Category: motivational

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Why is it so Hard to Motivate Patients?

Weather is to lose weight, to adhere to a healthy diet or even to take their medications every day. It often seems like most of my patients make little progress in controlling their diabetes or high blood pressure. Thinking I was doing a good job by reviewing the complications of diabetes and high blood pressure, IT MIGHT HAVE BEEN DOING THE OPPOSITE. We are told to educate patients regarding complications which often results in scaring patients. We are told that by scaring patients, will lead patients to make the right decisions. But the sad reality is that it doesn’t work. Why was I not able to motivate patients into making better decisions based on what could happened in the future? Why is it so hard to motivate patients?
If you try to stop yourself from snacking, we will tell our self you will be fat. If some one is smoking you will tell them, you will die of cancer. We have a deep-rooted belief that by scaring ourselves or others we will do the right thing. Except that science shows that warnings have limited impact on behavior. Graphic images on cigarette packets, do not deter people from smoking. (Ruite & Kok, 2005; Taubman Ben-Ari, Florian & mikulincer, 1999’ Trenholm et al, 2007; Ennett et al, 10994)

Warning and treats work but have a very limited impact in motivating people into action.

When animals get scared, they have two reactions, freezing or fleeing. Human beings are animals and have the same responses to fear or being scared. When something is scary, we try to eliminate what is scaring us using rationalization. We could tell ourselves, I had my blood sugars high for a while now and nothing has happened. The process makes you feel stronger than before and makes it harder to do the right thing.
Many of us will act like the Ostridge and place our head on the ground. We ignore what is front of us, people avoid negative information because it makes us feel bad. People will start facing reality when is too late, when we have bad outcomes or complications that can not be ignored. People will avoid worrying about something that might or might not happen in the future now, they choose to worry about it when it does happen.
Studies show that people prefer to go along with the better or positive outcome. People listen to the positive information. Ability to learn from positive information remains the same throughout life, where learning from bad news is less in the young and elder but better with those right before midlife.

How can we use this information to motivate ourselves and others?

Using positive information uses three principles that drive peoples’ decision and behavior. The first is:

*Social incentives (response to opinion of others that lead to change, Edelson, Sharot, Dolan & Dudai, 2011=science). We are social people, we want to know what others are doing and we want to do it better.
*Immediate reward Values rewards you can get now more than rewards you can get in the future. Choose something tangible now rather than something is insure in the future. Can you reward people now for actions that are good for them in the future? Actions become associated with the rewards, leading to the desire outcomes.
*Progress monitoring highlight progress not the decline.

Do we need to stop communicating risks? No but we might want to re-think how to approach motivating ourselves and others. Because fear of loosing your health will lead to inaction or freezing. While positive information will lead to action.

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Mindful Eating

What is mindful eating? Mindful eating can bring us awareness of our own actions, thoughts, feelings and motivations, and insight into the roots of health and contentment.

Mindful Eating allows yourself to become aware of the positive and nurturing opportunities that are available through food selection and preparation by respecting your own inner wisdom. By using all your senses in choosing to eat food that is both satisfying to you and nourishing to your body. Acknowledging responses to food (likes, dislikes or neutral) without judgment. Becoming aware of physical hunger and satiety cues to guide your decisions to begin and end eating.

Principles of Mindfulness:

  • Mindfulness is deliberately paying attention, non-judgmentally, in the present moment.
  • Mindfulness encompasses both internal processes and external environments.
  • Mindfulness is being aware of your thoughts, emotions and physical sensations in the present moment.
  • With practice, mindfulness cultivates the possibility of freeing yourself of reactive, habitual patterns of thinking, feeling and acting.
  • Mindfulness promotes balance, choice, wisdom and acceptance of what is.

Mindful eating can help us lose weight, it is a well-known fact that most weight loss programs don’t work in the long term.  Around 85% of obese individuals who lose weight return to or exceed their initial weight within a few years. Binge eating, emotional eating, external eating and eating in response to food cravings have been linked to weight gain and weight regain after successful weight loss. Chronic exposure to stress may also play a large role in overeating and the development of obesity. The vast majority of studies agree that mindful eating helps you lose weight by changing eating behaviors and reducing stress. A 6-week group seminar on mindful eating among obese individuals resulted in an average weight loss of 9 lbs (4 kg) during the seminar and the 12-week follow-up period.  By changing the way you think about food, the negative feelings that may be associated with eating are replaced with awareness, improved self-control and positive emotions. When unwanted eating behaviors are addressed, the chances of long-term weight loss success are increased.

Where do we start, especially when coming off the season of overindulgence?

The first thing is to be aware of what you’re eating. Take time during the day and write it down: How many times a day do you eat? When do you feel most hungry?

Consider portion sizes. Use smaller plates and containers. Use measuring spoons and cups. Don’t rely on your eye to get it right.

We can all eat better and if you are like me and need to lose weight, mindful eating can help.

 

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Why Lose weight?

Why do we want to lose weight? Aren’t we all a little more cheerful when we have a little weight? What is the harm in not being super skinny?  Is it just social pressure and social conventions that say we should be a certain size?

A new study suggests that previous studies have under estimated the harmful effects of carrying extra weight. The new study, conducted by researchers from the University of Bristol in the United Kingdom, attempted to find a link between Body Mass Index (BMI) and risk of death.

Other studies have also suggested that even a small amount of weight gain in healthy, young individuals is associated with worsening heart function, posing a greater risk for future heart failure. People who were not obese at baseline and gained weight had a greater negative impact on their cardiac structure and function than people who were obese already.

What are the benefits of losing weight?

1.      Feeling better:

·         Having more energy

·         Sleeping better and waking up feeling rested and in a good mood

·         Having fewer aches and pains

·         Improved ability to move and get around

·         Finding it easier to breathe

·         Improved immune system (ability to fight off illness)

2.      Reduce risk of diseases like diabetes, heart disease, stroke, weight related cancers

·         Asthma

·         Arthritis

·         Deformity of the lower legs (Blount’s disease)

·         Sleep apnoea (a person temporarily stops breathing during sleep)

·         High blood pressure

·         Fatty liver

·         Polycystic ovary syndrome (PCOS) where cysts form in the ovaries

·         Menstrual (period) problems

·         Insulin resistance meaning that the body becomes resistant to insulin, the hormone that controls the amount of sugar in the blood.

·         Type 2 diabetes

The Best way to lose weight is through lifestyle changes (healthy diet) and exercise. The endocrine Society came out with clinical practice guidelines in 2015 for the use of medications in weight loss. Use of approved weight-loss medications is endorsed for people with a body mass index (BMI) of 30 kg/m2 and above or at least 27 kg/m2 with one or more comorbidities.  Yet many of the drugs are not being used because not everyone is convinced of the safety of these medications. The newer drugs to the market are bupropion/naltrexone (Contrave, Orexigen Therapeutics) and liraglutide(Saxenda, Novo Nordisk) for weight loss. These new comers join  controlled-release phentermine and topiramate (Qsymia, Vivus), and lorcaserin (Belviq, Arena Pharmaceuticals) and over the counter orlistat (Alli, GlaxoSmithKline).  Another consideration is that weight loss medications are usually not cover by insurances and can be quite expensive.

Is always best to speak to your Primary Care Doctor before embarking in any diet or exercise changes

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Happy New Year

New year, new you! With the start of a new year we all feel like it is the start of a new you, that is why we make resolutions for the new year. Having had to deal with the illness of a family member and having to make tough decisions like palliative care; it has become increasingly clear to me that we have a finite amount of time and we should make the most out of it. Since we are here for a set amount of time, it should be clear that we should take care of our bodies so that we may have longer healthier life and enjoy more the world out there. As humans we are not perfect, and we can always improve, personally, health wise and improve relationships with family. Like many of you I find myself needing to lose weight and start exercising more. I will start an exercise program and eat healthier.

The first step is setting health goals that are realistic and obtainable, choose one to two goals instead of having too many which will make it hard to keep track of them, and break the larger goals into smaller steps that will be easier to do.  If loosing weight is one of your goals, you want to make sure to do it the right way and stay away from gimmicks. One way to lose weight is adjusting your calorie intake, this new online tool can help you figure out how to adjust your calorie intake.  Small changes can add up and make a big difference, so start small with changes you know you can stick with.

Don’t forget exercise as it is one of the best things you can do to keep you healthy and loose weight. Logging what you eat can help you see how much you are eating and keep track of calories. There are many apps for your smart phone that you can use. There are also apps that can help you exercise such as the 7-minute workout. Writing down goals and letting your friends and family know can help you stay on track. Lastly, don’t for get to schedule time for exercise, if can’t do it daily start with three days per week. What ever your goals, the most important thing is to get started.

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What is Self-Management?

Self-management is the key to good diabetes control.

• Self-management is what people with diabetes do to manage their chronic condition and the effects on their health, daily activities, social relationships and emotions.

• Self-management uses education and strategies to increase diabetes management skills and confidence. It can also refer to the organizational structure such as your Primary Care Doctor’s office educational programs for diabetes patients.

• The goal of self-management is to help people achieve good quality of life and improve those aspects of life worsened by diabetes.

Self-Management is the Use of Skills to…

• Deal with your illness (medication, physical activity, doctor visits, changing diet)

• Continue your normal daily activities (chores, employment, social life, etc.)

• Manage the changing emotions brought about by dealing with a chronic condition

(stress, uncertainty about the future, worry, anxiety, resentment, changed goals and expectations, depression, etc.)

Road to self-managing includes the follow wing steps

1.    Set goals

2.    Making an action plan

3.    Feed back

4.    Problem solving if needed

5.    Making a new Action Plan

6.    Acknowledge progress

Always check with your Primary Care physician or endocrinologist to see if there is a diabetes education program, a Certified Diabetes Educator or a diabetes group that can help you manage your diabetes.

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Chronic Disease and the Holidays

Chronic disease — defined as illnesses lasting more than three months, being persistent or recurrent, having a significant health impact, and typically being incurable. So, with holidays like Christmas and Hanukkah at hand, there is always a temptation to abandon healthful living routines.  Eating too much, not getting enough exercise, staying up late, worrying about family members getting along — all these things can make you feel worse.

Patients with diabetes, heart conditions, or epilepsy, for example, must take care of yourself or the disease gets worse. With autoimmune diseases, such as MS, fibromyalgia, or lupus, your symptoms will get worse but not the disease itself.

Holidays bring out all the physical and social concerns around chronic diseases. The demands and expectations around holidays can “out” people whose conditions were hardly noticeable. During the year, they spend so much of their energy working and handling the daily chores of living that they have little time left for socializing. Come the holidays, they’re expected to show up and contribute.

Many chronic illnesses, such as diabetes, depression, arthritis, fibromyalgia, etc., are not noticeable. “People go to work or volunteer or shuttle kids to school. Most of the time, they don’t look sick. When illness flares up, their pain is invisible. Or they have bone-numbing fatigue, so bad that they can’t take a shower and go to the store in the same day. There’s a cultural misperception that says you’re not sick unless you look sick. They need to make their illness visible by talking about it.”

An article in Arthritis Today offers three tips for managing holiday stress:

Daily rest and relaxation. Don’t get stuck in a never-ending to-do list. Do a crossword puzzle or take a walk or a nap. The mental and physical break will rejuvenate you.

Prioritize. Decide how much shopping, cooking, or partying you can do and stick to it. Ask for help.

Volunteer. Take toys to the Marine Toys-for-Tots Foundation, take food to homebound seniors through Meals on Wheels, or provide goods and services for Hurricane victims. It will boost your spirit and remind you what the holidays are about.

The holidays can be hard on everyone but more so to patients with chronic diseases. Family members and in general people need to be more accommodating to those who have chronic illnesses.

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Is Eating Vegan Healthy?

A few years ago, one of my patients asked me if I knew anything about Forks over knives. She reported she saw a cardiologist to get cleared for surgery, he told her he would not clear her but encouraged her to see the documentary Forks over Knives and to follow the diet. The patient was very stressing over the fact she could not get the surgery, she told me that the cardiologist encouraged her to eat a vegan diet. Vegans abstain from eating any animal products while vegetarians do not eat animal meat but still eat eggs, cheese, milk.  The Forks over Knife documentary and book explores the claim that all deteriorating diseases can be control, even reverse by not eating animal based and processed foods.

Most people become vegan to avoid animal cruelty products and wanting to be healthier. But is a vegan diet Healthy? Around 2.5 percent of people in the United States (U.S.) are vegans, according to a 2016 poll. Here are some facts about the vegan diet:

The vegan diet contains only plant-based foods. All protein, vitamins, and minerals must come from non-animal sources, so food choice and preparation are important. Tofu, tempeh, and mushrooms are three of the many alternatives than can provide the nutrients found in meat. A vegan diet can help to protect bone and heart health, and lower the risk of cancer.  Supplements are recommended to replace levels of certain nutrients abundant in meat, such as vitamin B12.

Animal fats have been linked to various cancers, diabetes, rheumatoid arthritis, hypertension, heart disease, and a range of illnesses and conditions. Animal sources are likely to account for 13 of the top 15 sources of cholesterol-raising fats in the U.S.  Not eating meat reduces the overall risk of mortality.

The following are likely to be in short supply on a vegan diet, but alternatives are available.

  • Vitamin B12: Vitamin-B12 fortified plant foods, such as fortified soy, seaweed, cereals, and nutritional yeast can supplement intake.
  • Iron: Dried beans and dark leafy greens may be better sources of iron than meat on a per-calorie basis. Using a cast-iron skillet to prepare a meal is a good way to absorb more iron into the food.
  • Calcium: Eat more tofu, tahini, and green, leafy vegetables.
  • Vitamin D: Regularly consuming more vitamin-D fortified foods and spending time in the sun can boost vitamin D levels.
  • Omega-3 fatty acids such as DHA and ALA: Omega-3 fatty acids, such as fish oil, are vital for cardiovascular health, eye function, and brain function. Though EPA, another type of omega-3, can’t be obtained with a vegan diet, ALA and DHA can be found in ground flaxseed, walnuts, canola oil, soy products, and hemp beverages.
  • Zinc: Whole grains, legumes, and soy products are rich in zinc.

My patient followed the diet and lost around 20 lbs., reported feeling better, got off most of her medications and could get her surgery. The patient was not able to stick with the diet for more than 18 months, and has since started to eat meat again. While eating vegan can be healthy, making sure to get vitamin B12, iron, calcium, vitamin D, omega 3 acids and zinc; is important.

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Even a little bit of movement matters

The take-home message from a mountain of data is that less sitting and more exercise is the goal, and even a little bit of improvement helps. For those who have a desk job, taking short movement breaks throughout the day is protective.

Scientific evidence strongly suggests that the more time a person spends sitting, the higher their risk of death from any cause. Multiple large studies and high-quality data analyses show that regardless of age or health issues, the hours we spend in our office chairs, cars, or on the sofa watching television can literally kill us.

A well-conducted study published in July 2016 in The Lancet looked at a massive amount of data from 16 large studies and including over a million subjects. What they found was that 60 to 75 minutes of moderate physical activity (The CDC has published a table describing many activities ) like walking to work, walking the dog, riding a stationary bike, line dancing, golf or softball, doubles tennis, or coaching sports eliminates the risk of death related to sitting, even from sitting for more than eight hours per day.

Can’t get in an hour of these types of activities per day? Just 25 minutes of moderate activity is somewhat protective, even for people who sit for eight or more hours per day. Other studies have suggested that exercise can be broken up and spread out throughout the day and still be beneficial. One study found that even hourly breaks of light activity decreased measurable damage to our arteries.

Time spent sitting was analyzed separately from time spent sitting and watching television. TV time is associated with even greater risk of death, and exercise was not as protective. Even more than an hour per day of moderate activity did not eliminate the risks associated with five or more hours per day of zoning in front of the tube. Why the extra negative effect of TV watching? The authors hypothesize that people are more likely to get up and walk around at work than they are while watching TV. In addition, people tend to watch TV in the evening after eating dinner, which may have negative effects on our blood sugars and fat metabolism. Or, perhaps people are prompted to snack on unhealthy foods during those commercials breaks. Watching large number of hours of television? Consider an exercise bike or a treadmill, place it in front of the screen.

Whether it’s sitting in an office chair or watching TV, those who get less than five minutes of moderate activity per day fare the worst, and the longer they sit, the higher their risk of death from any cause – be it heart disease or cancer.

For more information see: exercise recommendations for patients with diabetes.

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Setting Health Goals

We all set goals for work, for education, for careers and for life in general. What about setting goals for your health? How many times have you wanted to diet, exercise only to say “I will do it tomorrow, I will start my diet tomorrow or I will start exercise tomorrow”.  For patients with chronic diseases such as diabetes, high blood pressure, cholesterol, COPD, etc. postponing those goals can bring bad consequences.

Setting goals is the start of the road to better health. Do you keep your promises? Goals are a type of promise that you make to yourself. Honor your commitments, especially those made to yourself.  For each goals, smaller steps can be set so as not to get over whelmed.  Set SMART goals:

S: Specific

Be specific, don’t just say I will exercise starting tomorrow. State how much and what types of exercise you will do. Example: I will start exercising tomorrow, I will start walking 30 minutes three days per week on Mondays, Wednesdays and Fridays in the morning.

M:Measurable

Have a way to measure your progress. if you are trying to loose weight for example; weigh your self daily or at the end of every week.  If you are going to start walking measure how far you walk for 30 minutes or how fast.

A:Attainable

Your goals should be meaningful to you, they  should specific to you and they should be goals that you really want to achieve.

R:Realistic

Your goals should not be impossible but goals you will be able to work toward.  Loosing 20 lbs in one month is probably not realistic. Create a plan and commit to it.

T:Time sensitive

Set a time in which you will accomplish your goals. Saying “I will work three times a week for 30 minutes” is good but not as good as saying “I will walk three times a week for 30 minutes per week and will walk 3 miles in 30 minutes by the end of three months”.

Writing down your goals, making a very specific plan and sharing it with friends or love ones can increase the odds that you will stick to your goals. Commit to your self and improve your health today.