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The Challenge of Making Lifestyle Changes and Making Them Last

by Dr. Sheri Colberg, Ph.D., FACSM
I recently received an angry e-mail from someone I didn’t know, and it really started me thinking about how to approach the challenge of making permanent lifestyle changes to manage diabetes and improve health.

In her e-mail "Irene" stated, "Your diabetes treatment advice to lose weight and exercise is not new. Telling people to lose weight and exercise is the cure for everything. I am tired of this advice from skinny women who were never overweight or lose weight easily due to the hormones they were born with. I was born fat with a hardy [her spelling of "hearty"] appetite, and due to a disability am not able to exercise."

Poor adherence to regular exercise is a documented challenge among people with diabetes, heart disease, obesity, and many other health conditions. Some individuals truly are not able to exercise in a traditional manner, and many others face numerous obstacles to improving their diet as well (e.g., financial issues, lack of time to cook at home, non-support from family and friends, and ignorance about what constitutes a healthier diet). In fact, despite a growing evidence base for the health benefits of making such changes, we have yet to find an effective way to make lifestyle interventions permanent behavior changes for most.

One problem facing making lasting lifestyle changes is that it’s hard to sell "prevention." Most of us for one reason or another are simply reactive when it comes to our health. If we have an immediate health problem that absolutely requires us to eat differently, we will do it. Without that, though, on a daily basis even when we know we should eat healthier, it’s easier to get a fast-food meal on the run than make one at home when we’re strapped for time, stressed out, or fatigued due to work, family, and other obligations. We will also choose to skip our regular exercise for the same and other reasons.

Humans are social beings, and it may be that the answer to selling preventive health strategies lies in using the newfound power of social media to create lasting lifestyle changes on community levels, not just individual ones. Consider the power of the latest social media fad, the ALS Ice Bucket Challenge. Believe it or not, that movement gained its power in less than a month (mid-July to Mid-August 2014, and it already has its own page on Wikipedia: http://en.wikipedia.org/wiki/Ice_Bucket_Challenge).

While I’m not keen on dumping ice water over my head, I have been amazed at how quickly the movement has spread, how it has raised awareness about that particular health condition (along with significant funds for its charity: http://www.alsa.org/fight-als/ice-bucket-challenge.html), and how willing people are to participate in it—just to be a part of it. Why can’t we find a way to do something similar to make everyone more aware of how to live and be healthier? What about the "Diabetes Eat-An-Apple Challenge"? No—too boring, and people would be choking on apples when they try to eat them fast enough to videotape (although that could raise awareness about the Heimlich maneuver, I guess!) Maybe the "Diabetes Jump-10 Challenge" where people video themselves doing 10 jumping jacks to be more active? Okay, I’m reaching here, but you get the point. The novelty of the ice bucket videos will wear off eventually (especially when it gets colder outside), and a new fad will come along to replace it. Why not make it one that can reach across society to improve lifestyle habits?

Getting back to Irene’s e-mail, my first impulse was to respond to her defensively (yes, I’m thin, but I have to work at staying that way just like everyone else), but I realized that would not be helpful to her. In the end, my e-mail reply to Irene was simply the following:

"While I understand how you feel, the advice that many people give to lose weight to manage diabetes is based on many, many research studies that show positive outcomes from doing so. Just losing a small amount of fat weight can help manage it in most cases, not all of the fat. What I personally think is more important is making small changes to your lifestyle that can help your body handle food intake better, such as standing up more and moving more all day long however you can. Also, cutting back on refined carbs (made with white flour, white sugar, etc.) truly does help with diabetes management–probably more than losing any weight ever could. Focus on that instead."

My advice was not very novel or exciting (or video-worthy), but good enough for anyone feeling overwhelmed by the prospect of making lasting lifestyle changes. Someday we’ll all be living healthier lives for reactive reasons if nothing else, but in the meantime, I challenge all of you: Think of a novel behavior that anyone can do, videotape, and post to challenge others to do the same that will help spread positive health behaviors to prevent and control diabetes—but I’ll give you more than 24 hours to do it! How about a week?