Every year it happens: people come to me telling of what they are going to be doing different in this fresh new year. People are going to stop smoking, start exercising, and (especially) lose weight. This year, I am among the resolvers.
Every year, most people fail.
Which makes me wonder what it is about us humans that allows us to act against what we know is best. Why is it that educating people is rarely enough to fix a problem? Why should we have an obesity \”epidemic\” when very few people really want to be obese?
I wrote a post about the use of shame as a weapon in society and how it is used against obese people. It is one of my all-time most read posts, and the one that first got me in the NY Times (aside from that incident with the llama and Silly String in the airport). Our society – and us physicians especially – are very fond of telling people things they already know in patronizing ways. \”You need to loose some weight.\” \”Smoking is very bad for you, you know.\” \”You and your teenager need to communicate better.\”
These things aren\’t wrong, but they are so obvious that our saying them implies a: the other person is really stupid, b: they are totally uneducated and out of touch, c: they are weak, or d: all of the above. One of the performance measures physicians will likely be measured by in the future is counseling about obesity, smoking, etc. The problem is, our counseling does as much good as the billion New Years resolutions done every year. It brings focus on a problem that the person obviously has trouble solving without giving a solution. It\’s like me seeing a person with depression and telling them: \”you know, you should really stop being depressed.\”
Duh.
The problem is one of understanding the true underlying problem. Quitting smoking is actually quite simple; you just stop smoking. But the problem is not quitting, it is wanting to quit. The problem with the obese person is even more complex, as there are huge societal, physiological, and psychological factors that are encouraging people to eat more than their bodies need. To simply tell them to eat less and exercise more fails to address any of the reasons why the person is eating more and exercising less (if that\’s the reason for their obesity). Ironically, it\’s the person who is lecturing the obese person who has the real gap in understanding.
Come on, folks! 1/3 of our population is struggling with this! Shouldn\’t that suggest to us that the problem is a little deeper than just \”poor self-control?\” It\’s not an epidemic of stupidity or moral weakness.
So what can we do about these obese smokers who don\’t exercise? The reason I feel powerless when facing people in the exam room with this because I cant make people want to change. I\’ve struggled with my weight over the years, mainly because there are periods of time my want for eating overpowers my want for taking care of my health. During those periods, I want to want to take care of myself, and I want to not want to eat as much. The battle rages in the area of my wants. This is why people employ guilt and shame to get others to change: we hope it changes their wants. It usually fails.
Here are some things from personal experience that have been most effective in helping people keep their resolutions:
- Don\’t make people feel inferior. One of the greatest benefits from having my own personal struggles is that I come at people already knowing that I can be a moron, so I am less likely to look down on their moronic behavior. I have told patients that one of the best things about doing my job is that I get to see that everyone else is just as screwed up as I am. Smokers, obese people, and non-exercisers are what they are for one reason: they are humans. Would I really be a non-smoker if I didn\’t grow up in a house where nobody smoked?
- Let them know you realize their struggle is hard. It is simple to stop smoking, but it is also very difficult. When I am helping someone overcome an issue like this, I am joining in on a very difficult task.
- Don\’t promise magic fixes. It would be nice if a pill would make us thin. It would be great if somehow I could suddenly want to exercise more. I personally crave easy answers for my problems because I don\’t want to do the hard stuff. But my life is defined far more by the hard things I accomplish than by easy ones. I used to recommend the Atkin\’s diet and prescribe diet pills. They worked only until people stopped using them, but 99% of the weight loss accomplished in this manner would be gone in a year. Why? Because changing wants is not done by magic; it is done by hard work (usually).
- Keep focus small. Weight loss is not a good resolution because it is not directly in a person\’s control. Eating better is under control to some extent because people can choose to do it. But the best goal is to eat a good dinner tonight. Tonight is far more in our control than next week. Advice should focus on this as well – keeping things practical.
OK, it sounds like I am a real expert. Well, I am an expert at trying and failing. I am an expert on knowing what doesn\’t work. I can communicate with others, but those donuts still hold an amazing sway over me. I still don\’t exercise much because getting up at 5:30 AM sounds like purgatory and I am too tired at the end of my day.
Well, I am resolving to do better. I am resolving to take better care of myself and to be a better person. But to fight and win these battles it will take a lot of time, a lot of failure, a lot of help, and a lot of resolve.
Thank you for your compassion. I am a licensed Mental Health Counselor and am quite aware of the difficulty in trying to change yourself and others. Very few people want to do the hard work to change and we all want it to happen quickly. This is especially true in our age of microwave meals, drive throughs and instant messaging from around the world. I think that your point of keeping change small is really important. A little change can be the biggest catalyst. Probably the most helpful advice is that we should all work on being aware of what we’re doing. Most people in therapy progress from “I did it again” to “I’m doing it again” to “I’m about to do it again”. If we can make that change in even one area of our lives (which is quite hard), a lot has been accomplished. Happy New Year to you, Dr Rob.
Thank you for your compassion. I am a licensed Mental Health Counselor and am quite aware of the difficulty in trying to change yourself and others. Very few people want to do the hard work to change and we all want it to happen quickly. This is especially true in our age of microwave meals, drive throughs and instant messaging from around the world. I think that your point of keeping change small is really important. A little change can be the biggest catalyst. Probably the most helpful advice is that we should all work on being aware of what we’re doing. Most people in therapy progress from “I did it again” to “I’m doing it again” to “I’m about to do it again”. If we can make that change in even one area of our lives (which is quite hard), a lot has been accomplished. Happy New Year to you, Dr Rob.
Thank you for being so understanding of the human condition! I tried to quit smoking by using Chantix. It made me so nauseated that I nearly spent all of New Year’s Day in the loo. I know how I could actually quit smoking — put me to sleep for two weeks, then wake me up. However, since I think that I have early-onset Alzheimer’s, I think I’ll just wait until my mind is totally gone and then other people will prevent me from smoking. They’ll want to prolong my life, although, with Alzheimer’s, it won’t be MY life anymore.
Thank you for being so understanding of the human condition! I tried to quit smoking by using Chantix. It made me so nauseated that I nearly spent all of New Year’s Day in the loo. I know how I could actually quit smoking — put me to sleep for two weeks, then wake me up. However, since I think that I have early-onset Alzheimer’s, I think I’ll just wait until my mind is totally gone and then other people will prevent me from smoking. They’ll want to prolong my life, although, with Alzheimer’s, it won’t be MY life anymore.
Happy New Year to you, Dr. Rob, and thanks for the post. As someone who has lost weight and still wants to lose more, I know what I need to do, I just have to get started. Again. Starting is the hardest thing, *continuing* is not.
For everyone out there struggling to fulfill a resolution, make a small, tiny start. Start over every day, every *hour* if you have to, but start. Celebrate that start, pride yourself on it. Remind yourself every chance you get that you did (or didn’t do) that one thing RIGHT. Keep it up until it’s habit or second nature. You can do (or not do) it! You’re always in charge, even if you don’t realize it now.
Wishing everyone a happy, healthy, successful and fulfilling 2010.
Happy New Year to you, Dr. Rob, and thanks for the post. As someone who has lost weight and still wants to lose more, I know what I need to do, I just have to get started. Again. Starting is the hardest thing, *continuing* is not.
For everyone out there struggling to fulfill a resolution, make a small, tiny start. Start over every day, every *hour* if you have to, but start. Celebrate that start, pride yourself on it. Remind yourself every chance you get that you did (or didn’t do) that one thing RIGHT. Keep it up until it’s habit or second nature. You can do (or not do) it! You’re always in charge, even if you don’t realize it now.
Wishing everyone a happy, healthy, successful and fulfilling 2010.
Happy New Year, one and all!
Regarding “stopping smoking”, I’m a life-long non-smoker, so not best placed to give people advice on the subject. That said, I know several people who stopped and made it stick for 40 plus years (or as long as I’ve known them, whichever is shorter). The key things that they’ve all had in common are:-
1) Wanting to do something that they couldn’t do if they kept smoking.
2) They always just said that they don’t smoke if someone who didn’t know them offered them one.
Happy New Year, one and all!
Regarding “stopping smoking”, I’m a life-long non-smoker, so not best placed to give people advice on the subject. That said, I know several people who stopped and made it stick for 40 plus years (or as long as I’ve known them, whichever is shorter). The key things that they’ve all had in common are:-
1) Wanting to do something that they couldn’t do if they kept smoking.
2) They always just said that they don’t smoke if someone who didn’t know them offered them one.
You can’t fail if you don’t give up.
You can’t fail if you don’t give up.
I had a primary care doctor tell me that if I’d just stop eating cheese on my vegetables and sprinkle something called lemon pepper seasoning on top instead, I could lose weight. Only problem with that is that I only eat cheese on my vegetables when I make my favorite baked spinach dish or in zucchini lasagna, I know what lemon pepper seasoning is and use it often on chicken, and the reason I was in her office was because my foot had been crushed and was several times its normal size, not to discuss my weight. When I mentioned that fact, she told me to take ibuprofen and lose ten pounds and my foot would be fine. The only thing I was motivated to do by her talk was to never go back.
I had a primary care doctor tell me that if I’d just stop eating cheese on my vegetables and sprinkle something called lemon pepper seasoning on top instead, I could lose weight. Only problem with that is that I only eat cheese on my vegetables when I make my favorite baked spinach dish or in zucchini lasagna, I know what lemon pepper seasoning is and use it often on chicken, and the reason I was in her office was because my foot had been crushed and was several times its normal size, not to discuss my weight. When I mentioned that fact, she told me to take ibuprofen and lose ten pounds and my foot would be fine. The only thing I was motivated to do by her talk was to never go back.
Rob, I want to congratulate you on such a fine post. You’ve come back strong.Failing isn’t failure. It’s part of our humanity.
Rob, I want to congratulate you on such a fine post. You’ve come back strong.Failing isn’t failure. It’s part of our humanity.
The smartest people are the ones who recognize how much they don’t know, and the wisest are the ones who can see things from others’ perspectives. Dr. Rob, you are smart and wise. I appreciate this post.
The smartest people are the ones who recognize how much they don’t know, and the wisest are the ones who can see things from others’ perspectives. Dr. Rob, you are smart and wise. I appreciate this post.
Just found your blog. This year was the first time in many years I decided to come up with a resolution (had nothing to do with my health, weight or anything like that). I stupidly committed myself to reading a minimum of 3 books a month and I picked some insane books to tackle. I'm probably going to fail as life issues take up my time.
Maybe my resolution should be (as it would be to my benefit) is to schedule an appointment with a doctor. I haven't been to one in years and years (except to urgent care when I had a dog bite, another time with a scratched cornea). I guess not going would qualify as stupid and when I do finally show up, I hope that whoever sees me will treat me not like an imbecile for waiting so long (and I mean at least 20 years since I've had any sort of checkup), but as someone that just put things off.
Have enjoyed reading your blog so far and had fun reading the llama posts. I'm in California and boy could I tell you some crazy stuff that goes on here.
Just found your blog. This year was the first time in many years I decided to come up with a resolution (had nothing to do with my health, weight or anything like that). I stupidly committed myself to reading a minimum of 3 books a month and I picked some insane books to tackle. I'm probably going to fail as life issues take up my time.
Maybe my resolution should be (as it would be to my benefit) is to schedule an appointment with a doctor. I haven't been to one in years and years (except to urgent care when I had a dog bite, another time with a scratched cornea). I guess not going would qualify as stupid and when I do finally show up, I hope that whoever sees me will treat me not like an imbecile for waiting so long (and I mean at least 20 years since I've had any sort of checkup), but as someone that just put things off.
Have enjoyed reading your blog so far and had fun reading the llama posts. I'm in California and boy could I tell you some crazy stuff that goes on here.