Psychosocial Behaviors of Chronic Disease

This is a really hard topic to discuss but I think that it's worth discussing and to have dialogue on how we can help people to live their best lives based on the way that we approach the way that they eat. This is more about the psycho social pressures vs anything to do with the actual consumption of food and the guilt and shame that patients feel in relation to these events which in turn just make it harder for them to eat well.

As I've switched from being solely an online coach into a full time pharmacy health coach with nutrition coaching on the side , but doing a lot of the same type coaching in person, I've noticed some key differences. I think that it is of note that patients are referred to me due to their risk factors or current presence of chronic disease states such as high blood pressure, high cholesterol, diabetes, and sometimes anxiety and depression.

1) Many of the patients that come to see me don't necessarily WANT to be there. Some most definitely do, but some just want to get the incentive debit card and know that they have to do these appointments to do so. If someone comes to me for nutrition coaching, they pay me because they WANT to be doing the work. 

2) There's a huge element of mistrust in the beginning. When patients are coming to see me, they are literally talking to me for the first time and most of the time, I'm younger than they are. I'm this tiny little chick sitting behind a big office desk, and it's intimidating. Then, I'm all like "let's get vulnerable and talk about your health problems that are mostly related to diet." Yea, no. It doesn't work well. (I think they think I'm going to tell them to start eating kale shakes but I know they don't know me yet haha). With my coaching online, the internet and email provided a space for women to be free to be vulnerable with me. They had got to know me through my blog and in turn trusted me with their deepest secrets.

I have noticed that most of the time (and it's only human nature), the blame game starts. Everyone is embarrassed to tell me their height and weight, and then go into the reasons of why they weigh what they do. I am literally not mocking this. This is just literally what everyone does. Sometimes I preface the question with the disclaimer that no matter what they say, I will not be judging them and that I just need it for data purposes. It's almost like when the photographer tells you to just act natural. You make a goofy face anyway. haha! It's just what people do. 

But, what I've noticed is pain and suffering in their eyes when they tell me about their weight gain. I won't say MOST but a large percentage of the people that I'm going to be working with need to lose a pretty significant amount of weight and it's to the point that it's caused disease. I have a dietician on staff that I can refer them to, but many times patients aren't even interested in this service. I can remember three instances of women telling me about their 50-100pound weight gain, and I can almost SEE visible tears in their eyes, but when I say that I want to help them to make big changes, the first thing they say is: 

"My mom is overweight." "It's hereditary." "This medicine caused it." "My metabolism has been slow since I was a child" 

... and on and on and on.

The problem with this, as a culture, patients have begun to believe this 100%. They are not just saying these things to me just to feed me a line or they wouldn't be looking at me with tears in their eyes. They truly believe that the weight that they have gained is from things that are outside of their control, and in many circumstances, there are things that ARE outside of their control therefore not trying at all seems to be the most viable and reasonable option. But there is unfortunately a victim mentality (again please hear my HEART and finding ways to help NOT judge but that is the truth).

I begin to ask if there is any anxiety or depression present and patients start to open up. This isn't always the case, but then slowly it might come out that there is some emotional eating going on that they can't get a handle on. Being from the deep south, everything is deep fried here and if it's not, then people think it's healthy. Yall, my family just discovered how much they love guacamole and I love them, but I have lovingly laughed at them that I KNOW the reason that they "haven't liked guac" is because something such as avocado in Shelby is considered healthy and is then considered gross (quinoa & hummus are other examples of such foods that "sound healthy therefore = gross lol). All of that to say, intuitive eating for most everyone here is not one of true balance that has any form of good nutrition. Most patients tell me they eat oatmeal, grilled chicken and veggies and same for dinner and of course, that just doesn't add up. I don't want to say they lie to me, but it's funny how everyone says this.

As a health coach, I think there needs to be more dialogue about all of this. Where does self acceptance/hatred end and health begin? There has to be the balance, and I think that we are a culture of self acceptance and body love and if you are feeding your body CORRECTLY to prevent disease then that's wonderful, but we all want to live happy and healthy lives with the ones that we love so how do we do both and not believe all the lies that society feeds us to make us feel better about all the things that we are doing to ourselves? In the exact opposite, there are people that hate themselves so much that they see no point in the things that they KNOW they should be doing or they have disease states (PCOS, Hashimotos) and it becomes very VERY difficult and meticulously watching their diet is not the way they want to live their life.

I would love to foster better relationships with food in this town, but I know that's also a big dream. I would love for people to know that it doesn't have to be all diet or nothing. They hear that, but I'd love for the concept of intuitive eating to really sink in. A patient yesterday was explaining that any time she eats McDonalds, she feels disgusted with herself, she orders 2 cheeseburgers and fries when she doesn't even have the desire to eat that much but it's "off the diet" so she almost feels she "has to" eat more. It's this never ending cycle, and an unhealthy relationship with food is what is causing our obesity epidemic. We have magazines with decadent cakes but also diet plans on the same page. They preach balance, but what does that even really mean? Why do my patients think that they have to drink shakes and wrap themselves in aluminum foil to get their blood glucose and high blood pressure down.

I believe that as I continue to foster relationships with these individuals, I will hopefully allow a space of trust and for them to open up to me and allow me to hopefully help them, but until they want to, of course as we know, there will be no change which is a shame. They deserve more. They deserve to know that sometimes just "accepting" genetics and disease states is not something they have to do. They CAN feel better, but they have stopped trying because they don't believe in a system of success and stopped believing in themselves to be able to get there.

After listening to the book that I referenced in my last blog post, there was a large section about how individuals will do better time and again when they believe that they are going to be successful. They do better when they have an audience watching (i.e. social media) and they will do better in communities. I'm hoping that I can build a community that lifts one another up to say I KNOW THAT THIS IS HARD BUT I KNOW THAT YOU DESERVE THIS. 

It's not about weight because I don't think that weight is causation for the disease at all. I don't think that the actual adipose tissue is what leads to the diabetes or the hyperlipidemia or hypertension. The unhealthy eating habits of course, but it's this unbalanced eating habit of all or nothing with the fluctuations, which have been shown in clinical trial to lead to MORE weight and early death. As I tell my patients, I'm not concerned that they have a 120/80 blood pressure because who cares about that number. What I care about is that a patient doesn't end up with a heart attack or stroke so that they can love on their people for a full long and happy life!!! 

Regardless, I feel as if this is going to be something that I enjoy SO much. I have so many ideas to implement into this county (if they will let me lol) and I think the first step is helping others to see that it's just me empowering them to do the things that they could always do on their own. As one patient said yesterday, "All fat people know how to lose weight. We need YOU to encourage, motivate, and cheer us on." GIRL, I GOT CHU.

I would love dialogue in the comments about how we can bridge this gap and any ideas that anyone has on how to better serve a community of people who genuinely do not believe that they are even capable of pressing START. (I LOVED the comments on my last post and getting to chat with everyone so feel free to comment if you have thoughts)

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