In keeping with last week’s departure from the indolent and intractable health care crisis, let’s talk about an issue that pervades and plagues the daily life of the practicing physician: lifestyle change.

Almost every treatise on every chronic illness ends with a list of recommended therapies that ends with “lifestyle change.” It’s so pervasive it’s become almost background noise. But its ubiquity isn’t the only reason it is often ignored—it’s the single most difficult thing to achieve.

How many people park their car in the garage and let it sit for a few months, or years? No one, right? It’s a sure-fire way to deplete the battery and then destroy the engine. You also wouldn’t think of letting it go without an oil change or a tune-up periodically. You certainly wouldn’t pour water in the fuel tank (note to smokers). And this is for something that, granted its expense, is replaceable.

But a surprising number of people think nothing of engaging in long-term behaviors that hasten the deterioration of the irreplaceable vessel that houses the brain that harbors the mind that’s destroying the body. Ironic, isn’t it? But that doesn’t mean it isn’t understandable. Healthy diets, regular aerobic exercise—these are things that require discipline over the long haul and can be boring and painful in the short run. There are some jocks and “health nuts” out there that truly enjoy “the lifestyle,” but they are decidedly in the minority. I know I’m not one of them. Oh, I enjoy the consequences of doing what I must to fight the midriff bulge and keep my blood sugar from springing from the starting gate like some oats-primed thoroughbred at Churchill Downs, but the thought of doing that 20-30 minutes on the elliptical trainer doesn’t cause my spirits to soar any more than yours. When we were younger most of us exercised as a matter of course; we played softball, tennis, soccer, or whatever and the pain was hidden in the exhilaration of the competition and camaraderie. As we got older, life’s stresses mounted and time constraints took priority. On top of this, various aches and ailments began to surface, interfering with the goal of an active lifestyle.

The truth is, except for those with serious physical limitations, I’ve found that most people have to realign their priorities. You wouldn’t think of not brushing your teeth every day but you’ll go months without using your lungs and muscles. “I don’t have time,” is the most frequent excuse. But, if you wanted to make the time, if you thought it were important enough, how much time could you spare? An hour a day? A half hour? If you can convince me that you don’t have a half hour four to five times a week, I’ll concede you aren’t a candidate for lifestyle change—only psychiatric counseling.

So that’s what I recommend to my patients, who, if any of them are reading this, will readily recognize the rant. Find an aerobic and muscle resistance regimen that you can do for a half hour four to five times a week, cut your carbs in half, and stick with it long term. If you have a bad day, do fifteen minutes to stay in the psychological loop. Avoid niche or crash diets which will give short term gains for you and long term (financial) gains for the vendors.

If you don’t want to do it for yourself, then do it for your poor doctor. Because the better you’re doing, the less hard I have to work.

And that makes me feel much better.


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