Power of Habits - Breaking, Changing & Creating with Habit Scientist Dr Gina Cleo

Felicity Cohen: Hello, I’m Felicity Cohen. I’m so excited to introduce you to my Wellness Warriors podcast. For over 20 years, I’ve been a passionate advocate for helping thousands of Australians find solutions to treating obesity and health-related complications through surgical intervention and holistic managed care.

My podcast is dedicated to all the people past, present, and future who have helped shape my journey and continue to inspire me to work consistently to achieve a healthier Australia in both adults and future generations. I hope you enjoy it. Welcome to the Wellness Warriors podcast today. I would like to introduce Dr

Gina cleo. Gina has so many different qualifications. I’m not sure which one to share first. She’s a dietitian, a habit change scientist among many other things. And it’s an absolute pleasure to welcome you today. Thank you so much coming in.

Dr Gina Cleo: Thanks Felicity, It’s great to be here.

Felicity Cohen: Lovely to learn a little bit about you, about your background and all the wonderful things that you’re doing here, living on the Gold Coast.

So originally from Egypt and lived around the world, but here on the Gold Coast or in Australia now for 20 years?

Dr Gina Cleo: Yeah, nearly 20 years. And I love the Gold Coast, I love living here. I love the beach and the lifestyle and yeah, it’s great here, yeah.

Felicity Cohen: It is the greatest place to live. So let’s start with your life as a dietitian.

What originally took you into the world of dietetics and, where did that idea come from?

Dr Gina Cleo: Yeah, so both my grandparents had type 2 diabetes. And back in that time, there was sort of not as much research or support around what they can eat and not. And I really saw them sort of struggling through the whole world of trying to navigate through what to eat.

And so I felt like I wanted to help and understand what they were going through a bit more, so that’s why I trained as a dietitian. I actually didn’t even know that’s what I wanted to do. I was taking a walk on the beach with a friend and she said, “oh, I was reading this article, the dietitian wrote something.”

And I was like, that’s it, that’s what I want to do. And a week later I had registered to go to university and finished my degree. Yeah, and then I worked as a dietitian for several years, various hospitals and in private practice. And I absolutely loved doing that.

Felicity Cohen: What are some of the best things that you learned when you were practicing as a dietitian, as opposed to maybe some of the worst things that you saw?

Dr Gina Cleo: Oh, I learned that we certainly don’t just eat when we’re hungry. That there’s so many different reasons to the reason we do eat. And it’s such a personal and vulnerable conversation. And I think creating that really close and safe relationship with my patients was so much more important than any other kind of marketing I could have done.

It was really just building that, that rapport with them. And, you know, I, I felt like if I was to talk to these patients about more about the why and the how, rather than the, what they were eating, we would get so much further than if I was just to offer them, say a standard meal plan.

Felicity Cohen: It’s so interesting. I think some of the top triggers that I would identify that I talked to patients about here all the time, things like stress, you know, whether there are emotional triggers, boredom, all these other things that are the triggers and the, and their why that we do within a holistic environment before we actually even get to, you know, how do we change the approach to food and what they’re eating.

Dr Gina Cleo: Absolutely.

Felicity Cohen: Yeah. Non, non hungry eating cues are a big thing. And working on mindful eating behavior techniques are a big thing also.

Dr Gina Cleo: Huge, and people don’t often realise what they’re eating or how much they’re eating or when they’re eating. Or even if they are hungry or not at the time.

Felicity Cohen: What about in a hospital setting that must’ve been a real eye-opening experience for you to see how we look after patients in a hospital environment. What are some of the things that you felt were important or that you would’ve liked to have changed in that environment?

Dr Gina Cleo: Yeah, that’s such a unique environment working in a hospital as a dietitian because you’re sort of limited to what you can do and what the hospital supplies are, and sometimes it’s simply a life or death.

You know, consultation with somebody, whether they are in ICU intensive care and they need to be tube fed, and it’s really just a numbers game and it’s much less of a holistic approach. It’s very, you know, you’re losing weight or you’re having surgery or, you know, you’ve got these gut issues. And so this is the nutrition that we’re recommending, but there was always a lot of, I guess, limitations.

It was a very fulfilling role. One of my favorite wards to work on, and it was actually oncology because in oncology there was a lot less rules. It was, what do you feel like eating? You want a chocolate milkshake, let’s do it. And we can just sort of break all the rules for that, and I really enjoyed the fulfillment that I got from that.

Felicity Cohen: Yeah, love that. And so from dietetics and working as a dietitian, then you then decided to go on and work in the space of, of research?

Dr Gina Cleo: I did. It was sort of because of my clinic, so I, and I was working in a private practice. I was able to help a lot of patients to lose weight, regain their confidence and their wellbeing.

I absolutely loved doing that, but I often found that these patients would come back to work on the things that we’d already worked on before, and there was a sense of frustration from them and from me. And at first I just thought I must have been a terrible dietitian because I love food, and I’m a big time foodie.

But then when I started to look at the research about sustainable change, not this short-term sort of yo-yo change, I realised that, you know, up to 95% of people who lose weight do tend to put it back on in the conventional lifestyle change type of approach. So I wanted to really focus on longterm change.

Felicity Cohen: Absolutely. Look, I think that’s a really important point just to stop and really break that down because I think that there’s a lot of misconceptions that people are fed, whether it’s via their general practitioners or other health professionals, that they should really know what to do, and they should be able to get results themselves.

And I think that that sets up a pattern of behaviour where people feel like they’re being set up for more and more failure. And I think that 95% in some, whether it’s between 95, 97%, I think is the statistic that I’ve heard quoted so frequently in the literature that a diet and exercise approach is likely to fail at some point, whether it’s at one year out or up to five years out.

So breaking that cycle of behaviour and finding something that will be sustainable and permanent, that’s the goal that is the absolute goal. And what we all want for people is that they don’t have to see themselves as setting themselves up for another failure. So how did you set about starting this research?

Tell me all about that.

Dr Gina Cleo: Yeah, well, so I, basically I spoke to a professor at Bond University about this idea that I had, and I said, “I don’t know what I’m researching, I don’t know even where to start, but I know that there is a gap missing when it comes to understanding sustainable change and to doing so successfully.”

So I was offered a scholarship to start my PhD at bond. And for the first three months I was really just reading, I was just trying to find anything that resembled successful longterm change when it came to weight management and health. And interestingly, I’ve found this, I’ve found a bit of literature in this habit change space.

And I, I was getting really excited because it seemed to be the only proven and evidence-based solution to sustainable successful change. But then I was curious as to why it wasn’t in the mainstream media and in the mainstream clinics. And, you know, as much as habits impact and influence so much of our day-to-day lives, they’ve only been researched for the past sort of 10 to 15 years.

We focus so much on behaviour change and the doing the conscious doing, that we’ve kind of neglected the subconscious actions that make up up to 80% of our day. So that’s how it sort of started. And then when I found that habits is really the avenue that I wanted to go down. That’s when I started doing various studies, I recruited participants and we ran programs and yeah.

Had amazing success with it.

Felicity Cohen: Wow. So what are some of the things that people wanted to look at to change? If they could identify, for example, a bad habit, what were some of the top bad habits that people were coming and saying to you, these are the things that I really would like to change, but I don’t know how.

Dr Gina Cleo: Mindless eating, definitely. So snacking, over eating and like they’re sort of the general ones around food. And then some of the others things, you know, you hear is things like drinking or out like drinking, alcohol, smoking, all those kinds of habits, but there’s also habits people wanted to create and implement in their life.

And there were often things like exercising more, saving more money, those kinds of things as well.

Felicity Cohen: Okay. So let’s start with, first of all, I’m changing something that people would like to change such as the overeating or the snacking. What does the process look like and how did you actually develop a programme for those people that will become effective? Let’s start with that one.

Dr Gina Cleo: Yeah. So, I mean, we actually recruited participants who were interested in losing weight and actually had excess weight to lose. And I created two programs or used two programs. One of them was around forming new healthy habits and the other one was around breaking old habits.

And then there was a control group as well. So with the forming new habits, interestingly, we didn’t talk about diet and exercise at all, the habits were things just to create more mindfulness in somebody’s day. So they might’ve been things like keeping a food diary, actually ticking off the habits that they done for that day.

Doing more steps in the day, like walking more steps than they had previously, just small things like that. Packing a piece of fruit on their way to work. So they weren’t really focus on actually losing weight, but they were certainly improving lifestyle. And then the breaking habits program, that one was completely random.

It sends you text messages on random days of the week at random times with completely random tasks to do. And they were things like drive a different way to work today, or write a short story or call a long lost friend. Again, nothing to do really with diet and exercise. But because habits feed off each other and one habit links to the next habit,

if you can break a cycle of somebody’s day, then you’re also breaking the habits. So if somebody drives a different way to work, they’re using a different neural pathway. So when they get to work, instead of doing their usual coffee and muffin in the morning, because there’s a new neural pathway, the question becomes “do I actually feel like a coffee and a muffin today?” and sort of the automaticity and the automatic actions of normally doing that.

Felicity Cohen: It’s so interesting. You know, we are such creatures of habit and setting up those habits, whether they’re bad or good, you know, they tend to be so ingrained in our behaviour on a daily basis, so fascinating.

So what’s the timeframe to change a habit? If you, if you’re talking to someone who does want to, you know, stop snacking and you’re implementing one of your programs, what is the normal kind of timeframe to start to actually, what did you actually show in terms of the research and the literature?

What do we need? You know, we I’ve always heard the 28 days, but I don’t, I’m not believer in that.

Dr Gina Cleo: I’m glad you don’t believe that, I believe that’s a total myth. The 28 days actually was a research done in the, in the 1960s with certain patients that had had a limb amputation. And there’s the idea of the Phantom Limb, where they, their limb is no longer there, but their brain hasn’t quite caught up yet.

And it took them about 21 to 28 days for their brain to realise, okay, my limbs not there. Obviously that study is not generalizable to the rest of the population has really nothing to do with habits, but that’s where that myth has come from. And it’s just very interestingly, like going through the generations.

So I’d love to give you a proper number because I don’t like the word it depends, but that’s what I have to give you. It’s the answer of how long it takes to change a habit? It depends. There is a range between about 18 days to 254 days. And there is a, you know, the range is because it depends on how, how complex the habit

that you’re trying to change is, how much you want to change that habit, so there has to be that desire, and also how habitual you are as a person. You know, I’m not a very habitual person by nature, but other people are. And so it might take them a little bit longer to break an old habit that they’ve had.

If I was to look at it, an average number from the literature, it’s about 66 days to change a habit.

Felicity Cohen: Okay. So here in this environment, we like to work with patients over a 12 month period because there is a lot of, I guess, sustainable information that tells us that if we can work with people for 12 months, which I think for a lot of people, that’s a luxury.

But if we’ve got 12 months where we can work with a whole multidisciplinary team, then we’re looking at breaking down previously, you know, bad habits that have been long-term but also working on establishing new habits. So hopefully for us that 12 months is a good recipe for setting up success.

Dr Gina Cleo: Absolutely. I think having 12 months of that kind of accountability and support is a complete game changer because oftentimes it’s, you know, a patient might see a dietitian and they’ll get a meal plan and they’ll follow that for a while and they’ll get good success, but they’re the, I used to call them frequent flyers.

They’re also the patients that might come back because they’ve yo-yo’d and they’ve put back the weight that they’ve worked so hard to lose. Whereas having that support and that accountability for a year, it’s a beautiful timeframe to really know that these patients have solidified some of the habits. And they’ve, they’ve also teased out some of the bad habits that they’ve got in their life that they’ve been able to identify.

And really the idea with breaking old habits the first step is to acknowledge and identify that habit. When do you do it? What’s triggering you? So it’s the, when are you doing it? Where are you doing it? Who you with? How are you feeling? And there’s generally a pattern there. And if someone can identify that and then identify the action, which is the habit that they’ve got,

you know, then you can work with it, but telling someone you should stop doing that, it doesn’t work because there’s a trigger behind it. And it’s really the trigger that needs to be addressed.

Felicity Cohen: So that really leads me to thinking about, you know, GP attitude and often health professionals in our society that will tell patients you need to lose weight, you know what to do.

And I think that was maybe 20 years ago when I was starting in this area, so often that was what patients were hearing. Hopefully we’ve changed that attitude and that, you know, we all understand now that there’s this multidisciplinary approach to create a positive environment for change that will be sustainable.

So what are some of your key learnings from the research?

Dr Gina Cleo: My key learnings is a habit takes three ingredients, and that is there’s always a trigger, then there’s the actual habit, and then there’s a reward that we get from doing that habit. And so let’s say as an example, each time I come home in the evening, I’ll grab a snack,

and the more that I do this pattern coming home, having a snack, the more reinforced it will be until eventually just thinking of getting home will prompt me to have an urge, to have a snack. I used to say to myself, “Gina, you’re not hungry, you don’t need to have the snack” and I would try to just not eat the snack, but as soon as I’d get home, it’s like I would automatically walk straight to the fridge and I would grab myself a snack.

What I realised though, in one of the key learnings from the literature is that with this habit loop, which is the trigger, routine reward, really it starts with the trigger. So you have to identify the trigger and work on that. So for me, it was getting home and walking to the kitchen. As soon as I decided I’m going to get home and walk into the bedroom or the lounge room instead, that desire or the urge for the snack completely fell away.

And that’s how, that’s the mind shift from looking at the behaviour that we’re trying to change to actually looking at what’s behind that behaviour. And I love that you say multidisciplinary approach because it really is, there’s so much psychology behind why we do what we do. And why are we do the things that we don’t want to do and why we don’t do the things we want to do.

You know, there’s a lot of subconscious stuff going on there that’s really important to address as well, so that’s one of the main things. The other key learning is the importance of accountability. Having accountability, the literature shows, doubles the success of weight management, and we know that having the person on the other end of the phone or that, you know, you’re going to come in and meet somebody,

that is holding you accountable, makes you consider your actions throughout the weeks or months, because there’s always that voice in your head that says I will do it later, we’ll start on Monday, we’ll start after my birthday, we’ll start in the new year. But if there’s close and consistent accountability, you’re going to have the luxury of , I guess there’s fleeting timeframes, which might not actually ever come up.

Felicity Cohen: Oh, I absolutely am such a believer in that, and I think the accountability approach in terms of having an accountability partner, if you’re exercising or someone that you have to show up for makes a massive difference. So I hope that that’s the kind of behavioural style that our patients will subscribe to as well that, you know, I’ve got an appointment with a psychologist I need to be there and that’s going to be helpful.

So those things I think are really critical. So you’ve published the research?

Dr Gina Cleo: Yes, I’ve published several studies, and it’s been awesome actually, because from that, there was a lot of media attention. And the reason I love that is because a lot of research is found behind these paid walls and it’s targeted other scientists and other researchers, but when it becomes a media than the rest of the world can have access to the science and understand it better too.

So out of that, actually I created a Habit Change Institute and now I teach other practitioners about habit change and they can become certified as habit practitioners. And it’s really exciting to see how the community and the world really is understanding a little bit more about the importance and the power of habits.

Felicity Cohen: This is so exciting. What does it take to become a certified habit practitioner?

Dr Gina Cleo: So there’s a course that I run, it’s a six week course and you just sign up online for it and it’s all live, I do it all via zoom. There are 12 modules and we go through everything from the neuroscience of habits to the difference between habits and behaviours, to how to sort of expedite the breaking old habits and forming new habits and all sorts of things about understanding motivation.

So the course you can sign up through the Habit Change Institute website, or you can just send me an email and I can send you some details about that.

Felicity Cohen: Fabulous, and what about creating a new habit? So obviously quite a different kind of process than breaking a previously learned behaviour. What are some of the things that you kind of implement when you’re looking to create that new positive behaviour? How does that work?

Dr Gina Cleo: So going back to the habit loop that we spoke about earlier, the trigger, routine, reward. So instead of saying things like I’m going to exercise more, which is a lovely goal, and it’s a great intention, the goal should really be attached to a trigger. So it might be the trigger might be the time of day or the place that you’re in.

So it might be at 7:00 AM I’m going to go for 30 minute walk. So you have to attach a trigger to the behaviour that you want to create. And at the beginning you might set an alarm and to remind you, or a friend calls you and says, I’m outside, let’s go. But then eventually the more you do it, the more that you do,

it’s it’s a key based repetition, so it’s a trigger based repetition. It’s the trigger routine, it’s an automatic thing that starts to happen in your brain. And you actually start to create new neural pathways in your brain that then remind you at 7:00 AM I go for a walk, and eventually you won’t even need your alarm anymore.

You’ll remember to do it, and then eventually again, it’ll feel like second nature, and it’ll almost feel strange if you don’t go for that walk at 7:00 AM. So that’s with forming new habits, it’s really about saying, when am I going to do that? Or where am I going to do that? And then attaching that habit to that trigger.

Felicity Cohen: If you put yourself through some of this process, is there something specific that you’ve actually implemented throughout this journey for yourself?

Dr Gina Cleo: Yeah, absolutely. I am my own biggest Guinea pig because I really like to firstly, practice what I preach, but I love to experience what it’s like because changing behaviour is a beautiful idea, but it’s hard and it takes time.

And one of the reasons that habits aren’t in the mainstream conventional space is because there’s nothing sexy about it. There’s nothing sexy about me saying to you, it might take you up to a year to change this habit, you know, we want the quick fix. So for me, I definitely exercise way more than I used to.

I used to see training as a chore, but now I absolutely love it. And I learned that I just firstly, needed to find the movement that I enjoyed, and secondly, I needed to remove any barriers. So that might mean I packed my gym bag the night before and I put it in the car, I had all my work clothes ready so that when I woke up in the morning, I didn’t have to motivate myself to do all this other stuff as well as go to the gym.

Now it’s all there, all I need to do is just slip in my clothes and get in the car. So that’s one thing I’ve done. I’ve certainly broken some bad habits.

Felicity Cohen: Tell me about one of those. I kind of, you don’t look like you’ve got any bad habits.

Dr Gina Cleo: Oh no, I definitely do, well, used to for sure. I used to come home from work and just sort of bludge around which, which is fine, but it was such a, you know, I live on acreage.

I have a German Shepherd cross Kelpie who has plenty of energy and it made a lot more sense to go for a walk or enjoy the sunset. I love being in nature and I knew that that would make for a much better afternoon for me. So I broke a habit of coming home and sitting on a couch. And now I just take a stroll in nature with my dog.

And it’s a beautiful habit that I’ve created.

Felicity Cohen: I love that. How long do you feel like that took you to implement and make that a routine habit for yourself? Dr Gina Cleo: I started with giving my myself a goal of just doing it twice a week because habits is important to sort of incrementally go into. So I did it for twice a week and it took me about a month for that to feel like it’s normal and it’s something that I really wanted to do.

And then as I increased it to daily, I would say it took me a good three to four months for it to be my normal routine and what I expected my afternoon to look like.

Felicity Cohen: So you’re also an associate professor at Bond University, are you enjoying that role?

Dr Gina Cleo: I love that role. I get to teach medical students actually about human behaviour and behaviour change, which is really exciting.

I’m also the head of student wellbeing for the medical faculty and that’s been such a rewarding role because, you know, students support, as well as student discipline when required, it’s really about behaviour change and understanding one’s behavior. So I’ve really been able to implement a lot of my research and my understanding around habits in my role at Bond, and I absolutely love it there.

Felicity Cohen: That’s pretty spectacular, so we can expect the doctors of the future to have really good understanding of their own personal habits and wellbeing and I think that’s going to make them better doctors in the future as well.

Dr Gina Cleo: I hope so. That’s certainly the goal.

Felicity Cohen: That’s fantastic.

I love that. What did you find was difficult or challenging last year? I think for a lot of university students in particular, it was one of the hardest years that they could have ever faced because they were so isolated and solo. And I think, you know, some bad habits would have crept in for many of them, and managing and coping and moving forward.

I hope they’ve all done really well. But for you personally, was it a challenge?

Dr Gina Cleo: Yeah, it definitely was the challenge. You know, I was out of routine and although I said before, I’m not a habitual person, I still prefer routine to some degree. And that routine, because, you know, we find safety and security, and routines it’s where we feel like our day is predictable.

And there’s a sense of safety in that, even though, even if you’re a spontaneous person, you still want to know that I go to the gym this many times, I have a cup of tea in the morning. I go to work at 9:00 AM. There’s sort of predictability that helps, and I think not knowing what tomorrow would look like with the restrictions changing and the workplace restrictions changing.

It was certainly a challenge, but one thing that I really learned was just how to let go, how to let go of those expectations of those needs to have a set structure and just sort of go with it and focus on what I knew I could control, which was the work that I was doing, which essentially I could do from anywhere.

I know for a lot of our students, they had to really self-motivate because they weren’t face to face classes so they had to be online. For some of them who went home, that was going to be all sorts of times of the day, especially if, if they were overseas. So I know that was a struggle. And then a lot of research has come out to show how people snacking habits really changed in 2020, how we snacked a lot more on sort of process convention, confectionary foods, and how we’ve sort of support some of those, I guess, unhelpful habits into 2020.

Felicity Cohen: Wow, so there’s a lot of work for the Habit Institute to do now. And I think, you know, for us too, we’re seeing a lot of that, whether it was people faced with seeing themselves on zoom every day, you know, all of a sudden they had this different connection with themselves, apart from the fact that their working lives had changed, they were seeing themselves differently.

And being aware that that maybe they’ve actually put on weight, you know, the COVID kilos issue became a big problem, so now tackling that this year, I think is a big thing as well.

Dr Gina Cleo: Absolutely. And I think it’s realising that with any big lifestyle changes is it’s the perfect time to create habit changes.

So as our lives are integrating back more and more to how they used to be pre COVID, I think it’s so important to take advantage of those teachable moments or those moments where, you know, you can allow new routines to come in and be really intentional with what it is you want your day and your life to look like.

And the one thing that I always think of is the more you do a habit, the more subconscious and automatic it becomes, and therefore the more natural it becomes. And it’s equally the same with the less you do a habit, the more it falls away and becomes no longer part of who you are and what you do. So everyday matters, you know, every time you do or don’t do a habit, it matters.

And it really adds to the neuroscience of a behaviour.

Felicity Cohen: Where do you see the future of the research going for the Habit Change Institute? Have you got some ideas or projections for where you’d like to go in the future?

Dr Gina Cleo: I’m really fascinated with the idea of how our temperaments and our personalities impacts the way that we create habits.

You know,. I certainly know that there are personalities that prefer a more rigid structure, some personalities feel suffocated in structure, and I would love to know, I would love to run some science and some research just to actually test the theory because I think then we can really help patients in, in even more personalised approach, you know, a person who loves structure will do fabulously with a meal plan and, you know, do this at this time,

and they’ll do really well with that. Whereas someone who’s a bit more spontaneous by nature, won’t do so well with that, you know, they’ll feel suffocated under that kind of guidance and they probably want something more along a bullet point of these are some great ideas, pick and choose which one feels right for you on the day, it’s equally as effective, but I’d love to do that.

Felicity Cohen: So that’s kind of more looking at the intuitive approach as opposed to a structured detailed plan approach?

Dr Gina Cleo: Yeah.

Felicity Cohen: Different personalities.

Dr Gina Cleo: That’s right.

Felicity Cohen: I love what you’re doing with the Habit Change Institute. I think it is so fascinating and such a really interesting area of research and so much that we can think about and apply in what we’re doing here, but what people in general can do by connecting with you

through the Habit Change Institute. I really appreciate you coming in today and having a chat with me. My final question that I like to ask all of my guests is what does wellness mean to you?

Dr Gina Cleo: Ah, wellness is very much for me, it’s a state of being, it’s a state of, it’s a complete body, whole body approach.

And that is my mind and my thoughts. It is the way that I live my day to day, but it’s also the ease of that. I think if I’m living a healthy lifestyle, but it’s a chore and it’s difficult, I’m not sure that that’s completely I’m not completely in a space of wellness because it takes a lot of effort for me to do that.

So wellness for me is the, the automaticity of living a healthy lifestyle.

Felicity Cohen: Beautiful. Thank you so much, please thank Gina Cleo. Thank you so much for coming in.

Dr Gina Cleo: Thank you so much Felicity, it’s been fun.

Felicity Cohen: Thank you for joining the Wellness Warriors podcast. It’s been a pleasure to have you online with us.

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