Doing my masters thesis in behaviour change motivation: motivational factors such as guilt and shame have a knack of significantly improving ones ability to uptake behaviour change but with a very very low likelihood of sticking with it over a period of time. The study is highlighting that those initial feelings need to be replaced with intrinsic motivation in order for maintenance to happen.

Eli5: you don't tend to continue exercising regularly if your main motivation is feeling chubby, it can be a gateway but you need feelings such as pride, self worth and enjoyment to sustain changes.

Why is this important: DRS can use this to understand how to engage patients about lifestyle change. If they say you are too fat then this may make them feel super guilty and therefore they may join a gym and start a diet, but for that membership to be used consistently they're going to have to find positive factors from within, otherwise it'll start a shame spiral which could have an impact on their mental health.