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Tuesday Jan 07, 2020

Small Steps Are Key to Making Resolutions Stick

Editor's note: Most New Year's resolutions fail before February. We asked our new physician bloggers how they help patients make lifestyle changes that last. Here's what they had to say.

[new year's plans]

Gradual Evolution

I was born on New Year's Eve, so I am all too familiar with the flurry of well-intended resolutions and the sense of positive potential that accompany each new year. I am also keenly aware of the reluctant acceptance that gradually comes during the following months as we negotiate with ourselves and settle on lesser goals or give up on them entirely, at least until next year.

The age-old challenge that most of us face has to do with self-discipline, whether it pertains to diet, exercise or a perceived vice such as smoking, drinking, excessive screen time or a chocolate obsession, just to name a familiar few. It doesn't help that the major holidays that lead up to the new year are often accompanied by indulgence in the things that eventually leave us looking disapprovingly in the mirror at a flabbier, weaker version of ourselves. This is followed by a newfound resolve to make a change for the better that will finally stick. We are determined to regain our 21-year-old body, imbue it with the soul of a monk, and attach to its chiseled torso the head of someone who possesses an iron will and better decision-making abilities.

Therein lies the problem. We expect radical change from ourselves, when what we really need is the foresight and ability to play the long game of gradual evolution. Based on my own experience, I encourage my patients to integrate small changes into their lifestyles that fit well with their personalities and routines. For instance, I discovered I had lactose intolerance about 15 years ago, but it wasn't until just a few years ago that I seriously committed to a 30-day elimination diet and discovered just how positively life-changing strict elimination of lactose from my diet could be. Within a few days of eating nonprocessed, dairy-free foods, my gastrointestinal issues greatly improved. Next was the elimination of wheat products, which brought about an even bigger surprise as my heartburn went away, along with fatigue, brain fog, body aches, headaches and skin issues. I also reached my goal weight after only six weeks of strict dieting. Five years later, I continue to eat a modified version of this diet because it made a difference, and I feel better.

Finally, I have found that when it comes to working out, the key is to keep exercise equipment in places where it is easily accessible and convenient to use. For instance, I keep my free weights and exercise bands upstairs where I have quick access to them before settling down for the night, but my exercise bike and total gym are downstairs in our TV room where I can use them while watching a show. I have also started bringing exercise bands with me when I travel.

There are smaller but more consistently beneficial changes one can make, like increasing time spent walking the dog or jogging instead of walking. Engaging in outdoor work or recreation instead of staying cooped up in the house is always a win and could easily jumpstart a new lifestyle change. The key is to employ many small and achievable changes that you can shuffle to avoid getting bored or overwhelmed. In doing so, you just may wake up some New Year's Day and look in the mirror with an approving grin on your face.

Kurt Bravata, M.D., Buffalo, Mo.

Where to Start?

The best and most difficult medicine is changing your life. I wish we could bottle a healthy diet or turn exercise into a pill, but there is no substitute for changing your life if your goal is to, well, change your life. This starts with considering a few questions.

First, what changes are we talking about, exactly? Here's a list.

  • Stop smoking if you smoke.
  • Drink less alcohol if you have more than two drinks a day.
  • Sleep seven to eight hours a night.
  • Drink water.
  • Decrease the stress in your life as much as possible.
  • Exercise.
  • Eat well.

Second, why should we care enough about these suggestions to make big changes related to them? Well, there is enough data behind them to merit a separate blog post, but I can sum it up in one sentence: If you want to be in your own home instead of a nursing home when you're 80, you should do these things now as a favor to your future self.

Third, how do we make these changes stick? This is the hard part. Taking pill takes a commitment of 10 seconds each day. It's easy to remember and easy to stop thinking about after you've done it. Changing your life requires attention all day long, every day. We all hate the side effects of medications. This is the side effect of lifestyle change -- you have to pay attention, and it's not easy. You won't get a rash and you won't get diarrhea. You will, in fact, feel better every day that you do it, but give yourself credit for doing something hard.

A primary care doctor can help patients with things such as smoking cessation, insomnia, poor nutrition and alcohol misuse, but we cannot follow patients home and cook for them, so the challenge for patients is one of endurance.

If changing a life is a marathon, not a sprint, let's treat it like one. Start slow.

If you want to eat healthier, start with lunches. Or snacks. Or no meat with breakfast. If you want to exercise five days a week, start with one. Start with a 10-minute exercise video at home. Start with chair yoga.

Slowly progress. You don't need to change everything in one day, but you should stick with the changes you make.

Make something habitual. Start meatless Mondays. Start Tuesday walk clubs. Put it in your schedule not just for this week, but for every week, same time, same place.

If you fail, try again. If you are successful 10% of the time, your 80-year-old self will be that much better off, so it's worth trying again and again and again.

Stewart Decker, M.D., Klamath Falls, Ore.

Sustained Transformation

New Year's comes with a hope for change and a renewed effort to make better choices. Better known as New Year's resolutions, people often commit themselves to making these big, bold and sweeping lifestyle changes.

However, on average, people stick with said resolutions for less than two weeks.(nypost.com) As a family physician who is a strong proponent of using lifestyle medicine to promote and maintain health, one of my largest tasks is helping people make changes that last.

Unfortunately, evidence shows us that big and bold is not the way to make lasting lifestyle changes. I have seen many patients try to run marathons without much previous physical activity. They start training too hard with too much intensity, end up injured and then give up altogether. Whether it's quitting smoking, drinking less caffeine, becoming more physically active or implementing a plant-based diet, research has shown us that small, consistent and incremental changes(www.apa.org) are much more likely to result in sustained transformation.

I recommend my patients make a plan; set small, attainable and realistic goals; and only make one change at a time. For example, drink one less soda each day for two weeks and then increase the goal to two fewer sodas daily for two more weeks. When that goal is reached, start walking five minutes after dinner twice a week and continue to make one small change at a time.

Lastly, and perhaps most importantly, ask for support and involve a friend or family member. If you are trying to eat more veggies and no one else in your household is trying to do the same, it can be a lot harder. I have found this is also true for patients trying to stop smoking alone compared with those who try it with support. Similarly, if you are meeting a friend for a walk at lunchtime, you are much less likely to skip it. Letting others know about your goals and having them check in on you can help make you more accountable for your actions.

Alex Mroszczyk-McDonald, M.D., Fontana, Calif.

Make SMART Changes

Human behavior is hard to change. Yet we're realizing that many of our behaviors are unhealthy, and research has shown that true lifestyle modifications can positively impact both disease prevention and progression. Guidelines recommend(www.uspreventiveservicestaskforce.org) we discuss these modifications with our patients, but we have all likely struggled to find ways to prescribe them during our limited visit time in a way that will realistically help our patients make lasting, healthy changes.

I have spent the past year trying to fine-tune how I speak with patients about establishing habits that stick. I tell them to think of "small but sustainable" changes, to create SMART (Specific, Measurable, Achievable, Relevant and Time-focused) goals, and to associate new habits with simple rituals that they're already doing every day. For example, I tell them to pick a small goal that they know they can meet. If they want to walk more or eat more vegetables, I suggest a specific goal like walking for five minutes three times a week or adding five baby carrots to their snack twice a week. No goal is too small, but make sure it is measurable.

If your neighborhood doesn't feel safe to walk in or you're not the one doing the grocery shopping, pick a different goal. Make it relevant to your overall health goals. And commit to this goal for a set period of time. (I often recommend four weeks, and we schedule a follow-up visit.)

Finally, I offer tips to help patients associate their goals with something they're already doing. Want to drink more water? Put a big glass by your bed and when your feet touch the floor in the morning, drink it. Want to work out to that online exercise video? Put some workout gear right where you place your keys when you get home and immediately put it on.

In addition to the growing body of evidence that these methods work, I have found them to be true for me, which gives them credibility and enables me to speak from experience. Thus, going into another year, I encourage patients and my colleagues to make small New Year's resolutions that can be reasonably accomplished.

With time, you can add to these successes. And hopefully, by this time next year, you'll find that you've made some big changes and are feeling like the healthier you you've envisioned. Happy New Year!

Margaux Lazarin, D.O., M.P.H., Redwood City, Calif.

Posted at 12:48PM Jan 07, 2020 by Kurt Bravata, M.D.

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