Mary-Jo Murphy, MS, RN, CDE, certified diabetes educator
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Fishing For Advice

2/27/2012

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When a friend says, “Tell me what to do to lose weight, lower my blood pressure, get my cholesterol, blood sugar, under control…” I hesitate. NOPE! I think, because if I do, the inquirer will often get defensive. “I know that,” they say.

 “Good. Then may I offer this bit of Chinese wisdom to contemplate?”

 “What?”

Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.

“Are you suggesting I run out and buy a boat? Then I’d just sit around all day drinking beer. That wouldn’t be good for my diet. Besides I hate fish.”

The fact is that Omega-3 fatty acids do protect against heart disease, but beyond the occasional tuna sandwich, fatty fish two times a week is hard-sell.   “No, “ I say, “fishing isn’t even very good exercise.”

All the while I’m thinking, why ask me? Cold-blooded health advice is out there on baited hook. Pop into any bookstore or grocery store. Tantalizing titles and promising products offer the latest quick fix. I’m expecting the next delicious supplement to be called, The Stick With It Bar, guaranteed to change your life one bite at a time.

Type in the H-word on your computer and mind-deadening amounts of information are available for your reading confusion. What a challenge it is to translate the latest facts and factoids into something that can actually be useful in our daily, complicated, lives.

I’m an information junky too. So just for fun I typed in Learning to Fish. The site starts with THE BASICS, and speaks of “dreams of catching the monster fish and a little relaxation.”

Dreams! Goals! I think of my friend who keeps a photograph of her thinner self on her refrigerator, so she will ask herself every time, “Is this ice cream worth it?”

Learning to fish and taking on weight loss and exercise have a lot in common. Both begin with a dream and involve encountering pain and frustration. Both take a lot of time and a huge investment. Tangled lines, bug bites, lost lures, embarrassment, no fish, are not dissimilar to hunger pains, sore muscles and (pardon the pun) scales that won’t budge.

How is changing behavior like mastering the art of fishing?
It takes a long time and much pain before the relaxation kicks in.     And- you get to choose how you take on the task, whether you use all the fancy equipment or take the simple approach. 

My friends, who ask me to tell them what to do, already know. And, unlike me, they know what has worked or not worked for them.

One said recently, “Why is it that when I was going to an exercise class, I always showed up, but when I try to exercise alone I can’t do it? 


Whether you show up for a group or go it alone doesn’t matter. It’s the difference between deep sea fishing and standing by the side of stream. Just do what works for you to catch your big fish. A hook, a line and a permit are all you really need to learn to fish, that and time. Keep it simple. 

The ancient philosopher, Lao Tzu, said that at the center of your being you have the answer; you know who you are and you know what you want.

Now here are some of my own philosophical ramblings in case you are wanting:
  • If you give a person a diet book, they’ll be insulted.
  •  If you give a guy a gym membership, he’ll feel like a 250-pound weakling for the first few months.
  • If you tell a person to exercise they’ll tell you how hard it is and how much they hate it. If you suggest their dog will stop chewing up things 
  • if they walk him every morning and night, they might find there is something in it for them.
  • If you love cookies and you buy them in bulk, they will call out to you in the middle of the night.
  • If you compliment someone on their weight loss, you give them some reason to go on. Even better, if you ask how they did it, they’ll give you advice.
**************************************************

Health Tips for those Rip Van Winkles who really DON’T know what to do:
  • Eat five servings of fruits and vegetables
  • Switch to whole grains
  • 30 minutes of exercise every day
  • Drink water, especially a glass right before your meal
  • Wear your seat belt
  • Once a week, reward yourself for progress


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The Health Police

2/22/2012

12 Comments

 
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THE HEALTH POLICE
If you’ve ever seen the flashing lights of a CHP officer in your rearview mirror you've probably thought, "I'll never do that again." 

After you have your expensive ticket in hand, you console yourself that this is "a wake-up call.” 

The officer conducting my Traffic School one Saturday morning offered insightful words. “If you are here, you did something and got away with it. You did it again and got away with it. You did it again and got away with it...And you got to thinking that you could continue to do it and not get caught. That’s why you’re here.” 

The second time you see those flashing lights, you have some idea why fear is only short-term motivator. Changing long-established behaviors is a complex process only vaguely related to willpower. 

Shame doesn't work either. When asked by nosy reporters about his struggles with tobacco, President Obama should have shot back, "Don't you know that most people fail seven times before they manage to give up smoking?" 

Progress not perfection. We all fail. We all fall off the wagon. We don't have to beat ourselves up about it, feel ashamed. We can take note and get back on. 

In June, 2009, 15,000 people gathered in New Orleans for the 69th American Diabetes Association Scientific Sessions. Talking about The Obesity Epidemic in the city of food, is like having a 12-Step meeting at a casino in Las Vegas. For five days, doctors, nurses, dietitians, researchers listened to lectures, because we were trying to figure something out. 

In terms of peddling our wares, in this case prevention, we were searching for some rules of the road, a compelling GPS system that reminds our clients, "Slow down on that pizza. Don't exit here at the ice cream store. It's dangerous to drive in fast food neighborhoods." 

It's my opinion that health care professionals think they have more control than they do. Just as the CHP officers only catch a small percentage of speeders, we only get through once in a while. 90% of health decisions take place outside the watchful eye of the Health Police. Most of our criminals get away. 

Humans like to get away with things. Most hate rules, mandates and or-elses. Advice and reprimands are just as boring when you're forty as when you're fourteen. Who wants to listen to the hygienist reminder of the importance of flossing, or our doctor's warnings about smoking? Haven't you heard it all before? Don't you already know what you're supposed to do? 

I remember one of my patients patiently listening to my sage advice. He was young, but had lived with diabetes for many years. When I was finished he said, "Thanks for telling me what I already know." 

"It's my job," I replied. I didn't mean to be a boring, know-it-all. It's my job to try. Some of what was discussed at the ADA meeting was how to try better. 

One session I attended, after a lunch of catfish and bread pudding, was entitled, Lifestyle Changes that Last. Evidence from Prevention Trials. 3,819 people participated for 24 weeks. 

The people in the study were not on their own. They had the flashing lights of information and encouragement behind them on their journey. Still, not all succeeded in becoming healthier, but those who lost weight, lowered their blood pressures, decreased the fat in their blood, offered some practical insights into their success. Those who met the goals had these things in common: 

1.     They wanted to do something not to get sick. 

2.     The kept their goals realistic and changed gradually. 

3.     They had practical instruction. 

4.     What they did took into account their culture. 

5.     They felt important and listened to. 

6.     They made their own decisions. 

Nowhere did the findings reveal that fear, shame or nagging helped anyone in their accomplishments. So as I walked back to my hotel to make up for my high fat lunch, I tried to translate what I had learned into something useful. Here's my sage advice, even if I am telling you something you already know:

It's good to have a little fear of the future. If the way to eat an elephant is one bite at a time, don't attempt to devour the whole thing in a sitting. Seek out practical advice. Respect your view of the world, and apply your strengths to the task. Don't isolate. Talk about your struggles. They don't call this an epidemic because you are the only one struggling.
Assemble your travel plans, and then make a decision about where you want to be, next week, next month, next year. Now, get behind the wheel, and keep your eye in that rear view mirror.

 Mary-Jo Murphy, MS, RN, CDE  

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