Change

Much of what I do in my clinic with patients who come in is education, sometimes medication, and almost always trying to elicit change behavior. It goes without saying that America has something of a weight issue and a smoking problem and a poor eating habit and a serious lack of exercise problem and...you get the point. For me, this is one of the most frustrating and exciting parts of my job, and I LOVE it. In many ways I view myself as a health adviser; I give people health information and if they choose to follow my advice it will get them a host of benefits, and if they don't then at least they know the consequences of said choice.

This leads us to the real question; how does one get another people to want to change and to actually follow-through with the change. One fact it nearly universal with people, they hate being told to do something. People dig in their heels and even if you have authority over them they will only do it grudgingly and half-heartedly unless it comes from within as well. So simply telling people to quit smoking or start exercising or lose weight simply doesn't work very well at all.

One strategy is to ask people what they really want out of life (usually this is very different than a blood pressure of 120/80). It's usually simple things like being able to play with their grand-kids, or to have their clothes fit better, or because they hate doing what they do. Then you try to tie the change behavior to the goal that they really want. Unfortunately when you ask them what they are going to do about it they usually say something vague like "eat healthier" or "get in shape" or something unrealistic like "lose 60 pounds in 2 months" or "not eat sugar again". These either don't get people very far or simply aren't a sustainable way of life.

So that leaves us with our main question, how do I get people to want to change.

I recently read an interesting article about will-power in the NY Times about New Year's resolutions. It was very insightful. Combined with a recent book I read called "Switch: How to change when change is hard" has changed how I approach my patients and myself.
(http://www.nytimes.com/2012/01/08/sunday-review/new-years-resolutions-stick-when-willpower-is-reinforced.html?_r=1&scp=4&sq=new%20year%27s%20resolutions&st=cse).
Some of the most interesting points were these.
1. "To keep a New Year’s resolution is to anticipate the limits of your willpower."

2. "People with the best self-control, paradoxically, are the ones who use their willpower less often. Instead of fending off one urge after another, these people set up their lives to minimize temptations. They play offense, not defense, using their willpower in advance so that they avoid crises, conserve their energy and outsource as much self-control as they can"

How do you incorporate these into your life and actually have the changes stick. Don't overestimate your willpower for starters. People start out all full of spit and vinegar (as evidenced by the packed gyms around New Years or the first two weeks of a diet) and then quickly fade out. People need to admit that they have limits to their willpower and simply wishing it to be different won't make them less likely to be tired at times and likely to cheat on their diet or stop exercising. They also need to set up limits and avoid situations that will test their willpower.
- Set out your clothes the night before
- Agree to meet with a friend
- Have a workout plan already set up that is reasonable with your schedule
- Make a plan to go to bed early enough to not be tired in the morning
- Set up your meals ahead of time and buy the ingredients ahead of time to avoid simply ordering pizza and go grocery shopping when you are full and (relatively) well-rested.
- Get rid of the snacks in your house so you aren't tempted (people pay a lot of money for weight loss, just think of this as an investment ahead of time)
Our willpower has limits and is finite, people who overtax it or are overly tired will find that they will make poorer choices.

The last thing that has stuck out to me had to do with smoking cessation, but is applicable to many areas of life. The average smoker tries to quit 10 times before he actually does quit. Some only try once, some try twenty. If someone comes into my office and says, "Doc, I've tried to quit once and it didn't work", what do you think I'm going to say? Try again. The same goes for any change behavior, keep trying. Set up the path you want to go down to be as easy as possible and set up the path you usually go down to be harder one. If this doesn't work the first time, back up and re-assess the situation, analyze why it didn't work and then try a different tactic. Eventually one of these will work, but too many people throw in the towel with one failure.