A Note to Health and Wellness Professionals
If you read this book, you are likely interested in better understanding why so many of your patients fail to stick with their intentions to exercise, change their eating habits, and lose weight—and what you can do to change this. This book was designed to help you in your professional capacity as well as in your own life.
As you’ve seen in your work, getting people to say they want to change their health behaviors can come easily—at first. The problem is that people quickly revert to old habits, resulting in high rates of disease, lost productivity, poor mental health, and spiraling healthcare costs. Most of us in health promotion and healthcare have been taught that we should promote “better health” and “disease prevention” as the valuable outcomes to motivate people to practice the lifestyle behaviors necessary for healthier living and disease management.
The problem is that what we’ve learned and how we’ve been taught to prescribe “behavior” comes out of a medical framework, one that doesn’t take human decision making, motivation, and behavior into account.
Research shows that future health benefits, such as disease prevention, are too abstract to overcome people’s inertia and hectic schedules. When motivation is linked to distant, clinical, or abstract goals, health behaviors are not compelling enough to trump the many other daily goals and priorities they constantly compete with. Even weight loss as an impetus for diet and exercise, particularly for women, is often based in self-rejection; while it is great at eliciting intentions to change, in the long run it frequently fails to motivate behavior long term.
In this new era of healthcare, patient self-management and self-regulation decisions are essential for improving outcomes and decreasing costs. Yet, as a result of the many distractions and alternative choices that are a constant part of their busy daily lives, patients are at risk of self-management failure. A prescription for lifestyle change to optimize health seems like good medicine. But if most people are not motivated to sustain it over time, then the actual health benefits will be small.
In fact, we might even consider that promoting the wrong reasons for a behavior change as being a very costly strategy, expensive for everyone. It’s expensive for our organizations because they are investing their resources in promoting future reasons for change that tend to drive short-term results (not a very good ROI). It’s expensive for us professionals because when the people we counsel don’t follow through we feel discouraged and ineffective, and maybe even stop enjoying our work (a recipe for burnout). It’s expensive for our patients and clients because they really do want to change, so when they are not successful sustaining their desired behavioral changes, their hopes are dashed and they often become ambivalent about and resistant to investing again in their own self-care.
The health-related reasons for making lifestyle changes that we health professionals care about are irrelevant to which reasons will be most relevant and compelling to patients’ lives. It doesn’t matter whether or not things like weight loss or better health are “good” or actual goals that we want our patients to achieve from behaviors like physical activity. It does matter, however, that these goals may be ineffective for many because they don’t make physical activity explicitly relevant to our most important daily roles and priorities. As a result, these types of goals don’t imbue exercising with the type of significance that has the positivity and potency to consistently motivate most people to prioritize and sustain physical activity and other self-care behaviors in their lives. My research and other science suggest that people are more likely to sustain behaviors that are essential to their daily lives in immediate and noticeable ways.* This simple idea is also supported by the tried and true methods that marketers use to promote ongoing customer behavior.
No Sweat is written for individuals looking for real and sustainable ways to feel better, live better, and become happier, healthier, and fit. Because most people who intend to get healthy or who start exercising drop out within six months, professionals who work with patients, businesses that promote exercise to their employees, and the government, which funds Medicaid and Medicare, are all desperate for new behavioral solutions that are grounded in research and that can actually work long term.
No Sweat provides a scientifically supported, simple, and time-tested health-and-fitness solution that can fill this need for a very large market. However, the approach I teach should not replace medically necessary behaviors. My approach, though, can be used as a strategic ally—as an “in”—to enhance motivation even when there is a very real and compelling medical need. This philosophy and approach is inherently patient-centered. I hope No Sweat can help you identify new ways to help your patients discover the reasons that will truly motivate them, and that you will recommend the book to your clients and patients, especially those who are ambivalent or lack the motivation to stick with self-care behaviors, like physical activity, sleep, or dietary changes for the long term. No Sweat is also a resource for people who don’t feel comfortable or confident prioritizing time for their own self-care. For more information, please go to www.michellesegar.com.
* Michelle L. Segar and Caroline R. Richardson, “Prescribing Pleasure and Meaning: Cultivating Walking Motivation and Maintenance,” American Journal of Preventive Medicine 47(6), December 2014, 838–841.