In our everyday lives there are many activities and pursuits we spend our time and mental energy on. There are our careers, which consume considerable time and brain-space. There are family activities such as school and many pursuits to enhance our social well-being. In our society there have emerged institutions around nutrition (the food we eat, what diet are you on?), fashion, our homes and living spaces. We thrive on entertainment – sports, activities, movies, the arts. These various cultures are highly developed.
For most people, being able to physically perform daily activities at an adequate level may be the highest bar for health. We usually do not spend much time or effort on ‘being healthy’. For example, we tend not to make sleep, rest and good nutrition a priority. Our lives are busy, and there is little time for such things. Furthermore, it would require significant effort to make changes in lifestyle or nutrition that may improve one’s outcome or perhaps prevent the onset of disease.
In our society, getting someone to change their behavior is a tremendous and oftentimes insurmountable feat. When given a choice, individuals will often choose the option that requires less work even if the outcome may have detriment to their overall health. When people become ill or sick, it requires little effort to visit a doctor and be prescribed a new medication or to sign up and show up for a surgical procedure. This attitude caters perfectly to people who see the medical system as something external to themselves, that you tap into when you are sick when you need someone to fix you. But this view removes the responsibility of wellness from individuals, and places it on health institutions.
Obesity is one form of unhealthiness in today’s society. Becoming overweight leads to increased cardiac disease, cancer and higher mortality. Over the last decade and a half, the ‘fat acceptance’ movement may have played a role in worsening the obesity epidemic. For the benefit of one’s self-esteem, the fat acceptance movement makes it okay to be satisfied with your weight and what you look like, regardless of the detriment to your health. The fat acceptance movement tells people to stop striving and stressing over losing the weight, that is you, so own it. There are more overweight people now who feel content with their weight now than ever before.
Furthermore, people would rather consider bariatric surgery, medications or devices. It is easier to lay on the operating room table and be gastrically rerouted under anesthesia than it is to commit to long-term healthier eating or being healthy. But it is well known that people unwilling to change their food choices are not likely to succeed in long-term weight reduction after bariatric surgery.
Perhaps the simplest solution to weight reduction is calorie-counting. By keeping track of what is consumed, a person can identify how many calories they are taking in per day and make modest adjustments in order to reduce that number. However, many people find ‘counting calories’ to be overwhelming, stressful and even stigmatizing. When it comes to health, people want immediate results, and lifestyle changes that are slow and require education and close monitoring are not acceptable solutions. People would rather subscribe to an exotic, nationally advertised diet when seeking to lose weight. But these are unsustainable. Weight loss and better nutrition will be fraught with setbacks and multiple failed efforts. It requires ongoing diligence to maintain long-term health.
We are a society of living in the moment where for many ‘healthy seeming’ people, health is taken for granted. When we have a precious resource or commodity, a fancy car for example, we frequently wash it and keep it well-tuned. But people think little of their future health. How could we get a 20 year old to seriously consider that, “Someday I too, will walk slowly, feel stiff and have trouble sleeping at night. I may need to get up to the bathroom several times a night, and I may be incontinent.”
Our current healthcare delivery system is a disease-focused approach. The resources are stacked heavily in favor of medications, devices and surgeries. As mentioned before, the healthcare industry is treatment focused as medications and drugs are a billion dollar business. Physicians find it time-consuming to counsel patients on the principles of nutrition and regular exercise. A patient who is not visibly unhealthy may not receive any particular counseling by the physician. A patient whose weight crosses a certain threshold may be reminded to work on an exercise program. Prescribing an appetite suppressant or referring an obese patient for consultation for gastric bypass surgery are examples of definitive actions that on the surface take care of the issue. However, a disease-focused approach is like stamping out forest fires.Preventive health, a popular term that does not get the in-depth counseling and education it may deserve is really the only way to establish a culture of health.
How do we get society to adopt more of a ‘health culture’? People indeed have the capacity to improve and change if they want to and can be motivated by understanding the importance of good health to their general well-being. The first step must be education around simple nutritional principles. On-going coaching and health counseling and imparting a mindset that growth and change are possible. Once people begin to feel better after making these changes with encouragement, they will want to be the new person that they feel. The health improvement that they experience will help motivate the continued behavior. But in order for any change to be sustainable, there must be continued counseling and coaching. Members of our traditional healthcare teams may not be able to provide this on-going but critical care.
