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.