- Walking Man in Munich, Germany,2004 by Stefan Eggert (User Bernau) (Own Work) GFDL (www.gnu.org/copy/leftfdl.html), Tags: exercise, wellness, behavior change, new year’s resolutions, obesity.
2012 began with more of a whimper than a bang, with new year’s resolutions taking a hit. Commentators urged people to take it slow, rather than set huge goals for change and wellness. Dramatic change sets you up for a fall, according to a slew of articles and blog posts. Better to opt for small, incremental change, and look inside for sustainable behavioral change and adopting healthy habits. I like the idea of your own existential despair guiding change, but I don’t think many Americans can wrap their head around much more than magic bullets. Clearly, news and blogs were absolutely schizophrenic about the new year: magic-bullet points ran side-by-side next to the “be at peace with yourself, be kind, go at your own pace” wellness articles.
Incremental change is not sexy and it hardly makes for compelling reading –at least most of the time. How do you maintain interest in walking longer each day, giving up sugary drinks, or going to the gym twice a week? Is creating the structure yourself too much for many people?
Years ago, I worked with the Multiple Risk Factor Intervention Trial (AKA Mr. Fit), one of the first primary prevention programs, which strived to identify people (unfortunately, in that era, just working men!) at increased risk for coronary heart disease, stroke, and premature death. One goal of the program was to show people how their behavior contributed to increased risk, for example, cigarette smoking, minimal exercise, eating salty and fried food, and the like, and poor fitness, more illness, and increased risk for heart attacks, strokes, and more. Intervention programs were set up for participants to help them stop smoking, lose weight, and change their diet. For some high-risk individuals, changing diet, exercise, and smoking all at once worked very well, argued the researchers. I don’t know how people abandon bad habits and take better care.
So here we are in 2012. Recent CDC data suggests that obesity may be peaking at 1 in 3 adults and 1 in 6 children – but higher in some groups. Cigarette smoking is down in many groups, but not as much among poor and minority groups.
Do you have any insight into your own pitfalls in trying to live healthier? Why is it so impossible at times? What public policies might help people live better? Do you have any ideas about what sort of societal changes would help Americans live healthier?
I think to give changes on the individual level a chance at success we need to make massive changes to this country’s infrastructure. There are very, very few cities in the US in which it is possible to live without a car. (Full disclosure: I am enough of a cynic to believe that the reason that we do not make substantial improvements to the infrastructure in this country is that too many industries make too much profit by maintaining the status quo.) Bicycling is dangerous in most areas, buses are inadequate, there are no local trains or shuttles in most places and these sort of transportation issues lead to things like over-shopping at the mega-grocery stores (usually processed foods that will last so we can limit our shopping trips to once a week), exercise becomes something we need to ‘add-on’ to our already hectic lives rather than a natural part of living your life. Once a person becomes overweight, it is very, very difficult to lose weight (but we have a multi-billion dollar weight loss industry in case you can be convinced that there is a magic bullet), it is also very difficult to exercise. In fact, when you are overweight (and I speak from experience) *everything* is more difficult — and I mean EVERYTHING, not to mention you are uncomfortable all the time. I don’t know what the solution is, but I would start with a massive re-structuring of the infrastructure of the entire country, guaranteed free and excellent health care for every person living in the US, and health education (something that goes beyond the gym teacher telling girls they will get their periods) for every student, and stop production on all the blatantly unhealthy processed, refined foods that take up so much space on our grocery isles (think of breakfast cereals alone!). More NIH research needs to be done, with health, not profit, as the motivating factor.
I wish this was easier. I agree that major societal and infrastructure changes are imperative if people are going to make big changes. I’d like to see more healthy food affordable and easy to prepare, exercise facilities accessible for all, and decent, affordable healthcare for all. I have also felt jaded about the weight loss industry. Once you lose the weight and gain some back more than once with a paid program, you have to wonder whether ultimately it comes down to you doing it right.
Laura,
I thought the result of the MRFIT trial was that the interventions had no effect on the most important hard end point — survival.
Multiple Risk Factor Intervention Trial (JAMA 1982;248:1465-1477) http://jama.ama-assn.org/content/248/12/1465.abstract?ijkey=3b06e42526da959917fbf0e02ecd03dbd034d222&keytype2=tf_ipsecsha
I think the lesson of MRFIT is the danger of wasting resources on interventions that intuitively seem as if they would work, but haven’t been proven to work with scientific evidence.
Unproven interventions make health commissioners feel good, but they don’t make patients any better, and sometimes make patients worse. There are many examples particularly in women’s health.