A well-known endocrinologist dropped by the clinic the other day to ask me whether our three psychologists could help his diabetic patients who knew what to eat but, for psychosocial reasons, weren’t doing it. Providers across Hawaii express frustration that despite rigorous efforts at health education, patients continue to engage in counterproductive lifestyle behaviors that manage to overpower the best medications money can buy.
Too many calories, especially the wrong kind, and too little activity results in what is now called "metabolic syndrome." It is defined as a combination of diabetes, high blood pressure and high cholesterol plus a spare tire at the midriff, otherwise affectionately known as "muffin tops." As if these diagnoses weren’t enough to keep primary care doctors busy, complications of metabolic syndrome, such as heart attack, stroke, kidney failure and blindness keep medical specialists equally occupied and at still greater economic cost.
Health education is key to both prevention and intervention in unhealthy lifestyle behaviors. Nevertheless, although the majority of people who suffer from diabetes can tell you an apple is more healthful than a french fry, this knowledge doesn’t necessarily translate to healthy food choices.
Family habits and traditions can play an important role in defining our relationship to food. Many of us grow up in households where soda, beer and potato chips are standard fare, or maybe in families that celebrate occasions by indulging in pies, fried foods and heavy carbohydrates. Dietary counseling and education about how our food choices affect our health can often make a positive difference.
Most of us would much rather feel better, look better and live longer. So why is it that just knowing what to eat might not be enough to get there? There are plenty of reasons. If we live at home and someone else is doing the cooking, then we might just eat what is served. If we go to school and eat lunch in the cafeteria, we might not feel like there are a lot of choices. Also, knowing what to eat is not the same as knowing where and how to buy healthful food, having the money to purchase it or time and ability to prepare it.
Then there are those who have the knowledge, capacity and ability to eat well and still don’t do it. Emotional eating, old habits, the desire to please others, poor self-control and self-sabotage are among the many other factors that influence our relationship to food and affect what, how much and how often we eat. A psychologist’s specialized training in behavioral choices, thought processes and emotions can prove invaluable when applied to eating behaviors.
Unfortunately, there remains some stigma around receiving psychological services. Concerns about being labeled mentally ill can prevent people from seeking expert guidance. Seeing a psychologist, more often than not, is about acquiring a new skill set, shifting one’s perception and learning fresh strategies to tackle old problems.
In truth, psychologists can aptly address cultural, interpersonal, social, cognitive and behavioral influences around a patient’s nutritional choices. This involves an assessment of an individual’s readiness for change and then a collaborative effort between patient and psychologist targeted toward useful, time-limited interventions that inspire patients to develop a sense of confidence and mastery over their nutritional and lifestyle plan. It works.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to firstname.lastname@example.org