What would it take for you to change your life?
Imagine this: You keep saying you'll start a diet next week, or that you'll go to the gym tomorrow. Until, one day, a chest pain or a cough or a lump sends you to the doctor. And you cross your fingers and hope that the news isn't the worst you can imagine.
So there you are, in the doctor's office. You're waiting for some word. What does the doctor need to say to trigger you to do those things that you probably already know you should do? What sort of information would compel you to take action?
Would it take a diagnosis of a disease - that something has already happened to you - to get you to act? Or would you change your life simply by hearing that you are at risk of disease - that your odds have gotten worse, but that you still have some chance of avoiding a disease?
This is one of the biggest challenges that I researched in writing my new book, The Decision Tree. And it's a problem that may have a solution: It turns out that when you scare people about their health, that can sometimes (though not always) turn them to better health. It's an intriguing question: Do we need to be afraid before we'll actually care?
Risk-based disease has taken off in recent decades, as conditions from metabolic syndrome to pre-diabetes to high cholesterol have earned status as legitimate, treatable conditions.
These risk-based conditions aren't exactly a disease, but they are a specific kind of feedback. They constitute a diagnosis, a declaration that right now, in the immediate present, something is wrong. This alarm--which I'll call a health crisis--can be a very effective tool for behavior change. It may wake us out of our "yeah, I'll do it someday" reverie and compel us to act.
A 2008 study of smokers and obese people in the United Kingdom found that people who experienced a health crisis were significantly more likely to change their behaviors. Some of these crises were quite harrowing: two collapsed lungs and pneumonia due to morbid obesity, chest pains in smokers, and the like. For others, the crisis was more understated: a pregnancy, or turning 30 and deciding to quit smoking once and for all. Whatever its form, a true crisis can serve as a catalyst for change, the researchers concluded, a mechanism that disrupts the course of normal life and arouses a reevaluation of identity. It puts meaning together with behavior change. A health crisis gives people permission to behave in a new way.
Such research leads naturally to the idea that a risk-based diagnosis might constitute such a crisis and therefore stir action. But not every crisis has quite the same impact. And a risk-based diagnosis, as helpful as it can be in warding off disease, can sometimes not be enough to compel action.
This is the problem that doctors call "compliance"--which means how well people adhere to recommended medical behaviors and treatments. Too many of us just don't do what we're told, even when it's in our best interests. An meta-analysis of research studying patients who were prescribed medications for diabetes, high blood pressure, and high cholesterol found that only about 60 percent consistently took their medications on schedule. Patients on statins were the worst, with barely half following their prescription schedules consistently. It seems that when a diagnosis is rooted in risk for disease, rather than pegged to a symptom that causes pain or discomfort or simply makes one fret, it's less likely that pills will be taken when they should be.
If that's what happens among patients with established conditions like high cholesterol or diabetes, where does it leave a risk-based condition like metabolic syndrome? In that indefinite place, between a bona-fide tool for change and a gimmick. Just as metabolic syndrome has been criticized for diluting the concept of disease, so might it dilute the degree of crisis, falling short, perhaps, of the acuity needed to disrupt life enough to change it. Engaging with our health shouldn't require us to confront our deaths, or even that we be diagnosed with a specific condition. Yes, we should know our risks. But rather than measuring them as milestones toward inevitable decline and demise, why not use them to sustain our health?
Think of it this way: What if we managed our health like we do our investments? what if metabolic syndrome and other risk-based diagnoses hinted at an era of disease portfolios, like investment portfolios? In the long term, we would be mindful of those conditions that we are genetically predisposed for, the things we have a family history of, and take measures to fend them off. In the medium term, we would actively screen for conditions that we are perhaps trending toward so we can get a jump on intervention and treatment.
And in the short term we would monitor the day-to-day checklist of behaviors we want to engage in, as well as a list of the conditions that have already taken hold that we are actively managing. Throughout, our overall objective should not be to avoid or manage disease. Rather, we should aim to maximize and improve our health.
It shouldn't take a health crisis to get us to act. But sometimes, it takes a jolt out of the blue - something profound and powerful - to get us to reconsider how we're living our lives, and to compel us to change our habits. If being told that we have a risk for disease does the job as well as being told that we have an actual disease, well, that's probably all for the better.