Doctor’s Tip: Dietary changes are evolutionary not revolutionary

Dr. Richard Crosby
Doctor’s Tip

Being a newcomer to the valley, one of the first few people I met was Dr. Greg Feinsinger. I had previously read many of his columns and was thus delighted to have a chance to talk with him, and more than glad to write this guest column.

As a university professor of public health, my career is based on investigating how people adopt health-protective behaviors. The principles are vastly different and vary based on the behavior in question. For instance, an easy health behavior to alter is having an annual flu shot — sound public health practice dictates that making vaccination “easy to do” will greatly increase vaccination rates. A somewhat more demanding example involves screenings for preventable cancers such as those occurring in the cervix, breast or colon. My career has been focused on an even more demanding challenge: promoting the consistent use of condoms among people most at-risk of acquiring HIV.

However, throughout my 22 years in public health it has been clear that two health behaviors are by far the most challenging to alter: exercise and diet. This is true for three reasons: 1) meaningful clinical benefit occurs only with constant (daily in the case of diet) repetition of the behavior, 2) “results” of the behaviors are often not readily apparent (particularly with dietary changes), and 3) the surrounding cultural, physical and “market” environments may not support the new behaviors.

Regarding culture/environment, in my short time being part of the valley community it is apparent that the prevailing culture and environment strongly support vigorous exercise behaviors. Thus, the ultimate “health challenge” for people reading this column is probably the ongoing process of making dietary changes. Although I am tempted to describe numerous theories of health behavior that explain how long-lasting dietary changes occur, I have opted instead to “compact” the major tenets into a few key points to consider the next time you “feel guilty” about not making a major dietary change or not keeping one you had begun.

• Foods high in refined carbohydrates have an addictive quality — this physiological reaction sets up a positive reinforcement pathway that can be very difficult to overcome.

• Social and “market” support for eating high-fiber, single-ingredient, low-sodium/low sugar, and low-fat foods is often lacking in U.S. society — this barrier can be overwhelming.

• Americans view food as a source of pleasure. This means that healthy alternatives must be prepared in a way that translates into a “taste experience” meeting or exceeding that coming from traditional diets of meat, potatoes, refined carbohydrates, etc.

So the solution here is not simple, but it does exist. First, learn as much as you can about healthy food options — the more you know the less you will appreciate the somewhat empty experience of refined foods and animal products. Second, engineer your environment as much as possible to make eating the right foods the easy option (your choices in the grocery store may be as important as your health care decisions). Third, learn how to cook (or where to buy) healthy foods that taste exquisite to your palate.

Let me conclude with the counter-argument. Namely, these changes do not occur quickly. Instead, they should be thought about as evolving — often with instances of reversal or avoidance. What this means is that nobody should ever feel like they cannot succeed in making meaningful dietary changes — everyone who succeeds also has multiple instances of failures. In short, dietary changes are difficult — the key is persistence in your efforts rather than giving into feelings that the task is overwhelming.

Dr. Crosby holds a PhD from Indiana University and began a public health career as a Fellow of the Association of Teachers of Preventive Medicine (assigned to the Centers for Disease Control and to the Rollins School of Public Health at Emory University). Crosby has been an active researcher and teacher in public health since 1998. As the author of 10 textbooks used to train the next generation of public health professionals, Crosby’s primary focal point is the application of the behavioral and social sciences to preventing both chronic and infectious diseases.

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