Rethinking that New Year's resolution

by Tamera Broughton

So here we are, in January...

For some, the end of the year represents stress and hardship. I see you. Take a deep breath, show yourself some kindness – you got through it.

The new year is also a time when we put a lot of pressure on ourselves to achieve big things.

If you are anything like me, you’ve set yourself dozens of New Year's resolutions over the years. If you’re also like me then you’ve found most of them don’t stick. Or maybe you kept your resolution, and you didn’t experience the big, meaningful change you were hoping for. Why is that?

Today I want to offer you a bit of different way to approach effective goal setting, as well as some tips to help you stay motivated, focused and achieve what’s actually important to you.

Goal setting and behaviour change – understanding what’s involved

When we set New Year's resolutions, what we’re really doing is drawing on two distinct psychological processes – goal setting and behaviour change. There is much literature and many schools of thought and perspectives within psychology and neuroscience in particular, surrounding these processes.

Goal setting and behaviour change aren’t easy. As James Clear says, “goal setting is not only about choosing the rewards you want to enjoy, but also the cost you are willing to pay.” Setting goals means acknowledging and being prepared to put in the work. We often need to change our behaviour, which takes mental and physical effort, dedication, consistency and determination.

In The New Rulebook, Chris Cheers offers us a reframe on the concepts of change and goal setting. He notes that long-term goals sometimes trick us into thinking that we’re in complete control of life, which can set us up for failure. He suggests that we focus more on what we’re in control of – the here and now – and dedicate our energy to changes we can make that will significantly shift our life. “It’s not about a dream that you want your life to take, but an action that takes a big step towards it.” It’s a bold, pragmatic leap – big change. Interesting.

Chris goes on to explain that our brains and nervous systems were shaped a long time ago by our prehistoric ancestors. Those who were more risk adverse and vigilant to danger had a better chance of survival. So, it’s actually a survival legacy that has been passed down to us, that change means uncertainty which creates anxiety and fear, leaving us less likely to action change and more likely to avoid short term discomfort. It’s this anticipation of discomfort that can prevent people from considering the change that will ultimately benefit them and not even set goals or action change in the first place. If this sounds familiar, you’re just very human.

Figuring out what we really want

But how do we know which goals or the big change we should be aiming for? Here is the important part.

There is so much pressure in our society today to BE something. Be skinny, be young, be fit, be rich, be successful, be social, be healthy, be happy. It’s kind of like the message is: be anything except what we already are. It makes complete sense then that we would craft our goals that are more about conformity.

The problem with this is that it rarely speaks to our actual, valid, real-life human needs. Being too focused on the expectations of others rarely helps us to achieve what we all really want – quality of life that feels meaningful to us. Our goals end up feeling empty at best and possibly actively harmful for us at worst. So of course, we don’t stick with them, and that can leave us feeling like a failure or like there is something wrong with us. I want to assure you friends, that there is nothing wrong with you.

There is also nothing wrong with wanting big change for yourself and or wanting to set goals to achieve that change. But I want to give you permission to shut out all the external noise, go inwards and really connect with what the need is that is driving the change you seek.

For example, a common new year’s resolution is to exercise more. Why is that? I think a lot of us feel the pressure to fit a particular body size and shape, so sometimes the drive to exercise is actually more about shame or judgment.

What if, instead, we had a goal of wanting to exercise more but was able to connect with a super valid, and also very human, underlying need? Well then, it might sound something like; I need movement to keep my body healthy and feel better. Or I need movement to have fun. Or I need movement to connect with others. Or I need movement to help me manage and move stress out of my body. Connecting with the underlying need (feeling physically better, connecting with others, having fun, managing stress) then becomes a far more motivating and authentic reason to exercise. You are more likely to stick with it and it becomes an avenue whereby you are living the life that is meaningful to you and meeting your needs.

How to achieve big changes in five steps:

1. Be clear about your needs and values

From an Acceptance and Commitment Therapy (ACT) perspective we talk a lot about values. What is important to you? Who do you want to be? How do you want to show up for friends and family or at work and in your community? In ACT the belief is that our needs and values should guide our behaviour, which helps us to live true to ourselves and our purpose and significantly increases our quality of life. So, I encourage you to reflect on your life right now. Are you able to name your needs and values? Does it feel like your needs are being met? What change is required to start meeting your needs and living your values? This is a really important step. Thinking about big change or setting goals in terms of your needs and values (what’s important to you, who you want to be, what you want to represent) will increase your commitment to behavior change, even when things feel hard. You can try the exercise from ACT Made Simple at the end of this article to get started.

2. Set your intention

Here’s where you get to have some fun. Visualize what you want, go wild – journal, create a vison board, start a Pinterest board, draw or paint your vision – do whatever gets you invested in your goal, excited for the possibilities and clear about what you’d like the end result to be.

3. Get specific in the here and now

What big step towards your goal can you make in the here and now? Here is a tool that may help. In the health field, where I come from, we love an acronym. Working in Mental Health we used the SMART tool to support clients to establish goals and work towards them. SMART stands for goals that are Specific, Measured, Achievable, Realistic and Time-based. Using a tool like this will help you develop a plan about what steps you need to take daily, weekly, monthly to move towards achieving your goal. The tool will also help you to work out ways of measuring your progress, and by setting yourself a timeframe to work within will help you stay focused and not get sidetracked.

4. Review your goal and progress regularly

In therapy, as a form of best practice, we regularly review goals and progress with our clients. This provides the opportunity to honestly reflect on how you are going. Are the things you’re doing actively helping you to achieve the change you really want? You may need to re-evaluate your actions or even the goal itself. This is not a failure. In fact, this is very important information for you to make informed choices which will help you achieve your desired outcome or improve your quality of life in the long run.

To make this step even more powerful, invite a friend or family member to be a part of this process. According to Dr Huberman, a central feature of goal attainment is actually fear of the consequences of not achieving the goal. So, including an element of accountability may provide the drive and determination to stick with your goal – even when that natural inclination to avoid the short-term discomfort kicks in.

5. Celebrate the wins

Life is all about the journey. Take the time to stop and reflect on your progress and celebrate the wins, little or big. Have fun, shower yourself with gratitude and kindness, be your own biggest cheer leader.

Make meaningful change

Setting New Year's resolutions is really about getting clear on what your underlying needs and values are and then understanding the change required to achieve those goals. It takes considerable effort, dedication, consistency and determination. But also, bravery, self-compassion, reflection and honesty. Remember, we’re most in control of the change we can make in the here and now. But getting clear on your values will help you stay committed to behaviour change and your goals in the longer term. Use the SMART tool to help you get specific on your goal and create a plan for monitoring and evaluating progress, review regularity and celebrate your progress.

Need Help?

If you are keen to learn more about goal setting, I would recommend Atomic Habits by James Clear. If you feel stuck, a therapist can help you explore your values and set goals. At Centre Self Collective we have in-person and telehealth appointments available. You can book an appointment or explore some other resources on our website.

Tamera Broughton is a mental health clinician and director of Centre Self Collective.

What do antiretrovirals have to do with my weight?

by Professor Jenny Hoy

As summer approaches, it is easy to become more critical of our bodies.

Think of how common it is to hear about being ‘summer body ready.’ This talk is so normalised that we can lose sight of whether achieving body standards actually contributes to our health and wellbeing.

People living with HIV have the added complication of trying to understand the influence of treatments on body weight – a phenomena that has been widely reported but which there is still much for science to learn about.

So, what does the evidence say?

The use of HIV medications, particularly the integrase inhibitor class (dolutegravir/bictegravir/elvitegravir – known as their trade names of tivicay, triumeq, dovato, biktarvy, genvoya) and the new formulation of tenofovir – tenofovir alafenamide or TAF have been associated with weight gain in many clinical trials and cohort studies. These drugs now make up the majority of HIV regimens used today. This is because they are easy to take (usually 1 or 2 pills once a day), they have very few side effects and are highly effective at keeping the amount of HIV in the blood at extremely low (undetectable) levels.

For people diagnosed with HIV more than 15 years ago, when the treatments involved multiple pills taken several times a day and had major side effects including nausea, diarrhoea and poor appetite, the newer medication is so much better tolerated and a welcome relief.

It is important to understand that the association of weight gain with the use of integrase inhibitors or TAF does not always equal causation – i.e. these drugs are causing the weight gain. Let’s look at a couple of scenarios.

When someone is diagnosed with HIV at an advanced stage their own immune system is trying to control HIV, causing increased inflammation, constitutional symptoms of weight loss and diarrhoea. Starting HIV treatment containing an integrase inhibitor and TAF will control the replication of HIV and allow the immune system to recover. This is called “return to health.” The weight gain back towards that person’s normal weight is not “caused” by the integrase inhibitors/TAF but is associated with their use, as the body is allowed to recover from uncontrolled HIV infection.

Another scenario of weight gain occurs when people switch their HIV treatment to one of the newer regimens containing the integrase inhibitors and TAF. Studies showed that people gained weight when switching from the older formulation of tenofovir – tenofovir disoproxil fumarate (TDF) and efavirenz. We now know that TDF and efavirenz caused appetite suppression. Stopping these drugs allowed people to have a normal appetite and eat more. Again, it is not the TAF or integrase inhibitors “causing” the weight gain – it is likely that stopping TDF and efavirenz allowed weight gain to occur – this is another example of association but not causation.

Some of the original signals of weight gain with integrase inhibitors and TAF came from randomised controlled trials, performed in Africa in people who had not taken HIV treatments before. Everybody gained weight in these trials, but people who were randomised to the integrase inhibitor and TAF gained the greatest amount of weight, with those on an integrase inhibitor plus TDF gaining less, and those on efavirenz and TDF gaining the least amount. And women gained more weight than men in these studies. So clearly weight gain does occur with these drugs.

There are missing pieces of the puzzle of weight gain and HIV treatment. First, usually when a drug causes a side effect, the mechanism for how it causes that side effect in the body can be established – but despite a lot of effort, no such mechanisms have been found to date as to how integrase inhibitors and TAF cause weight gain.

Second, if the drug causes the side effect, stopping the drug should mean the reversal of that side effect. Again, cohort studies and randomised trials of switching the TAF and the integrase inhibitor to an alternative ART regimen have not been associated with loss of the weight gained.

Weight gain and loss are complex issues for anybody, not just people living with HIV.

Body weight alone does not give a full picture of a person's health. Depending on whether body weight comes from fat and where it is distributed it can increase the risk of heart attacks, high blood pressure, strokes, diabetes, fatty liver, and cancer. Once we gain this kind of weight, especially as we age, it is very difficult to lose. Understanding if your goal is motivated by managing these risks and improving your health or achieving body standards can help you to notice judgment and self-critical thoughts connected to your appearance.

For the overwhelming majority of people starting or switching HIV treatment to an integrase inhibitor and TAF, the weight gain is not excessive and usually amounts up to a couple of kilograms only. For the sake of well tolerated one-pill once-a-day HIV treatments that very effectively control HIV to undetectable levels – I would not be suggesting people worry about weight gain of just a couple of kg when choosing their initial HIV regimen. There are, however, a very small minority of people who gain significant amounts of weight when starting HIV treatment – up to 10 kg in a year, who will need assistance in managing their weight.

There are many other situations where weight gain can occur. We have just come out of significant “lockdowns” with COVID, where people were eating more, drinking significantly more alcohol, and exercising less. Alcohol intake can be a significant cause of weight gain that we sometimes forget. Also, as a health care provider, I have been imploring any of my patients who are still smoking to quit. We know people with HIV have twice the risk of heart attacks compared to the general population, and smoking is contributing to that. When people quit smoking they tend to gain weight. The same applies to cessation of recreational drugs, especially amphetamines.

It is important to be guided by the evidence when tackling weight loss. A nutritious diet combined with a moderate amount of exercise is the best proven method to maintain a healthy weight. The combination of the two is more effective and sustainable than either diet which severely limits calorie intake or extreme exercise. Sometimes we can overestimate the effectiveness of exercise to tackle weight loss alone and then eat excess food. While overly restrictive diets can be tough physically and mentally, leaving us with little energy to do the things we like or motivation to stick with the diet.

It can be better to think of eating and food as ways for us to find nourishment, pleasure and health rather than as a diet calculated to impact body shape and weight. Any movement is good for you and will make you feel better. This includes things that you enjoy doing or can easily fit into your routines.

As we approach the New Year, and our propensity to make New Year's resolutions around healthier lifestyles including better diets, less alcohol, and more exercise to effect weight loss, it is important to remember not to punish ourselves when our resolve falls through. Yo-yoing between strict diets and extreme exercise, and then excess food and alcohol is not good for us. Slow and steady gains in healthier lifestyles, with the occasional treats, are kinder, and will allow you to feel better about yourself, and improve quality of life for the long term.