You may have heard rumblings in the healthcare debate about the need to incorporate “personal responsibility” into reform or seen the recent New York Times article, "Fat Tax," which cites an idea favored by some economists, i.e., basing insurance premiums on body mass index.
Drastic circumstances call for drastic measures. In the past 20 years there has been a dramatic increase in chronic diseases such as heart disease and stroke, diabetes, arthritis, and cancer among U.S. adults.
The Centers for Disease Control and Prevention estimates that
- Nearly 50 percent of Americans live with at least one chronic illness
- Approximately one-fourth of people with chronic illness experience significant limitations in daily activities
- Chronic diseases cause 7 in 10 deaths each year
- More than 75% of health care costs are due to chronic conditions
Perhaps most alarming is the obesity epidemic: 1 in 3 adults and nearly 1 in 5 young people aged 6-19 are obese.
While genetics, environmental and societal issues, and to a lesser degree inferior medical care are all contributing factors to the high incidence of disease, up to 50 percent of premature deaths are the result unhealthy lifestyles and risky behaviors—tobacco use, alcohol and drug abuse, overeating, stress and physical inactivity.
Why Knowing Isn't Enough
Study after study reports on the benefits of nutrition, exercise, and stress management in preventing chronic illness and promoting mental wellbeing in people of all ages. Many of us know what we should do. Why don't we do it?
How we decide whether or not to adopt a behavior like healthy eating or exercise is dependant on a very complex interplay of physical, psychological, cultural, and societal factors—much too broad a subject to deal with in depth here but there are a few models directed at individual behavior change that have shown promise.
Assess Your Readiness to Change
One is the stages of change theory that describes an individual’s readiness to change in five stages:
- Precontemplation—Not thinking about change
- Contemplation—Thinking about change
- Decision/determination—Preparing to change
- Action—Actively making a change
- Maintenance—Maintaining a change
The idea is that by understanding where you are in the continuum for a specific behavior, you can set goals and develop action plans that are realistic and achievable. As you accomplish specific goals, you build confidence in your ability to adopt and maintain healthy behaviors.
As Liz’s experience with weight loss showed us (see August 23rd posting), small steps do lead to big changes.
Although stages are presented in a specific order, people do not necessarily go through every stage in sequence. Instead the model supports the concept that behavior change is an ongoing process. And because we are human, it also builds in “relapse” or, as I prefer to call it, “lessons learned.”
Understand & Overcome Your Personal Resistance to Change
So how do you motivate yourself to take those first steps? There is another tool—called motivational interviewing—that has demonstrated effectiveness in helping change behavior and is often used in combination with the stages of change model.
Very briefly, instead of taking the usual role of fixer and giving the patient general advice, a doctor may use motivational interviewing to help the patient explore their emotional resistance and ambivalence about change.
The patient then sets short-term goals and specific action plans that they are highly confident they will achieve. The emphasis is always on success rather than magnitude of change.
Self-reflection—thinking about your own personal goals and what is holding you back—is something you can explore on your own. Dr. Rick Botelho, Professor Emeritus of Family Medicine, University of Rochester, and author of “Motivating Healthy Behavior Change” suggests using a decision balance:
Self-reflection—thinking about your own personal goals and what is holding you back—is something you can explore on your own. Dr. Rick Botelho, Professor Emeritus of Family Medicine, University of Rochester, and author of “Motivating Healthy Behavior Change” suggests using a decision balance:
Decision Balance
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Resistance to Change
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Motivation to Change
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Keep Your Unhealthy Habit
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1. What are the benefits, upsides and/or advantages of your unhealthy habit?
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3. What are your concerns, downsides, disadvantages and/or risks about your unhealthy habit
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Change Your Unhealthy Habit
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2. What are your concerns, downsides and/or disadvantages about changing your unhealthy habit?
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4. What are the benefits, upsides and/or advantages of changing your unhealthy habit?
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From Botelho, R: Motivating Healthy Behavior Change. Accessed at http://www.motivatehealthyhabits.com/html/free-resources.html
Your answers may help you understand and lower your resistance to change so that you can effectively move forward toward your goal. And while none of us alone will solve our country's problems, changing our own behaviors may be an important first step toward positive communal change.
You can learn more about these tools and others by checking out the links below.
References & Resources
The Way We Live Now. Fat Tax, Should Overweight People Pay More for Health Insurance? By David Leonhardt. Accessed at http://www.nytimes.com/2009/08/16/magazine/16FOB-wwln-t.html?_r=1&scp=1&sq=Fat%20Tax&st=cse
Chronic Diseases. The Power to Prevent, The Call to Control. At a Glance 2009. Centers For Disease Control and Prevention. Accessed at http://www.cdc.gov/print.do?url=http://www.cdc.gov/nccdphp/publications/AAG/chronic.htm
Motivational Interviewing: http://www.motivatehealthyhabits.com/html/free-resources.html
SparkPeople promotes lifestyle change and offers comprehensive nutrition, health, and fitness tools, support, and resources that are 100% free. The site also incorporates an element of fun so that members stick with their programs. See www.SparkPeople.com
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