Sep 23, 2009

Why Is It Hard To Live Healthy?

Doctor D was going to write more about first visits next, but instead he decided to tackle a more interesting follow-up to the last post:

Why is it so hard to live healthy?
The Happy Hospitalist recently pointed out that we could prevent 80% of premature death by following some very basic health rules: don't smoke, eat healthy, exercise often, and don't get fat. He then notes out that only 10% of people do all four. Happy says the other 90% of us are “fat smoking lazy food-junkies,” and he doesn't want to pay for healthcare for such stupid people.

Are Americans really that stupid? No, but we do often ignore the basic rules of healthy living. Why? We learned this stuff in health class as kids, but why is it so hard to actually do?

The answer lies in history. The diseases that kill people now are not the same ones that threatened our ancestors. The human mind comes pre-programed with survival instincts for a completely different world. Up until just a few generations ago humans survived on the edge of starvation. Life involved a lot of work and there was barely enough food to go around. Starvation ended the lives of millions, and the many malnourished were at much higher risk from death when confronted with infection or violence. These things killed our ancestors far more often than heart disease or cancer.

The human body is built to live on low-calorie high-fiber foods while doing a tremendous amount of physical exertion—bodies always need these “healthy” things, but your ancestors never needed to look for them any more than they needed to look for oxygen.

The human mind, however, is finely tuned to constantly search out high calorie foods and ways to avoid strenuous work. Your ancestors didn't find these luxuries often, but they were constantly striving for them. An avoided exertion or a caloric meal could make the difference between life and death.

Only in the last 100 years or so have we reached a point technologically in the US where high-calorie foods are unlimited and a person can go indefinitely without any real exercise. We created the world in the shape of our instinctual desires and now it is killing us.

But our brains did not change quickly like the world around us. Your mind still works like that of a sustenance farmer preparing for a long winter. When millennia of human survival instincts tell you to skip the work-out and eat seconds you cannot help but pay attention. Happy Hospitalist threatening you with cutting you off his insurance plan isn't going to change your behavior much. You don't even really worry about getting heart disease in a few decades either, your brain is much more preoccupied with that famine it keeps expecting to show up.

Doctor D has never found that name-calling or threatening people with premature death does much to motivate them to live healthy. When doctors order people to eat better and slim down patients often go to crazy quick-fix diets that usually do more harm in the long run. It is just difficult for the human mind to accept a healthy lifestyle that runs contrary to our instincts.

Doctor D is not saying lifestyle change is impossible, but that it is difficult. Change requires understanding and respecting the power of instinctual drives. Most people who eat too much and avoid exercise don't even know why they do what they do. Doctors commanding patients to "just live healthy" is about as useful as telling an addict to just stop getting high or a depressed person to just cheer up.

Instincts have a strong influence on us, but they are not irresistible. It takes significant motivation, insight, and encouragement to resist the power of survival instincts. Doctors who understand this will do more for their patients' health than doctors who simply order patients to be healthy.
Have you made a difficult change to a healthy lifestyle? Did a doctor help you? How did you find the motivation? Doctor D would love to hear your experiences in the comments.


Nurse K said...

My doctor told me that my BMI was too LOW. That motivated me to start a pie-friendly lifestyle.

WarmSocks said...

After years of saying, "I have to get back in shape," but finding plenty of excuses not to, I signed my kids up for swimming lessons. It's important to me that they know how to swim. I figured that I could use the weight room while my kids were in the pool. Turned out that kids often get wait-listed unless a parent volunteers, so I spent a year teaching swimming lessons, swimming laps during the break between classes. It was a fun way to start exercising.

Doctor D said...

An ideal BMI while eating pie and an excellent writer! Nurse K is so perfect I'm not sure she's really human!

WarmSocks, if we could somehow tap into the energeticness of our kids we could solve inactivity and decrease our dependence on foreign oil.


My ex hubby(almost god) said that the problem is purely exercise. Years ago (many) people ate full cream, big man meals, drank full fat milk, lashings (so famous five) of butter/bread, steaks etc and were healthier than they were today.
Ah but the secret is working hard, walking alot, not blobbing in front of T.V's etc.
If we increased petrol prices to the Max (for commercial cars), people would ditch their cars, even busing would be too expensive, voila a healthy society....Maybe :)

Doctor D said...

By the way, Happy wrote a response post on his blog today.

Happy says only one thing influences human behavior--economics. Money quote: "The only instinct going on here is the lack of motivation in the pocket book."

Thus I suppose he only blogs to support those adds.

Doctor D is such a failure as an economic being! First he chooses Primary Care as a career and then he blogs without adds!

Anonymous said...

Movement is engineered OUT of most peoples' lifestyle. Even if you want to walk someplace, you might not be able to due to extreme distance from where you live, high speed roads, no sidewalks. Have you ever seen anybody walk to a gym? It's all about the car and the long commute.

Dr. D., can you change your comment field so it allows a person to type a name without a URL? Just wondering.


The Lonely Midwife said...

Went to Disney World last winter with the kiddos--that gave me loads of motivation. I think the "Larks" outnumbered those actually walking.

There are so many reasons for unhealthy behavior. Finances are a big motivator but won't solve the problem. It doesn't for smoking--cigarettes are expensive but kids and those with minimal means still light up despite their danger. I don't see that there is a "one size fits all" solution. Everyone's reasons are different, everyone's barriers are different, etc. Therefore, everyone's solution will be different.

Doctor D said...

Sorry Celeste,

I tried to tweek the settings, but this is the lowest security allows me to set for comments. You can still post "Anonymous" and put your name at the bottom.

You could also get a Blogger account just for commenting on blogs. I've seen people do that before.


Anonymous said...

I'd still like to see a post on what happens on a first visit.

queenofoptimism said...

Thanks for this post, Doctor D. Your patients are very lucky to have a PCP with integrity and who isn't stuck on one perspective. As a person who has focused on eating low calorie, high fiber foods for years, I wasn't confronted with the "stupid fat person" perspective until I gained weight rapidly last year. To tell doctors meeting me for the first time that I wasn't always overweight is futile. Fortunately, my PCP knows.

Spark Star said...

I ofeten wondered what kept me so lazy and reluctant to exercise. this answers it :)

Anonymous said...


I think the idea of instinctual weight gain is interesting. For me when I was 17 I got put on anti-depressants stopped exercising and gained about 35 pounds in four months. After a year once I finished high school through independent study I moved to Alaska and left the drugs behind. While there I lost all the weight within five months, got really fit and have kept it off since. I didn't deliberately try to diet or exercise, but I did get a job high volume short order cooking (ie 64hr/wk on my feet running around doing physical labor), learned how to cross country ski and went 4x wk during winter, learned how to drum and started a band, and did chores like gardening, running with the dogs and chopping the MOUNTAIN of wood needed to replenish winter stores. Plus, there are few things that burn more energy then doing physical activities in the heat or cold.

When I tried eating only salads and the like I had no energy and felt horrible and really really hungry. When I ignored my weight and ate when hungry I lost it easily.

My advice would be to forget counting calories, know carbs like bread and rice are not truly bad for you, just try to eat enough nutritious food and do lots of goal orientated physical activities and you will lose weight.

Also, it takes about two very painful weeks for your body to adjust to things like running or cross country skiing. Its rather painful but if you can get over the hump it becomes fun rather then torture.

That's what worked for me anyways. I know lots of overweight or obese people who are crazy about eating nutritious minimal calories and workout at least 3hrs/wk to no avail. Some of my friends and relatives constantly go on crash diets join groups etc. and can't seem to lose weight and keep it off. Some people do but it takes a long time and seems very hard and stressful for them. I think its because those tactics are like fighting some kind of mind vs body war and mostly the body will win. I think they need be more physical in general and the weight will come off.

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