I know what to do… but don’t do it!

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It can’t just be about knowledge

‘I know what I ought to do but don’t do it’,  is a statement that most overweight people can probably lay claim to, whether it comes to losing weight, exercising, getting enough sleep – and so on. What stops me from doing what I ought to do when I know what I ought to do?  It can’t just possibly be because of a lack of knowledge.  Think about it: there are literally thousands of diet books, meal plans, exercise programmes  and other weightloss resources available. Pubmed, the US National Library of Medicine’s search engine, has over 115000 studies listed containing the key words ‘weight loss’. Then  more than 430000 with ‘diet’ and over 330000 with ‘exercise’.  We may have a great deal of knowledge  at our fingertips and yet we, as well as the rest of the world, are getting fatter and sicker as each year goes by.

What are we missing?  This week, I’m going to explore a possible answer to this weightloss question.

 Advice giving doesn’t work – self-care does

‘I know what I ought to do but don’t do it’, is as we have seen, not just a question of knowledge. People who are overweight or obese are often ‘serial dieters’. They are dieting experts who don’t need to be told to lose weight, just as smokers don’t need to be told to stop smoking. Medical science, and I include psychology and behavioural science, has more often than not taken a ‘head’ approach to weight loss. By this I mean that the focus is generally on giving people advice informed  and supported by an amalgam of interventions. These include: public health announcements;  diets; exercise programmes;  medicines; various forms of psychotherapy, and even surgery (for those who can afford  to go under the knife). And as we know, these efforts largely come to nought .

Dr Edward Wagner, one of the developers of the well-accepted Chronic Care Model, said that patient self-management  or self-care is the most important aspect of the model. Being overweight or obese is generally accepted to be a chronic condition. This means that self-care, by definition,  has to be really important in dealing with this condition.

Changing behaviour is both a ‘head’ and a ‘heart’ thing

Could it be that ‘I know what I ought to do but don’t do it’ because I lack the power to transform knowledge into action? The power to effect self-care does not lie in the individual aspects of self-care: the physical, intellectual, emotional, social or spiritual aspects, even though each one is key when it comes to whole-person self-care. The power to change what I know I ought to do (duty) into doing what I ought to do (choice) is not extrinsic, i.e. “coming from outside”, although such factors, such as the opinions of significant others, may have some influence.  No, the power to align duty and choice is intrinsic – it’s inherent – and it lies at my centre – my ‘heart’.  This means that behavioural change is both a ‘heart’ thing and a ‘head’ thing.

Failure is normal: make it your friend and not your foe

We often fail to effect and sustain health behaviours because  we only focus on trying to get the ‘head’ bit sorted out – improve our knowledge. But we almost completely ignore what is in our ‘heart’ – our vision for our health and our life values. We also need to accept a central tenant of being human, which is that we will fail. None of us are perfect and so failure is ‘normal’. And yet you and I often treat failure as though it were a foe. Success is, in many instances, the transformation of a collation of past failures. The late Dr Joyce Brothers, a psychologist and author, wrote that, “ The person interested in success has to learn to view failure as a healthy, inevitable part of the process…”.

‘I know what I ought to do but don’t do it’ may be perceived as a mark of behavioural failure. And yet, as we have seen, the disconnect between duty ( knowing what to do) and choice (doing it) is less about failure than about the misalignment of ‘head’ knowledge and ‘heart’ desire.  The question then is what can we do to realign ‘head’ and ‘heart’ and so transform health behaviours from the negative (unhealthy) to the positive (healthy)? Firstly, we have to accept that transformation is a process and seldom an event. And being a process  this means that failure is a fellow traveller, (and not our foe), on our journey  to success. Secondly, as knowledge tends to be more or less cast in stone, e.g. insulin is a ‘fat building’ hormone, we are largely left with the ‘heart’ bit – our choices to focus on in terms of changing thoughts, attitudes and behaviours. Finally, we need to align these ‘heart’ elements with our repository of knowledge and set our health goals accordingly.

At UpForIt we place a great deal of emphasis on goal setting in helping people lose weight and improve their overall metabolic health.  What is clear is that transforming  “I know what to do but I don’t do it” into “I know what to do and do it” requires the alignment of ‘head’ and ‘heart’. This means that your health goals need to reflect such alignment. If you would like some help on your journey to improved health – be that losing weight, getting blood pressure or blood sugar under control, please pop me an email to askdrhill@upforit.co.za

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