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However, despite the fact that lifestyle change
is a key to restoration of health and the treatment
of underlying disease, it is not effectively integrated
into medical practice. Typically, physicians tell their
clients they need to lose weight, or stop smoking
or increase their exercise, but usually nothing is
done to help patients actually realise these critical
behavioural changes. Sure, doctors may hand out
fact sheets, give a list of exercises and even recipes
to their patients who need to change their exercise
and eating habits, but research shows us that such
"education" is not nearly enough to facilitate long
lasting change.
The research on lifestyle change has been
quite clear for decades. The success rate for people
changing behaviours like eating, exercise and even
sleep, let alone smoking, is depressingly low. When
people are left on their own to change these critical
habits, the success rate as measured by long-term
maintenance of change, is about 10%. In other
words 90% fail. This should not be a surprise. This is,
in fact, the common experience and we even now
have some more insight into why.
Neuroscience has confirmed that new
behaviours are initially controlled by areas of the
brain that are involved in higher function: in other
words they require thought and attention. However,
after a while, these behaviours get delegated lower
down in the nervous system and become free
from conscious control. Think, for example, about
the first few times you were learning to drive --
conscious control and attention were primary. Years
later these behaviours have become automatic and
don't require attention unless there is an alarm, like
a car headed straight for you.
In studies that have looked at the impact of
an intervention designed to improve habit change,
like counselling, the success rates are a little better
but no great shakes. For example, one study showed
that counselling could increase smoking cessation
success by 50% but given the base success rate
was only 5%, that is not a dramatic or significant
increase (up to 7.5%).
The fact is that the health profession and
especially the medical establishment haven't
properly wrapped their head around the fact that
behaviour change is extremely difficult but could
be significantly enhanced, not just or even by
counselling, but some very specific coaching. Such
coaches would work with patients individually to
increase motivation, set customised goals, provide
accountability and reinforcement, improve self-
efficacy, organise the social environment, all of
which have been identified as keys to adherence to
behaviour change programs. The fact is that such
coaching is not happening within health systems,
who have most to gain by the reduction of disease
risk. Of course, the costs would be high, but so
would the savings when patients are given access
to the tools that would significantly enhance their
chances of making the lifestyle changes that would
save trillions of dollars -- and their lives.
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