action that I'm speaking about, that's just essentially the habit that is triggered by the cue. So, the action itself using, reiterating that example of making a coffee. That would be my habit when I go into the kitchen. And then the final piece of this is the reward. So that's the benefit you gain from doing the habit. So essentially this is a really key part. They're all key ingredients, but the reward is the reason behind deciding that the cue and the routine are worth repeating again. So, if I use the coffee example, the reward I get from that is I get caffeine but also, you know, I just love the taste of coffee. So, I'm getting some sort of intrinsic or internal reward from having the coffee in the morning. And that's also a really important piece about the reward as well.

So, if your reward is internal or intrinsic. You're more likely to form a habit as opposed to an extrinsic or external reward. The example here of an internal reward would be, let's use another example. Let's say my habit is walking in the morning. And so, my cue might be my alarm going off at 7 30. My action might be going straight out the door after the alarm goes off to go for a walk.

So that's the habit. And then the internal reward that I get from doing the walk is Wow, I feel great. I feel more energetic now that I've completed the walk or I know this was part of my lifestyle goal So I know I've taken and excuse the pun a step towards achieving that goal. So that's an example of an internal reward the external reward for going for that walk would be something like someone's told you they'll give you $50 if you'll go for that walk.

Or maybe your doctor said, you need to start walking more. How many times have we had a health professional tell us what to do? And so that's an example, if we were only doing that walk for the external factor, it's likely we wouldn't build a habit as quickly or it wouldn't be sustainable. I think that's a really important piece.

Jess: So, from that it sounds like the reward is potentially one of the key sort of parts forming new habits?

Leif: I love that you asked that question, I spent a lot of time on the reward because it is a very important piece. But it's actually not. I want you to have a guess at what it might be.

You've got a 50 50 chance here.

Jess: Hmm. My brain's busy making decisions in the background, so I'm going to make a quick guess. Is it routine?

Leif: It's actually the cue or the trigger, surprisingly. The reason being is if there's no cue or trigger, the action won't follow. So, this is really the key takeaway. And when we start to talk about breaking habits, which we'll do in a moment, avoiding the cue or the trigger is one way to do that.

But I think we're getting ahead of ourselves because I want to keep talking about forming habits, the cue is actually the most important thing. And what I'll share here is the research has shown that when people change jobs, when people move house, go overseas, maybe end a relationship, it's actually shown that habitual behaviour’s completely change.

And this actually resonates with me, actually. I've got to say, when I'm on holidays, I notice that all my regular habits, maybe remember my regular eating habits, just go out the window. Everything's so different. Same with exercise as well. And it's very likely that it's because all my regular cues and triggers are just not there.

Jess: Right. Yes. I can totally understand and see that now.

Leif: Yeah. Can you think of anything in your life where that happens where, you know, there's particular cues that then an action or a routine actually happens from it?

Jess: Yeah. So for me, and this is maybe a funny one, but I instantly think of the days I dropped my daughter at daycare. I often get to work early, but when my partner drops her off and I'm free to just get to work without that extra task, I'm often late.

So it's really interesting now that I think about it.

Leif: That's, that's such a good one to share. I love that.

Jess: So the big question I'm sure that everyone wants to know is how long will it take to form a new habit or even break a habit? Is there a general consensus from the research about length of time?

Leif: There's actually some good quality research, Jess, and I would have to shout out one of the researchers, Dr. Pippa Lally, who did this great research and she, I guess, first of all, there's a lot of misconception out there on the internet on how long it can take to form or break a habit, but the evidence does say it's between 18 to 254 days. That's what the researchers found. So, you can see that it's quite a wide range. But they found the average was around 66 days to form or break a habit.

So, I think what's important or what the most important thing here is rather than the actual time frame is how long it depends will be on many factors, but there's three key factors to think about. So, if you're a really habitual person. You're likely to form habits quicker. The complexity of the behaviour that you're trying to change is really important.

And this one is kind of an obvious one, but I'm going to give you an example anyway. So, let's say I was trying to build a habit of drinking an extra glass of water per day. I would very likely build a habit around that a lot quicker. Then I would if I was trying to do 50 push ups each morning. So, the complexity of the behaviour that you're trying to change actually really matters.

And then the third piece of this is the reward value. How much of a reward do you get out of repeating the behaviour? So, if that reward's really strong then you're likely to build a habit a bit quicker.

Jess: And so, if that reward maybe isn't as strong, is that where we tend to either not form a habit or maybe even forming bad habits?

Leif: Not necessarily bad habits, but it would be a lot harder to form a habit if the reward wasn't strong. So that's a really great question. So, I guess in a practical sense, when you're thinking about building habits, think about habits that are going to give you some sort of internal reward or some sort of intrinsic reward, like we were talking about before, because you're much more likely to build a habit that way.

So, it's got the summary of that is it's got to be important to you. It's got to be worth doing on a repeated basis.

Jess: Yes, absolutely. I get what you're saying. It's really about personalizing those health recommendations. So, if your doctor is suggesting you drink more water, it's not just following those orders. It's making a personal value.

So, finding something that's meaningful to you, like wanting better health. You know, managing your chronic health condition. So, it makes it more than just advice. It really does become sort of part of your own values and priorities.

Leif: That's a really good point, Jess. And even if we're not talking about habit science, but just behavioural change in general finding things that are important to you is the first step.

Building that internal motivation and sometimes writing your why, or most of the time writing down your why can really help with that. And then also building up a priority for a behaviour you want to change. So, it's a really important point that you brought up.

Jess: So, you know, we've been talking a lot about building good habits and healthy habits and things that are really driven by our wellbeing. All of us have bad habits and things that we know we need to work on. So, what would your advice be on how to break bad habits or what can people do to get on top of these?

Leif: Yes. I'm looking forward to giving you an example of my own bad habit that I've, I've managed to actually turn around. But you're right. Everyone has bad habits that we want to change.

And again, thinking back, so there's actually two keyways or two proven ways to break a habit going back a step, the timeframe is still the same, as I said, sort of 66 days on average to break a habit between that 18 to 254 days. But the main thing is to think about the habit loop again, cue routine reward.

And the two proven ways to break a habit is either to avoid one, avoid the triggering cue, like we were talking about a bit earlier, or switch the undesired habit for a preferable one. So, I'll give you two examples here, and then I'll give you my personal example. But avoiding the triggering cue could be let's say for example, you're trying to save money.

And each time you do a great thing for your health, you walk home from work, but each time you walk home from work, you pass a service station. And each time you walk past that service station, you actually go in to get something, whatever it might be. And so, if you choose a different path or route home, you're avoiding that cue or trigger.

It's very likely that the habit is triggered by walking past the service station. So, if you just avoid that it's likely you'll be able to break that habit. Now, sometimes avoiding the triggering cue is just, you can't do it. For example, if you have a habit of coming home from work after a stressful day and going to the cupboard and grabbing some sort of discretionary food.

I know I've done that in the past. I'll be tired or stressed from work, got in the door, gone straight to the cupboard. Sometimes the cue would be coming home and sometimes you can't avoid coming home. So, what the other way to break the habit there would be to change the action.

So that could be instead of going to the cupboard, maybe you clear your cupboard out or maybe you put all the discretionary foods to the back of the cupboard outside of view and you put a healthier snack at the front of the cupboard. So, it's the first thing you see. So, when you come home from work, go to the cupboard, the first thing you see might be something healthier and you'll grab that.

So just to repeat the two ways to break a habit. First is avoiding the triggering cue. So that's one way or switch the undesired habit for a preferable one. And now I want to give you my example that you know, I think what I love about habit science is it. It's quite relatable. I think what we haven't mentioned so far is that there's so much information on what you should be doing.

As we mentioned, health professionals would always be saying, you need to do this, or we read, we need to do that. Or we just internally understand that we need to be moving more and eating healthily, et cetera. But one thing that I've found since being a health professional and really being a massive health nerd is there's not enough information on how we actually do things.

And how the practical nature of things is the most important. And so, bringing it back to habit side is my own bad habit that I had. I was waking up every morning and the first thing I do, so waking up would have been my cue, or maybe it was turning to the right to my bedside table. And I would pick up my phone as the first action of the day. Right. And I hope I'm not the only one doing this. I think some people can relate to this.

Jess: I definitely can.

Leif: So, my habit was waking up, turning to my bedside table, the action was picking up the phone and then I'd scroll social media or I'd look up sports results. I must have been getting some sort of dopamine hit or whatever from it. So that was the reward and that became a habit that I really wasn't proud of. I just wasn't proud of looking at my phone first thing in the morning. I wanted to be a little bit more wholesome than that. So, what I actually did was the second thing. I couldn't change the cue. I couldn't avoid the cue. I can't avoid waking up and turning to my right to my bedside table. However, I could change the action. So I've taken that simple measure of putting my phone outside of the room at the end of the day and I replaced it with a book because something else I was trying to do was build a habit of reading more and so now what happens in the morning, I'm actually very proud to say, now what happens in the morning I wake up, turn to my right, on the bedside table is a book.

I've built a habit of picking up that book, reading five or ten pages. You know, it's not that much, but it's still a good start to the day for me personally. And then I get that internal reward of, hey, this is going towards my goal of wanting to read more. And on top of that, I just feel smarter for it. So, and that's become a habit that's stuck for me for the last sort of, I would say 12 months. This is another good point, which I haven't raised, which is quite interesting is if you stop doing a behaviour and it starts to feel unusual.

That's likely, that likely means a habit is formed when it starts to become, or it starts to feel strange when you don't do the behaviour. So, the example is if I stopped picking up that book in the morning and it started to say, Hey, something's missing here that would mean that I'm quite habitual with reading in the morning.

Jess: Right, that's such a good example and it goes back to what we were discussing at the start of the podcast. You know that your brain has really automated that task. And I also really liked hearing that you turned what was a bad habit, so sort of a two in one, not only stopping the bad habit, but from that it sort of revamped into, into like a better habit.

Leif: Yes, it's a good, it's a good insight. It's one I'm shamelessly proud of. But yeah, I think that's a good example of when you can change the action you can, when instead of changing the triggering cue, even though that's more important to break a habit, if you can't avoid that cue and it has to be changing the action well, if you have an undesired habit, you can change that to a better habit.

So yes, really, really good insight.

Jess: And so what do you think about people that we all see, or maybe we've been guilty of this, but you can see people who are trying to go on a health kick and maybe all of a sudden they're trying to go to the gym every day and following a certain diet plan all at once. And we know this often isn't sustainable for most people.

So why is that? Is there a limit on how many new habits that we can do at once?

Leif: Yeah, at last check when I looked into this, or this was actually when I was doing my habit practitioner course, I was told that It's really hard to do any more or to build any more than three habits at once.

So even if you're a really habitual person, trying to build more than three habits at once is really difficult. And I think I would, when we start talking about some practical tips, one of my favorite things is one step at a time with habit science. But with behaviour change anyone I speak to, any one of my colleagues that I've spoken to at the past, doing things one step at a time is a really, really powerful way to build habits or change behaviour.

So, I always like to say, think about your goal being the top of the ladder. And you're taking one step at a time and before you get past that first thing that you want to do, well, you can't get to the next rung until you complete that. So just building up over time and not trying to do too much all at once is definitely something that I've found in, in my practice over the years to be the most impactful.

Jess: Yes, that's such a good point. No one can achieve perfection overnight, even though we'd all like to think we can sometimes. So, in terms of practical tips, what suggestions or advice do you have for people to help them in forming these new habits?

Leif: Yeah, I'm glad you asked because this is my favourite part. This is all about the how that we were talking about before. So, I guess essentially putting it all together.

And one way to think if we're talking about habits in particular, which we are, a good sort of practical tool is called implementation intentions. What an implementation intention is essentially it's a when I, I will. So, when I is the cue that we were talking about as part of the habit loop and the I will is the routine or the action itself.

So, one example to start with would be, I've been trying to build a habit of flossing, which again, I hope I'm not the only one that that's been difficult for me. But it would be when I brush my teeth at night. I will floss after. Or it could be using the walking example that we spoke about before. When I hear my alarm go off at 7am, I will go for a 30-minute walk. So, it's when I as the cue, I will as the action or the routine. And then you also have to pair an internal reward to that, remember, to complete the loop, but the implementation intention of when I, I will, can be a really good starting point. Another way to put this is a little hack I like to call well, it's not my, I can't take credit for it, but it's a hack out there called habit stacking. Have you heard of habit stacking before? Jess?

Jess: Hmm, I've heard that term before, but I think I could definitely use a refresher.

Leif: So yes, I'll just refresh your memory, Jess, on habit stacking. It's just another way to think about implementation intentions. So, you use an existing habit that you already have as the cue. Habit stacking is essentially having a habit already. And then stacking, trying to stack a new one onto that.

So, the example I was using before was my morning coffee. Let's say I was trying to drink more water. My when I, would be after I have my morning coffee, I will have a glass of water. So, I already have a habit of drinking coffee every morning. So that's an easy one to sort of think about as a cue.

Jess: So, it's like an efficient way or life hack to build habits

Leif: Yes, that's right. And we said it at the top of the show that 43 percent of what you do is habitual. So, we likely have a lot of habits that we can stack on top of. We likely have a lot of cues, or we definitely have a lot of cues already that we can use as a bit of a hack.

Jess: Yeah, right. So, it sounds like we have a lot of opportunities to look for in our day. Like, what can I add on to what I'm already doing? And I really like that, especially for people. Who maybe think, oh you know, I don't really have time to add or start a new habit. It's like, well, you know, just looking at ways you can add a simple step to something that you're already doing.

Leif: Yeah exactly. And again, you know, I keep saying this, but I just love habit science as because it's so practical. It's something that I think everyone can understand and relate to. But I've got to give you some other practical tips as promised. So, another one is to try and be consistent. So, your desired habit does need to be repeated consistently and always have the same cue as we've been speaking about a lot. So, when choosing your habits, pick times and places that you encounter frequently.

When it begins to feel strange not to do the behaviour, this is an indication that the habit is forming that we spoke about a little bit earlier. Another practical tip I would say is to set a cue reminder. So, a recurring alarm, a calendar notification on your phone, just before your chosen cue to carry out your implementation intention.

So, as we've mentioned before, a consistent cue is one of the most important things to habit formation. If there's no cue there's no habit.

Jess: That's a really great point you've made. And one thing you mentioned just stood out to me, which is that these things need to be done consistently. And I think that is often where it can sort of all fall apart. So, is it okay if we skip a day or two, or is it going to undo? You know, all of our hard work in building this new habit.

Leif: I'm so glad you brought that up as well because if I've learned anything over the course of being a practitioner or a clinician, it's that and I know this for myself, life just gets in the way. So, no one's perfect. No one can be perfect. And that's okay. You know, a lot of what I love to talk about is normalizing setbacks.

But if we bring this back to your question, you actually don't have to be perfect. So, the more often you repeat the behaviour during habit formation, the more automatic it will become. But you don't have to be perfect, as I mentioned. So, occasional gaps do not erase your progress. This is what I love about habit science.

So, you can miss a day or two without going back to zero, and some researchers actually think that that habit memory never actually goes away. So, you don't want to be missing weeks at a time, but if you miss a day or two, you're not going back to square one in terms of that habit formation and that habit building.

Jess: Right. So, it's good to know that we don't have to push ourselves to be perfect and we can still build habits with a few bumps along the way. So, what recommendations or resources would you suggest for people who are interested in delving deeper into the topic of habit formation?

Leif: Yeah, for sure. What I would say is in terms of resources, and this probably goes hand in hand with another practical tip is to track your habits.

So, we know that self-monitoring behaviours in general is a really powerful tool to bring a lot of awareness and self-accountability to what you're doing. So, a resource you could use to track your habits. Look, there's hundreds of habit apps out there that are free. And they can help you not only to track your habit.

But also, to track your cues. If you just want to have a starting point, say you're trying to break a habit, if you want a starting point, the first thing I would suggest is sit down or take a day or two or a week and just write down all your cues on one of those apps would be a really great resource to use.

But then if you're interested there's lots of great, if you want to go a bit deeper than what we've spoken about today, there's lots of great books out there. So, three come to mind. Again, a really famous habit scientist or habit researcher, Wendy Wood, she came out with a book not too long ago, actually, called Good Habits, Bad Habits.

It's quite science heavy, but it is very practical as well. There is a couple of books that are a little bit more easier to read, I would say, would be The Power of Habit by Charles Duhigg and also Atomic Habits by James Clear, which is a really popular book, which a lot of people have read already.

But if you haven't, there are a couple to look into.

Jess: Some great recommendations there. I'll have to check those books out too. Now, you have given us so much amazing information and strategies already, but if you had just one takeaway tip for people listening around habits and habit formation, what would that be?

Leif: It would probably be to start small and think about one step at a time as we were mentioning before. I think just, having spoken or supported thousands of people with their health goals over the years, I would definitely say start small give yourself some space. Don't try to do too much all at once and just build one healthy behaviour.

And once that's habitual and that's on automatic and you don't have to think about that anymore, then start working on the next one.

Jess: Absolutely. That's incredibly valuable advice and the tips and information you shared have been truly fascinating and I think we might all look at our days and what we do without realising a bit more and certainly have some strategies to build healthy habits in a more sustainable way.

Thank you so much for your time, Leif. It's been a pleasure speaking with you.

Leif: Jess, it's been a genuine pleasure and I hope the listeners took something out of it today.

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