“There are two ways to be fooled. One is to believe what isn't true; the other is to refuse to believe what is true.” - Soren Kierkegaard
My mom was not a good cook. She believed that all meat, whether it be a steak, pork chops, ham, or chicken, was best prepared in the oven at 350 degrees for 45 minutes. I grew up thinking that vegetables came from a can and that a salad consisted of cucumbers and iceberg lettuce smothered in a mixture of ketchup and mayonnaise. Luckily, what she lacked in culinary skills my mom made up for in baking. She was known for her pie crusts, and her cookies were better than anything the local bakeries sold. Even though dinners in my household were frequently unpalatable, we all knew that, at the very least, there was always dessert.
When my mother gave up baking after developing vision difficulties, she passed her recipes along to me. These were the recipes she had perfected over forty years, written on index cards which were stored in a small box. With recipes in hand, I followed them to the letter, but none of my cookies or pie crusts tasted anything like hers; frequently they were disasters. Frustrated, I asked her to sit in the kitchen while I baked. She couldn’t see so I described what I was doing. With every step, she’d ask what the batter looked like and then explain how to tweak the ingredients—a little less flour, a little more mixing, just the yolk rather than the entire egg, and so on. Clearly the recipe was just an outline. What made her pie crusts and cookies so perfect was the way she finessed the ingredients, an intuitive process she had perfected over time with practice, patience, and plenty of trial and error.
My mother’s recipes came to mind recently while reading a research study related to chronic disease. The first sentence of the article listed lifestyle factors as the most effective way of treating most chronic diseases, finding them to be more effective than medicine alone. The factors listed were so familiar—almost every article I read related to chronic disease references the same behavior changes, usually in the first paragraph. There is little to no variation—stop smoking, limit alcohol, maintain a healthy weight, eat a Mediterranean diet, exercise at least 150 minutes a week, get 7 to 8 hours of sleep a night, and reduce stress. Occasionally a research paper will recommend additional factors, but there is a common theme that emphasizes the same changes in smoking, alcohol, weight, physical activity, sleep, and stress.
What reminded me of my mother’s recipes was not the health consequences of eating cookies and pies (which, given my mother’s cooking skills may have been healthier) but how lifestyle factors are listed much the same way as the ingredients for my mother’s recipes were listed on those worn-out index cards. Much like the flour, butter, and sugar, they are usually presented in the same straightforward and simple manner. Many of us are no strangers to these lifestyle factors—they are ubiquitous in health reporting and are, in some areas of the country, accepted as general knowledge. Typically health care providers recite the list when your bloodwork is marginal. But like baking my mother’s cookies, staying healthy and avoiding chronic disease requires much more finesse than these lifestyle changes suggest. On paper they seem reasonable, but, as the saying goes, the devil is in the details.
Many in the medical community treat the human body as a machine, a collection of pipes, levers, pulleys, and electrical wiring that, given the right tools, can be propped up, rewired, or replaced when something breaks down. That might be true for some acute conditions, but not for our general health. Even so, this mechanistic approach persists, so it’s common for physicians to approach lifestyle factors in the same manner, presenting them as simple steps that, when done properly, will yield a predictable result. Anyone who has tried to make even one lifestyle change can attest to how faulty that thinking can be.
The human body is not a simple machine; we are more than the sum of our parts. The physical body cannot be separated from the person; ours is a complex, integrated system regulated by an internal loop in which the body impacts our emotions, behaviors, and values which then influences the body, and so on. Even a surgeon who replaces a heart valve cannot predict with absolute certainty the outcome. Even though a procedure is “bio-plausible”, meaning that intuition tells us it should work, it does not guarantee that it will work in a system as complicated as the human body.
To be fair, physicians are not solely at fault for ignoring the challenges of making lifestyle changes. When it comes to health, we are incredibly skilled at self-deception. Although most of us find liars morally reprehensible, we frequently lie to ourselves about our health habits in many subtle ways. You skip a workout because you are “too busy”, even though you found time to scroll through Amazon or stroll the aisles at Trader Joe’s. That mole on your back is getting bigger but you’ll put off having it checked until “Covid calms down”. The stress of your job is making you sick, but you shrug it off, believing that all jobs come with pressure and, besides, the salary is good, so why change?
Lying to ourselves about our health habits doesn’t make sense. After all, we are creating deception about a behavior that we know puts us at risk for serious illness. I had a friend who, during the red-meat obsessed 1980’s was a strict vegetarian, meticulous about consuming only organic food. She also smoked two packs of Camels a day, which she justified with an elaborate narrative about how her diet reduced the toxicity of the cigarettes. She willfully disregarded what she knew to be true about the dangers of smoking, engaging in self-deception because she wanted to smoke. It was more convenient to latch onto her story than give up her habit.
We also deceive ourselves when we ignore what we know to be true about the complexity and challenge of behavior change. Most of us have a strong sense of which behaviors are healthy and those that are not. But giving up unhealthy habits and replacing them with new ways of living can be daunting, so we are reluctant to let go of behaviors that give us pleasure. Change is frequently overwhelming and can feel like a slog when we navigate it day in and day out. We long for the ease and comfort of our old habits. No wonder we look for shortcuts, knowing in our hearts that doing so will most likely be unsuccessful. But, regardless, we take the shortcut, all the while lying to ourselves that perhaps, just maybe, this time it will work.
Procrastination is a form of self-deception in which we rationalize reasons to avoid taking action because doing so requires facing a problem head on, dealing with a challenge we find difficult or beyond our capabilities. It can be trivial (“I’ll meditate tomorrow.”) or catastrophic (“I’ll call the doctor about my chest pain next week.”). Self-deception is costly because failing to address health issues typically makes them worse. It also consumes so much energy because we must do the mental work of that task repeatedly without ever getting the payoff. Deceiving ourselves about “later” offers short-term relief from something we don’t want to do. In the long term, we are better off facing our discomfort, finding our ground, and being honest about the situation.
Perhaps the hardest part about improving our health through lifestyle change is that our attempts frequently don’t work or are extremely hard to maintain. The medical world is loaded with “should’s” for healthy living but stingy with the “how’s”. Even when health care providers do suggest strategies for change, they tend to be generic or vague. Some recommendations are so extreme that they are impossible to implement or sustain. Telling a working mother with three young children who is diagnosed high blood pressure to follow a strict vegetarian diet, get 8 hours of sleep a night, and find time to exercise borders on the ridiculous. A better approach would be to start with one or two possible behavior changes with a clear understanding of the time, resources and effort required. Most of us are willing to do what is necessary to be healthy, but not when these changes are imposed upon us or are outside the boundaries of what is possible. Change is more likely when we have a clear picture of what we need to do and the confidence in our ability to do it.
Carl Jung once said that what is true for us at one time in our life will, at some point, no longer serve us. Many of our unhealthy habits started out as a response to a need, but as our circumstances change, that habit becomes outdated. Turning our attention to the beliefs we hold about health can illuminate our actions and help us navigate our next steps. What we find important will hold our attention, and where our attention goes, our energy will follow. Taking the time for reflection about narratives about our health —the beliefs, values, and experience that direct our lifestyle choices—will lead to changes that resonate and are sustainable.
This month we’ll explore the subtle details related to behavior change—the finesse of living a healthier life. From debunking the “eat less and move more” myth (that, unfortunately, many still believe) to an understanding of the dynamics behind stress and sleep, we’ll review the “how’s” of several key lifestyle factors associated with well-being and a lower risk of developing chronic disease. We’ll go beyond the broad stroke recommendations heard repeatedly to examine the small details that are frequently overlooked but are vitally important to change.
As we head into February, a month that emphasizes heart health, I invite you to start exploring your health beliefs. What does it mean to be “healthy”? What are some habits you hold onto that may no longer serve you? How do your current lifestyle practices reflect your health beliefs? Approach these questions with honesty and curiosity. What are you willing to do for your health?
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