"I’ve always understood Coke to be cancer in a can, and Diet Coke to be even more full of chemicals. How can the British Society of Lifestyle Medicine be advocating people drinking Diet Coke, because this just goes against everything I believe in?"
This was a question asked at a nutrition talk that I recently attended, and it is an incredible question that we can learn a huge amount from. In two sentences it highlights not only how passionate people are about lifestyle change, but also what can sometimes be our biggest weakness in the fight for lifestyle change; our own preconceived ideas and beliefs. How easily we can totally miss the point when we place too much focus on our own rules rather than on how to help people establish their own. Particularly when we allow those rules to be based on our preconceived opinions, and our practice to be based on our beliefs, rather than scientific evidence (there is no current convincing evidence that sugar-free soft drinks are harmful to humans in moderation).
It is this black and white, all or nothing approach that I believe to be one of the greatest hindrances to us having a meaningful impact on lifestyle change at a public health level. And it’s a huge shame because it is probably entirely well meaning. To be outraged by the idea that someone might recommend your patients anything other that the purest, healthiest options surely demonstrates the deepest levels of care and concern, right? But that can easily take us from caring and attentive to sanctimonious and judgemental before we even realise it. If we tell people they have to give up everything that they enjoy, they will either fail or not bother in the first place. It is no different to advising nicotine replacement products to people who are trying to give up smoking. The lesser of the two evils can often be a really useful tool, in what has to be a gradual process.
To explain a little bit about this, I am going to use myself as a case study. In the last 6 years I have lost a total of 35kg in weight, 10 inches off my waist and 6 off my chest, I’ve gone from my exercise program being 15 minutes on a cross trainer and 15 minutes on an exercise bike to squatting over 100kg, doing Parkruns, 10Ks, a Tough Mudder (ok a Tough Mudder Half), a Hell Runner, and getting up at 5am to fit gym sessions in before work. But the most important part of this description of my story is this: six years.
You don’t wake up one day and go from being sedentary and living off eating out and convenience foods to suddenly being a gym bunny living off chicken and kale, but I have tried to do that many, many times. And that is why I failed many many times. Because I believed that successful lifestyle change meant a total overhaul, and anything less was failure. But willpower is finite. When you need to make changes this big, it shows that your habits, your mindset, your social constructs, your beliefs and your support system are probably in keeping with the lifestyle you’ve become accustomed to over many years. Your whole world is literally designed to keep you living this way, and the likelihood is that if you try and do too much too fast you may be more likely to fail.
With all the weight I have lost and all the ways my lifestyle has changed, I still drink Diet Coke. I still eat ready meals, I eat protein bars, and I skip the gym and go out for cake instead. I still want to raid the biscuit tin at work, and eat the free sandwiches at meetings. But am I fit? Am I healthy? These are questions too complicated to answer with yes or no, but there is no question in my mind that I am healthier now than I was before with 35kg of fat weighing me down, out of breath from walking up the stairs, embarrassed to wear anything other than black and buying my clothes online so that the shop assistants wouldn't see me buying 40” waist trousers. I am not perfect, no. But I am better. And because I know I am capable of being better, I am going to continue to do so.
And this is what the BSLM #1change campaign is all about. Lifestyle change isn't about being perfect; it isn’t about smoothies and chia seeds, avocado and quinoa and micronutrients. It’s about picking your battles and embracing easy wins; eating more vegetables, getting more steps in, swapping Coke for Diet Coke, the list goes on and on. Making just ONE change can have a huge impact on a person’s health while barely being noticeable day to day, and that success is likely to drive us to make more changes. And the sooner we stop focussing on perfection and start focussing on continuing to get a little bit better step by step, the sooner we can have a real an lasting impact on people’s health. So what are you waiting for? Choose your #1change and get started. Who knows where it might lead?