I still remember a patient from almost 20 years ago who struggled with her weight and diet and identified her Monday morning meeting with doughnuts and bagels (and fruit) as a particularly difficult time.  She would spend all weekend psyching herself up, she would eat an appropriate breakfast on Monday morning so she was not hungry, then she would spend all Monday morning at the meeting fighting with herself and usually losing the battle. She would leave the meeting after eating a doughnut or two, feeling judged by others and feeling very down. Why didn’t she just have more “willpower”?

Willpower is defined as the strength to act, or the strength to avoid acting, in the pursuit of a goal.  It can refer to self discipline, (training and control of oneself and one's conduct), self control (the ability of a person to exert his/her will over the inhibitions of their body or self), or it can be a philosophical concept that is defined most broadly as any internally motivated action (adapted from Wikipedia, http://en.wikipedia.org/wiki/Willpower, accessed 9/1/10).

As you might imagine, this patient was not unique. I hear several times a day from patients trying to make behavioral changes with diet and activity that they “know what to do”, but do not have the willpower to act on their knowledge. Despite the definition and example, I am still often confused as to what this really means, and what to do to help. 

My first thought usually goes to their goals. Are their overall as well as intermediate goals actionable/achievable, realistic, and time limited (see previous post on SMART goals for more details on this topic)? Perhaps they “lack willpower” because they are trying to climb an insurmountable mountain that easily beats them back at every attempt? Or, despite setting good goals, are they not able to achieve them due to obstacles or barriers that were are new or were not at first appreciated. Have obstacles like a family stress that demands more time, or a new injury that limits what can be done now gotten in the way? Whatever willpower is, it requires acting on something that you can control, so the first step is to be sure it is something you can control and not something out of your control that no amount of “willpower” will help you achieve the goal.

However, it might be argued that even for the patient trying to avoid the doughnuts at her morning meeting, it is not as simple as her not having the willpower to overcome eating the doughnuts (which she seemingly has full control over).  I recently read a study that was done over a decade ago where people told they were going to be in a study about how they tasted different foods, and then were brought in to a room with a plate of freshly baked chocolate chip cookies and a bowl of radishes (RF Baumeister et al J Person Soc Psychol 74:1252, 1998). They were asked to taste either the cookies or the radishes, then they were left alone in the room (although watched) and asked to taste only the food they had been assigned (and they all did very well at doing what they were requested). Afterwards, they were asked to solve a puzzle of tracing a figure without lifting the pencil. They were told they could try as many times and for as long as they wanted to solve the puzzle, however they did not know this puzzle was impossible to solve. In the end, those who had the radishes made almost half as many attempts and tried for less than half the time compared to those with the cookies. What this study seems to show is that, like other things that require effort or work (think of lifting weights), if you have to use a lot of willpower (eating radishes and avoiding cookies) you can run out of it later.

Going back to the initial story of my patient at her Monday morning meeting, after she was started on a common weight loss drug at that time (“fen/phen” which was found to have other dangerous side effects and appropriately removed from the market), she all of a sudden had a lot of willpower to avoid the doughnuts, and also noticed that there were important things discussed in the meeting she had never heard before because she was so focused on avoiding doughnuts.

As was mentioned above, willpower requires acting on something that you can control. However, looking at these last two stories (the cookie versus radish experiment and the sudden gain in “willpower” by increasing a couple of chemicals in the brain), it seems as though willpower is not really under our control, or at least not under as much of our control as we might think or hope.

So now when someone tells me they know what to do but just don’t have enough “willpower”, I often find they know what to do in the big picture but have not brought it down to the individual steps required. I ask them instead to look for things in their life really are under their control (usually around their diet and activity but it could be a simple as remembering to take their medicine every day), and what of these they want to change and can realistically change (perhaps using SMART goals).  Then the challenge becomes making those changes and making them stick. This can be difficult when other survival mechanisms and old behaviors get in the way (and then are misinterpreted as a lack of willpower), but that is topic to explore later.