Jordan D. Metzl, MD, a sports medicine physician at the Hospital for Special Surgery in New York City and author of, “The Exercise Cure,” explores this question in a recent article for Slate.com. He writes:
“If there were a drug that treated and prevented the chronic diseases that afflict Americans and we didn’t give it to everyone, we’d be withholding a magic pill. If this drug was free, in a country that spends more than $350 billion annually on prescription drugs, where the average 80-year-old takes eight medications, we’d be foolish not to encourage this cheaper and safer alternative as first-line treatment. If every doctor in every country around the world didn’t prescribe this drug for every patient, it might almost be considered medical malpractice.
We have that drug today, and it’s safe, free, and readily available.”
The drug is, of course, exercise; yet, many Americans don’t “take it.” With all the benefits it affords, “How can we motivate people to take a free, safe, magic pill?” he asks.
Exercise not only helps us maintain our weight, but research also suggests it lowers blood pressure and cholesterol, reduces risk for certain types of cancers, reduces inflammation, improves memory and concentration, improves certain sexual dysfunctions and reduces stress — all of which contribute to our country’s high healthcare costs.
So why, then, can’t Americans do the one thing that would give them all these benefits? And why can’t their healthcare providers successfully encourage patients to get moving?
The reason of course is that change is difficult, and often, the roadblocks aren’t physical, but mental.
An Atlantic article — drawing information from two Harvard professors — discusses how mindset plays a role in our ability — or inability — to meet goals. For example, we may have the mindset that we want to lose weight, but the mindset that we don’t want to deprive ourselves wins out. Or, we may have the mindset that desires to be active, but our desire to rest after a long day of work wins out.
How do we get the healthier mindset to prevail?
Kelly McGonigal, PhD, a Stanford psychologist and author of “The Willpower Instinct” who I’ve had the pleasure to hear speak, says that we can overcome our resistance to less attractive, but healthier, behaviors by actively approaching these behaviors, even when we feel resistance. Her book provides a great deal of ways to improve willpower, including getting enough sleep (yet another area where many Americans fall short), as sleep deprivation makes us more susceptible to temptation.
So, while change is hard, we do have a great deal of information on how to help us achieve change. Yet, not surprisingly, a great deal of information on willpower is written for people who already deeply want to change. What about the people — our patients — who haven’t internalized this desire yet? How do healthcare providers help them change their behavior for the better?
Education and compassion are a start. Many harried providers don’t have the time required to properly educate and motivate patients on why and how to change. Hopefully though, changes in how healthcare providers are paid — giving them incentives to improve population health — will make this more of an imperative.
Public and corporate policy also can play a role. The Slate article by Dr. Metzl describes a study where obese men successfully lost weight when offered financial incentives to do so. These men lost significantly more weight than men in the control group, who weren’t offered an incentive. This approach holds promise, and hopefully will be pursued by more and more employers. To really see change on a larger scale, though, public policy would need to change to allow for incentive programs among Americans covered by public payers, such as Medicare and Medicaid.
America is unhealthy, but we have the tools to change. So far, we haven’t put these tools to the best use. But, I’m optimistic that the transformational changes our industry is experiencing in terms of payment, delivery and incentives will start to turn the tide toward a healthier, more fit America.
What do you think?
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