Researchers studied a program called Strong Hearts, Healthy Communities that taught women in rural areas about eating better and exercising more. Over 6 months, 182 women attended classes twice a week. The study found that the women who lost the most weight were those who changed their eating habits and developed a healthier attitude toward food. Interestingly, exercise didn’t directly cause the weight loss, and getting support from friends and family didn’t help as much as expected. This suggests that focusing on what and how we eat might be more important than we thought for losing weight.

The Quick Take

  • What they studied: Which specific changes in eating and exercise habits actually cause weight loss when people join a community health program
  • Who participated: 182 women with an average age of 57 years living in rural communities that don’t have easy access to healthcare. Almost all participants were White, non-Hispanic.
  • Key finding: Women who changed their eating habits and developed better attitudes about healthy food lost the most weight. About 32% of the weight loss came from changing eating behaviors, and about 24% came from having a more positive mindset about healthy eating.
  • What it means for you: If you want to lose weight, focusing on improving your eating habits and your feelings about food might be more effective than just trying to exercise more. However, this study only looked at one specific program in rural areas, so results may differ for other groups.

The Research Details

This was a community-based study where 11 rural communities were randomly assigned to either start a health program right away or wait to start it later. The women in the program attended classes twice a week for 6 months. These classes taught them about healthy eating and physical activity. Researchers measured the women’s weight, eating habits, exercise levels, and their feelings about food and exercise at the beginning and end of the study.

The researchers then used statistical methods to figure out which specific changes actually caused the weight loss. They looked at whether changes in eating habits, exercise, attitudes about food, or support from friends and family were responsible for the weight loss. This approach helps identify what really works, rather than just knowing that the program worked overall.

This type of analysis is important because it tells us not just whether a program works, but why it works. This information helps doctors and health educators design better programs in the future.

Understanding the reasons why a program works is just as important as knowing that it works. By identifying which specific changes lead to weight loss, researchers can help future programs focus on the most effective strategies. This study is particularly valuable because it looked at rural communities that often have fewer health resources than cities.

This study has several strengths: it was a randomized controlled trial (considered one of the best types of studies), it had a decent number of participants, and it measured multiple factors that could affect weight loss. However, the study only included women in rural areas who were mostly White, so the results might not apply to men, younger people, or people from other racial or ethnic backgrounds. The study was also relatively short (6 months), so we don’t know if the weight loss lasted longer.

What the Results Show

The study found that three specific changes were most responsible for weight loss: (1) Improving eating habits and behaviors (this accounted for about 32% of the weight loss), (2) Developing a more positive attitude toward healthy eating (about 24% of weight loss), and (3) Practicing dietary restraint, which means being more mindful and intentional about food choices (about 30% of weight loss).

Interestingly, the amount of exercise people did was not directly connected to their weight loss in this study. However, there was an unexpected finding: women whose attitudes about exercise actually got worse still lost weight. This suggests that weight loss in this program was driven more by eating changes than by exercise changes.

Another surprise was that social support—getting encouragement from family and friends—didn’t change much during the program and didn’t help explain the weight loss. This was unexpected because many health programs emphasize the importance of support from others.

The study revealed that the program was successful at changing eating behaviors and attitudes about food, which are the main factors that led to weight loss. However, the program did not successfully increase social support for healthy eating and exercise, which represents a missed opportunity. The fact that exercise attitudes worsened in some women while they still lost weight suggests that people can lose weight through diet changes alone, even if they don’t feel more motivated to exercise.

Previous research has often emphasized that both diet and exercise are equally important for weight loss. This study suggests that diet changes may be more directly connected to weight loss than exercise changes, at least in the short term. The finding that social support didn’t play a major role is somewhat different from other studies, which might be because this particular program didn’t focus strongly on building social support networks.

This study only included women, so we don’t know if the same results would apply to men. The participants were mostly from one racial background, so results might be different for other groups. The study only lasted 6 months, so we don’t know if the weight loss continued or if people gained the weight back later. The study was done in rural communities with limited healthcare access, so results might be different in cities or areas with more resources. Finally, the study couldn’t prove cause-and-effect in the way a laboratory experiment can—it could only show which changes were associated with weight loss.

The Bottom Line

If you’re trying to lose weight, focus on changing your eating habits and developing a more positive attitude toward healthy food. This might be more effective than focusing primarily on exercise. Consider working with a health educator or joining a community program that teaches practical eating skills. Moderate confidence: These findings are based on a well-designed study, but results may vary depending on your individual situation, age, gender, and background.

This research is most relevant to middle-aged and older women in rural areas who want to lose weight. The findings may also apply to other adults trying to lose weight, though the program was specifically designed for women. People with certain medical conditions should talk to their doctor before making major changes to their diet or exercise routine.

Based on this study, women saw weight loss over a 6-month period with twice-weekly classes. You might expect to see changes in your eating habits within a few weeks, but noticeable weight loss typically takes 4-8 weeks. Remember that weight loss is not always steady—some weeks you might lose more than others.

Want to Apply This Research?

  • Track your daily eating habits using a food diary or app, noting not just what you eat but also your thoughts and feelings about the food. Rate your attitude toward healthy eating on a scale of 1-10 each week. This mirrors what the study found to be most important for weight loss.
  • Use the app to set specific, achievable eating goals (like ’eat vegetables at lunch 5 days this week’) rather than focusing only on exercise goals. Log your meals and note when you made conscious choices about portion sizes or food selection. Celebrate these behavioral wins, as they appear to be the real drivers of weight loss.
  • Weekly check-ins on eating behaviors and attitudes about food are more important than daily weigh-ins. Track changes in your food choices, how mindful you are while eating, and your confidence in making healthy eating decisions. Monitor weight monthly rather than daily to see the bigger picture and avoid discouragement from normal fluctuations.

This research describes findings from a specific study of women in rural communities and should not be considered personal medical advice. Weight loss and dietary changes can affect different people differently, and some individuals may have medical conditions that require special considerations. Before making significant changes to your diet or exercise routine, especially if you have existing health conditions, take medications, or have a history of eating disorders, please consult with your healthcare provider or a registered dietitian. This study shows associations between behavioral changes and weight loss but does not prove that these changes will work the same way for everyone.