"Listen, here's what I think. I think we can't go around measuring our goodness by what we don't do. By what we deny ourselves. What we resist, and who we exclude. I think we've got to measure goodness by what we embrace, what we create, and who we include."
-- from the movie, Chocolat
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Two days ago, after 16 years of review, the Centers for Medicare and Medicaid Services announced a proposed decision to provide Medicare coverage for the comprehensive lifestyle program for reversing heart disease that my colleagues and I at the non-profit Preventive Medicine Research Institute have developed and tested (www.pmri.org).
This is the first time that Medicare will be providing coverage for an integrative medicine program, so we are grateful to everyone involved in this decision. Since reimbursement is a major determinant of both medical practice and education, this is an important breakthrough. This is the first time that Medicare will be providing coverage for an integrative medicine program, so we are grateful to everyone involved in this decision. Since reimbursement is a major determinant of both medical practice and education, this is an important breakthrough. (The Pritikin Program also will be covered.)
So, in celebration of this, I'd like to share with you a brief summary of what my colleagues and I have learned so far about what really works to motivate people to make and maintain lasting changes in diet and lifestyle (part one):
It's not all or nothing. Diets aren't sustainable because they're all about what you can't have and what you must do. If you go on a diet, sooner or later you're likely to go off it.
What matters most is your overall way of eating and living. If you indulge yourself one day, you can eat more healthfully the next. If you're a couch potato one day, exercise a little more the next. If you don't have time to meditate for 20 minutes, do it for one minute -- the consistency is more important than the duration. Studies have shown that those who eat the healthiest overall are the ones who allow themselves some indulgences.
2. Even more than feeling healthy, most people want to feel free and in control.
If I tell people, "Eat this and don't eat that," or "Don't smoke," they immediately want to do the opposite. It's just human nature, and it goes back to the very first dietary intervention that failed -- "Don't eat the apple" -- and that was God talking, so we're not likely to do better than that... And if their spouse says, "Honey, you know you're not supposed to be eating that," people sometimes start to feel a little crazy.
Nobody wants to feel controlled or treated like a child. Even my son, Lucas, doesn't like to be treated like a child. When he was four, I said to him, "No one can tell you what to eat, not even me. You don't ever have to eat anything you don't want." He feels regarded and respected, so he feels free to make healthful choices that are sustainable. He understands the reasons for eating this way rather than telling him, "Because I said so!" Paradoxically, he eats much more healthfully than most of his friends because he feels free to choose.
In our home, we serve mostly healthful foods. If he wants a treat, or some dessert, and he's eaten his meal, then he gets it. But since there isn't a charge around it, it's not a "forbidden fruit," so he doesn't feel compelled to pig out.
Whether you're six or sixty, if you go on a diet and lifestyle program and feel constrained, you're likely to go off it sooner or later. Offering a spectrum of choices is much more effective; then, you feel free and empowered.
3. Eating bad food does not make you a bad person.
The language of behavioral modification often has a moralistic quality to it that turns off a lot of people (like "cheating" on a diet). It's a small step from thinking of some foods as "bad" to seeing yourself as a "bad person;" at that point, might as well finish the pint of ice cream.
Also, the term "patient compliance" has a fascist, creepy quality to it, sounding like one person manipulating or bending his or her will to another. In the short run, I may be able to pressure you into changing your diet, but sooner or later (usually sooner), some part of you will rebel.
What's sustainable are joy, pleasure, and freedom.
4. How you eat is as important as what you eat.
When I eat mindfully, I have more pleasure with fewer calories.
If I eat mindlessly while watching television, reading, or talking with someone else, I can go through an entire meal without tasting the food, without even noticing that I've been eating. The plate is empty but I didn't enjoy the food -- I had all of the calories and little of the pleasure. Instead, if I eat mindfully, paying attention to what I'm eating, smaller portions of food can be exquisitely satisfying.
"Eating with ecstasy" is much more sustainable than "portion control." Here's a downloadable guided meditation: http://www.pmri.org/spectrum/guided_meditations.html
Also, when you pay attention to what you're eating, you notice how different foods affect you, for better and for worse. More healthful foods make you feel good -- light, clear, energetic. Less healthful foods make you feel bad -- heavy, dull, sluggish. Then, it comes out of your own experience, not because some doctor or book or friend told you.
5. Joy of living is a much better motivator than fear of dying.
When you make healthy diet and lifestyle changes, most people find that they feel so much better, so quickly, it reframes the reason for changing from fear of dying to joy of living. Joy and love are powerful, sustainable motivators, but fear and deprivation are not.
Trying to scare people into changing doesn't work very well. Telling someone that they're likely to have a heart attack if they eat too many unhealthful foods or that they may get lung cancer if they don't quit smoking doesn't work very well, at least not for long. Efforts to motivate people to change based on fear of getting sick or dying prematurely are generally unsuccessful.
Why? It's too scary. We all know we're going to die one day -- the mortality rate is still 100 percent, one per person -- but who wants to think about it? Even someone who has had a heart attack usually changes for only a few weeks before they go back to their old patterns of living and eating.
Once we accept fully that we're going to die one day, then we can start to ask, "How can I live more fully?" As Quincy Jones likes to say, "Live every day like it's your last, and one day you'll be right."
For the same reasons, talking about "prevention" or "risk-factor reduction" is boring to most people. Telling someone they're going to live to be 86 instead of 85 is not very motivating -- even when they're 85 -- for who wants to live longer if you're not enjoying life?
Sometimes, people say, "I don't care if I die early -- I want to enjoy my life." Well, so do I. That's the false choice -- is it fun for me or is it good for me? Why not both? It's fun for you and good for you to look good, feel good, have more energy, think more clearly, need less sleep, taste better, smell better, and perform better athletically--and sexually.
Ironically, some of the behaviors that many people think are fun and sexy -- like smoking cigarettes, overeating, abusing alcohol, and chronic stress -- are the same ones that leave them aging faster and feeling tired, lethargic, depressed, and impotent. How fun is that? (Check out Christy Turlington's site, www.smokingisugly.com.)
When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain can grow so many new brain neurons in only three months that your brain can get measurably bigger! Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- the same way that drugs like Viagra work.
For many people, these are choices worth making -- not just to live longer, but also to live better. Life is to be fully enjoyed.
For more information: www.pmri.org
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Follow Dr. Dean Ornish on Twitter: www.twitter.com/deanornishmd