Some Habit Advisories

The most recent post, about non-compliance or non-adherence in a medical setting, stresses the crucial importance of habit formation because as Professor Gérard Reach phrased it, adherence then becomes non-intentional, “thereby sparing patients’ cognitive efforts.”

In other words, the person doesn’t have to think about it. Certain behaviors can be put on auto-pilot, which is only a problem when the behavior has negative effects. The secret is to make sure all our habits are positive ones. But first, how does a person even form a habit? In some cases, intentionally. Many seekers have discovered effective strategies.

Author and speaker James Clear names three simple methods for good habit-building. The first is to start with something “so easy you can’t say no.” The key is consistency. Even if you only exercise for one minute per day, the persistent dailiness of it will eventually take hold and blossom. Clear writes,

Prove to yourself that you can stick to something small for 30 days. Then, once you are on a roll and remaining consistent, you can worry about increasing the difficulty.

The second key is reflection. People being the complicated creatures that we are, there is often an emotionally-based roadblock in our way that doesn’t really need to be there. The example Clear gives is of a woman who realized the main reason she didn’t like to exercise was being looked at by other people.

One day her brain decided to expose the wonky thought process that kept her from working out, and her subconscious messaged her conscious brain and said the equivalent of, “Duh! I could get a video and do some yoga at home.” Committing to that, twice a week, became one of the foundations for positive habit-building.

The next one is, “Develop a plan for when you fail.” But wait — this is just basically assuming that failure is your destiny. Isn’t that terribly negative? Well, no, it’s just realistic. It is one of the built-in roadblocks, but it can be moved out of the way. Okay then, what would be a good plan for when you fail? Resolve that it will prove to be a lone instance. Clear writes,

Make this your new motto: “Never miss twice.” I find the “never miss twice” mindset to be particularly useful. Maybe I’ll miss one workout, but I’m not going to miss two in a row. Maybe I’ll eat an entire pizza, but I’ll follow it up with a healthy meal. Maybe I’ll forget to meditate today, but tomorrow morning I’ll be oozing with Zen.

The big message here is, our past is not our destiny. A simple, everyday thing — like a good habit — can make an enormous difference, and the only way to find out is to give it a try.

Your responses and feedback are welcome!

Source: “3 Simple Things You Can Do Right Now to Build Better Habits,” JamesClear.com, undated
Image by Nenad Stojkovic/CC BY 2.0

Non-Adherence Is the Default Option

Non-adherence is the default option. So says Gérard Reach of the Sorbonne’s Education and Health Promotion Laboratory, who wants to know why patients sometimes will not do what their medical advisors have advised them to do for their own good.

What does default mean, exactly? A couple of things, but the applicable meaning here is, “a selection made usually automatically or without active consideration due to lack of a viable alternative.” Another dictionary puts it a different way: “What happens or appears if you do not make any other choice or change.”

Sadly, the default option for humans is usually to do nothing, rather than something. This is strangely true even when the person knows full well that she or he ought to be doing something.

Non-adherence is the same as non-compliance, and it happens a lot, increasing the severity of serious illnesses and the number of unnecessary deaths. Just like so many other factors, patient non-compliance needlessly bumps up healthcare costs.

So, what can bring about an increase in patient adherence? What can make it possible? As in so many cases of human behavior, it appears that studying the most successful performers would give some clues. This has been done,

[…] using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses.

When someone brushes their teeth, they automatically rinse the toothpaste from their mouth. There is no need to consult the “to-do” list as a reminder. When a behavior is automatic, consciously remembering to do it is not a factor. Nor is it performed in order to dutifully check it off a list. Without reflection or debate, it just happens, as is the nature of a firmly ingrained habit.

How can that automatic quality be transferred to actions the doctor advises? Habit formation is crucial because it “allows adherence to become non-intentional, thereby sparing patients’ cognitive efforts.”

The author’s conclusions come from 20 years of observing patients with diabetes but, he says, “can be applied to all chronic diseases.” It seems that the relationship between the patient and the health professional is crucial. Two major factors are patient education, and shared medical decision-making.

The non-compliance problem was been officially recognized in academic literature for at least 40 years, although of course it is probably as old as time. It has been approached in various ways although, Reach says, “they fail to address its underlying mental mechanisms”:

Non-adherence may well be the default option, with only some patients managing, with considerable effort, to perform the unnatural action of practicing a treatment over the long term. The real question then becomes, how is patient adherence possible?

Your responses and feedback are welcome!

Source: “How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities,” Tandfonline.com, 07/18/23
Source: “Default,” Merriam-Webster.com, undated
Source: “Default,” OxfordLearnersDictionaries.com, undated
Image by 807th Medical Command/CC BY 2.0

Obesity and Comedy

What is it with comedians, obesity, and the compulsion to tell the public all about it? And here is a twist — two individuals in the entertainment business whose weight situations have proven interesting in ways that the public apparently never tires of.

Rebel Wilson gained 100 pounds in college because of polycystic ovarian syndrome, and still managed to launch a career as an actor and comedian. Another factor is a problem that most women will not face, but because of her role as a character called Fat Amy in a film series, she was contractually required to maintain her weight for five years.

Time goes on

Later on, approaching age 40, Wilson was compelled by the medical necessity of addressing the PCOS condition in hopes of being able to freeze some eggs. This led to declaring a “Year of Health” in which self-care would be her main mission. She switched to a high-protein diet and worked with a personal trainer, whose motto is “Weight loss is a marathon, not a sprint.” Then, though many people gained weight during the coronavirus pandemic, she found the lack of work-related demands helped her to ease up on the stress-related eating.

That same trainer also is in favor of progress photos. In Wilson’s case, these were shared widely along the way to an 80-pound weight loss. Her social media followers contributed lots of encouragement, although a subset of fans wanted her to remain the “funny fat girl.” She also found solace in the concept that if you love yourself as you are, it is much easier to change.

Comedian, pianist, and public speaker

As a child in a small, intolerant town, Owen Benjamin was abnormally tall and, in his own words, “super fat,” but not inclined to be combative. He endured quite a lot of bullying before discovering that he could get some relief by making people laugh. Thanks to his father’s professional connections, Benjamin was in the children’s chorus of an opera at age six, and knew from then on show business would be his life’s work.

As a grownup, he achieved a fair amount of success as a comedian, then decided to get back to the land and try farming and raising a family in a remote area of the country. But he keeps in touch with fans and critics through social media and podcasting. Some people love him; others, not so much. They just enjoy ragging on him and scoring points with other haters.

At some point in his adult life, Benjamin weighed 320 pounds, which is a lot even for a preternaturally tall human. He has at some point stated that “fat women are gross,” but with a professional comic, it’s hard to tell what is sincere and what is a bit. He has also publicly called former Confederate Alex Jones fat. And all along, weight has been a major issue. Only a couple of weeks ago, he posted a tweet saying,

I’m down 50 lbs in 3 months and want to report my findings. I gained a lot of weight homesteading because I figured nutrient and calorie rich food if it’s raw and unprocessed wouldn’t put on weight. I was very wrong.

Because of his provocative political opinions, which may be intentionally exaggerated for the purpose of keeping the public interested, Benjamin has a large number of followers who enjoy arguing about his true motives. A section of Reddit is devoted to him, where fans and foes love to bicker about how large he is/was/should be, and make fun of his selfie-jogging videos. They get all worked up, squabbling over their guesses about Benjamin’s BMI, which is a difficult call because his height is variously reported as 6’6″, 6’7″, and even 6’8″.

The bottom line is that this comedian seems to have segued into becoming a professional fat person, and may find out, as Rebel Wilson did, that it is not an easy role to escape from.

Your responses and feedback are welcome!

Source: “Here’s Exactly How Rebel Wilson Lost More Than 80 Pounds,” WomensHealthMag.com, 07/05/22
Source: “Girl on guy 116: owen benjamin,” GirlOnGuy.net, 12/03/13
Source: “Brainy Quote,” BrainyQuote.com, undated
Image by Carlos Pacheco/CC BY 2.0

Blake Hammond Brings on the Fat Jokes

It is always interesting to hear fat jokes from an obese comedian (others, not so much.) For anyone who works in the field of obesity prevention or alleviation, an overweight standup comic’s act might contain useful insights and even revelations.

For Blake Hammond, who bills himself as “Cincinnati’s premier fat comedian,” it all started when he was a small and “somewhat sickly” child, ditching first grade to stay home and watch Saturday Night Live reruns. He especially liked the Weekend Update segments, and later, after earning a degree in journalism, he became a freelance writer of reviews and features. But his reviews somehow tended to turn into roasts.

Accepting that he mainly wanted to write jokes, he started to dabble in live comedy by going up at open mics. At the same time, he was working intermittently at a restaurant, which enabled him to keep a finger on the pulse of what everyday people were thinking about, which is useful knowledge for anyone who puts together a comedy routine. With another comic, Jeremy Johnston, he co-hosts a podcast whose format is “two fat guys on a couch talking.”

Self-image and other issues

Hammond variously describes himself as a guy who looks like an Easter egg, a failed celebrity chef, or Jabba the Hutt. He talks about being picked on in grade school, “but I was fat, so I deserved it.” He recalls the marriage proposal he made: “I got down on my knee and my girlfriend called 911.”

He objects to the term “person of size” because it abbreviates to POS, the same initials as a very rude insult. (Sadly, his funniest fat jokes are not suitable for repetition here.) And there are dark hints. Hammond told an interviewer that he suffers from “crippling anxiety,” and he has referenced suicide. He talks about fat nightmares, which include shopping at the Big and Tall store and being weighed by the doctor.

Of course, if a certain type of crime occurs, there is an advantage to being fat, because “If they find a body on a hiking trail, they’re not going to come looking for me.”

For more on the intersection of obesity and comedy, see these posts:

“How Funny Is Obesity, Anyway?”
“A Strange Fellowship”
“Edutainment and Jim Gaffigan’s Books”
“Hefty Humor”
“Is Laughter Always Good Medicine?”
“Lisa Lampanelli and Stuffed”
“Mindy and Monica”
“‘Insatiable’ Revisited”

Your responses and feedback are welcome!

Source: “Cincinnati Comedian Blake Hammond to Tape Amazon Prime Special at MOTR Pub,” Citybeat.com, 10/26/21
Image by Twitter

More About New Drugs, Strong Arguments

Believe it or not, the response of a TV personality to a TV writer is worthy of an article in the New York Post. Gary Janetti quipped, “This summer on Bravo, The Real Housewives of Ozempic,’ to which Andy Cohen replied, “It’s already airing.” This exchange offered a foundation for unloading information about the popular weight-loss drug, just in case anybody in America has not heard of it yet.

Mayo Clinic endocrinologist Meera Shah had something to say about Ozempic and its siblings, in terms of their side effects. It seems that many people are not that bothered, and others are willing to tolerate the nausea, pain, diarrhea, and constipation. Folklore has it that the uncomfortable results diminish over time, but the cold fact is that “at least 10% of patients who start these drugs have to be taken off of them because the side effects do not improve.”

Dr. Shah specifically mentions the mental anxiety related to not knowing when a bathroom emergency will arise, especially in unfamiliar surroundings. It is very nerve-wracking to never know when pain might hit, or whether it is safe to eat away from home, or if a restroom is readily available. It gets worse. The brain is connected to the gut, and when the brain is in turmoil because of this kind of stress, it tends to make intestinal issues even more pronounced.

There is another medically significant issue: the threat of malnutrition because the appetite is suppressed too much for the person’s own good.

Shah said she commonly has to advise patients to take multivitamins or protein supplements in addition to the medication because they aren’t getting the nutrients they need from food.

Dr. Shah also mentioned to journalist Cara Korte that the job of a diagnosing physician is more difficult when a patient is not forthcoming about previous issues around eating disorders. If a patient admits to a history of disordered eating, she refers them first to another staff member, a behavioral psychologist.

Jens Juul Holst, who helped to develop the GLP-1 drugs, told the press, “[I]t’s unlikely that people will want to stay on the drugs for more than two years.” After a while, it’s a drag to not have an appetite or enjoy eating.

“That may eventually be a problem, that once you’ve been on this for a year or two, life is so miserably boring that you can’t stand it any longer and you have to go back to your old life,” Holst said. Some of these meds have been available since 2005, and “studies have shown that people don’t stay on them for a long time.”

Your responses and feedback are welcome!

Source: “Andy Cohen jokes ‘The Real Housewives of Ozempic’ is airing on Bravo,” NYPost.com, 06/21/23
Source: “Ozempic side effects could lead to hospitalization — and doctors warn that long-term impacts remain unknown,” CBSNews.com, 06/10/23
Source: “Scientist Who Pioneered Drugs Like Ozempic Says They Make Life ‘So Miserably Boring’ After Two Years of Use,” People.com, 06/15/23
Image by Lance Fisher/CC BY-SA 2.0

New Drugs, Strong Arguments

One of the fastest-moving news stories of the past months has been explosive growth in the release of, and the voracious market for, weight-loss medications based on semaglutide and other GLP-1 agonists.

Early in 2021, the “game-changer” chatter had already started, after The New England Journal of Medicine published news of semaglutide as an anti-obesity pharmaceutical. Phrases like “new era” and “huge potential” were being thrown around, and turned out to be quite prophetic.

Also prophetic: “Semaglutide is likely to be expensive,” as journalist Gina Kolata noted in The New York Times. (The injection “pens,” whether multiple-use or single-use, surely represent a significant proportion of the production cost.) And even then, cautious voices were saying things like,

A high-dose regimen of the drug has not been studied long enough to know if it has serious long-term consequences. And it is expected that patients would have to take it for a lifetime to prevent the weight loss from coming back.

In the spring of this year, some experts curbed their enthusiasm with phrases like “efficacy… within confined parameters,” “downside that some overweight individuals may not be inclined to acknowledge,” and “significant health hazards, such as pancreatitis and thyroid cancer.” Since then, both ecstatic endorsements and dire predictions just keep piling up.

At the top of the worry list for some is the prospect of children getting daily or weekly injections, while others hold that, in the name of preventing childhood obesity, “anything is justifiable.” By “anything,” they presumably mean acquainting and providing minors with injectable drugs which, face it, will happen anyway if the kids get type 2 diabetes.

A piece by Judith Wood was subtitled, “We should do the humane thing for our children, rather than question the ethics of weight-loss injections.” Having grabbed the audience’s attention — “What? Abandon ethics?” — the journalist justified the extreme stand by noting that the obesity crisis is “no longer looming, it has entered that state where it has well and truly arrived.”

And the United Kingdom may have reached the point where its citizens must face unpalatable facts and consider doing even “the unthinkable.” One argument is that due to the yearly cost of obesity-related illnesses, the United Kingdom is bound to run out of money:

Two in three adults in the UK are overweight or obese; if they weren’t, the NHS could save almost £14 billion… Maybe we can’t save those struggling with the effects of excess weight. But we can sure as hell try and save the next generation.

Your responses and feedback are welcome!

Source: “‘A Game Changer’: Drug Brings Weight Loss in Patients With Obesity,” NYTimes.com, 02/10/21
Source: “Mounjaro Weight Loss,” Benzinga.com, 05/06/23
Source: “David Heathcote: Childhood obesity. Is there a better solution than injecting our children?,” ConservativeHome.com, 05/12/23
Source: “Anything is justifiable to avoid childhood obesity in Britain,” Telegraph.co.uk, 05/19/23
Image by Rob Lee/CC BY-ND 2.0

Dr. Pretlow to Participate in Significant Upcoming Event

An interesting virtual get-together and meeting of minds will take place in August, and Dr. Pretlow will be a participant (more on that later). This is not surprising, because the basic ideas are derived from the document “Reconceptualization of eating addiction and obesity as displacement behavior and a possible treatment,” authored by Robert Pretlow & Suzette Glasner.

There is a great deal of interest in developing ways to diminish the cues that lead to overeating: the pervasive intrusion of advertising; the ubiquitous presence of fast-food outlets; the holidays on which people feel compelled to eat for social approval; and other insidious factors.

But getting rid of cues, triggers and temptations can only go so far. There is a number of reasons, some of them having to do with American freedoms. After a certain point, people begin to push back, muttering such phrases as “nanny state” and “government overreach.” But the aversion is not only to political involvement.

Basic human nature prompts children to start saying “No!” at an astonishingly early age. As kids grow, they can develop unrelenting stubbornness when being told what is good for them by parents, teachers, partners, or even healthcare professionals. The resistance trait often carries into adulthood. It tags along, as part of the familiar and unexamined luggage we drag through the years and sometimes need to be reminded about, so we can take it to the landfill and dump it in a hole.

The interesting part

There are people on whom cues and triggers do not work. They can look a bag of chips or a chicken wing straight in the eye and be unmoved. What is it about such people? What is their secret? Where does this superhuman ability come from?

If we consider the proposition that the true culprit is stress, the outlook becomes more hopeful, because that can be handled to some extent. If a person isn’t stressed out, cues and triggers have less opportunity to sink their teeth in. Apparently, some folks are simply not constitutionally predisposed to crumbling under stress. As with so many other human problems, there could be a genetic element.

It is also possible that these fortunate individuals have successfully and non-violently removed one or more sources of stress from their lives — and if so, this is also worth looking into. Maybe some folks have learned to cope with stress by cultivating proactive, creative and effective ways to burn off nervous energy. They don’t get overwhelmed and eat themselves into oblivion, because they have developed toolkits. A person can learn a skillset, which is what BrainWeighve is all about.

What to look forward to

The August event, “Consensus Building Workshops on addiction-like symptoms related to consumption of certain foods,” is the creation of four colleagues whose ambitious goal is to persuade the World Health Organization “to include symptoms of addiction related to food, as a disease, in the International Classification of Disease, ICD-11.”

It will consist of a number of online workshops on the subject of food addiction as a disease.

(To be continued…)

Your responses and feedback are welcome!

Source: “Reconceptualization of eating addiction and obesity as displacement behavior and a possible treatment,” Springer.com, 06/22/22