Saturday, December 20, 2014

Can We Force Someone to Be Healthy?

M. Hudnall Blast-from-the-past originally posted 11/2009 on WATRD.

Self-efficacy is a big word.  Okay, two words.  It’s about our belief in ourselves, essentially that we are in charge of our thoughts and actions.

The concept pops up in my mind every time I hear someone say it’s a person’s duty to live a healthy lifestyle.  We see these kinds of statements often in discussions that get into HAES principles. “It’s okay if someone is fat as long as they’re eating healthy, exercising, etc.”  Meaning it’s not okay if they’re not doing that because of the impact their choice may have on others such as family members who might have to care for them if they fall ill, or the rest of us who end up paying for it via health care costs.  I won’t get into whether people feel the same about someone who isn’t fat.

It also comes to mind when I hear discussions about taxing foods in order to address obesity problems.  (Disclaimer:  Not all obesity is problematic, and I happily reclaim use of the word obesity, thanks to Kim.)  Because many of us appear not to be able to handle eating problems by ourselves, some folks think legislating (translated: taxing) us into better eating habits will work.  Although I wonder without researching my question whether it might not be more reasonable for a whole lot of reasons to reduce corn subsidies that have made the sweetener used in sodas so inexpensive.  If sodas are taxed, seems like we’re paying for them twice.  But I digress.

My point about self-efficacy is that neither of the above scenarios helps build it in the person who is struggling with it.  Not everyone struggles with self-efficacy, but many people who struggle with eating, weight and body image do.  And feelings of self-efficacy are essential to successful change.  Generally, if someone doesn’t believe they can do something, they can’t.

In my eating disordered days, no one could have been more intent on leading a healthy lifestyle than I.  But my belief in myself was damaged by years of attention paid by family members to my weight.  Never obese in the clinical sense of the word, yet never really thin compared to siblings and other family members, I was always the odd one out in terms of size.  And they let me know it.  It damaged my self-esteem, growing up thinking I was somehow less acceptable than others because of my size. The often scornful comments I received about my weight from family members only made me feel worse about myself and sink deeper into the struggle that consumed my life.  My salvation was finding myself in other things; a healthy lifestyle followed because of my own desire, not because someone pushed or shamed me into it.

Long story short, it’s unlikely that any form of dictating to people is going to help them adopt healthy lifestyles, whether it’s a general belief by others that someone “should” or an attempt to force them into it.  Forget about how that might make someone dig in their heels and resist any attempt at change.  In essence, such thoughts and actions smack of disapproval, and all disapproval does is chip away at our ability to believe in ourselves.

How good are you at believing in yourself in the face of opposition? It definitely slows me down.

WATRD

photo courtesy of Vlados

Comments

31 Responses to “Can We Force Someone to Be Healthy?”
  1. Cait says:

    Marsha:

    I love that you’re here, and this essay you’ve just posted. It is exactly on topic to a lot of thoughts that have been floating around in my head recently, and I think you’re hitting a lot of topics that we really do need to cover in this blog. Thank you.

    For my own personal experience… I have a hard time learning when to let go. My stubbornness gets in the way of even listening to myself at times. That said, opposition doesn’t phase me much. People not believing in me is my standard status quo… and for a lot of my life, I didn’t believe in myself, either, but I did it (whatever the particular “it” in question entailed) anyway, and just refused to give myself (or my stubbornness) any credit when/if I actually succeeded.

    That’s not the same as self-efficacy, though. I still wasn’t succeeding in believing in myself, or believing I had control over my thoughts and actions. It was just slogging through the motions based on a “should” I didn’t even believe in. And once you take that mental state into account… being in that forced “should” state was the least healthy period of my life.

  2. Meems says:

    I’m with Cait on this one and can’t really say much that she hasn’t already. I will say that, while health is, to some extent, a priority for me (in that I choose to walk instead of drive or take public transportation on a regular basis and choose to eat a primarily all natural/organic, whole grain, lean protein, high in fruits and vegetables diet) I don’t really care what other people choose to do because it is their choice. The only responsibility an individual really has, in my opinion, is to him or herself, though this is a little different when someone has children.

    What does bother me is all this talk about the “American obesity epidemic” as though Americans are some monolithic group without individuality…and as though obesity in and of itself causes health problems when that hasn’t been conclusively proven.

    • Cait says:

      I don’t really care what other people choose to do because it is their choice. The only responsibility an individual really has, in my opinion, is to him or herself

      Is there a way to care, though, without shaming and forcing?

      I think it’s interesting that our society’s reaction to both the ED girls and obese people is the same, with this shame-and-force thing, and in neither case does it seem to work particularly well.

      So what I’m wondering is, without throwing our hands in the air and saying “your bad choices are your problem and I don’t care about them”, can we find a way to be genuinely helpful and encouraging to people who are putting other priorities ahead of their personal health?

      • Meems says:

        Ah, that’s not quite how I meant it. When I saw that I don’t care what other people choose to do, I mean it as in “it doesn’t bother me if people choose to eat McDonalds instead of home cooked food.”

        Is there a way to treat EDs without shame and force? I really hope so, but it’s not something I know a lot about.

      • “…can we find a way to be genuinely helpful and encouraging to people who are putting other priorities ahead of their personal health?”

        Cait, I think that’s what HAES is about. It’s about helping people see a way to health that isn’t shaming, deprivative, unpleasant. Too bad it’s so misunderstood.

        And thanks for the welcome. I love being here.

  3. lissa10279 says:

    What a thought-provoking post. I really think people have to WANT to be healthy. It is something that weighs each decision I make (even the chocolate I just had after walking the length of Detroit Airport’s Terminal A 4.5 times tonight!) I am not perfect, but health is at my forefront, but it isn’t at everyone’s. And we can encourage and inspire through our own beha vior.

    • Cait says:

      I am not perfect, but health is at my forefront, but it isn’t at everyone’s.

      This is a very interesting way of phrasing this, Lissa. I really like it.

      I wonder, though… do you attach judgment to that statement? Do you think it is morally important that we all should put health at our forefront? Because that’s where I always run into problems… it seems like the answer should be yes, that health is important, taking care of one’s body is important, and is something we should encourage.

      But on the other hand… it seems like there are reasons why people don’t always put health first… time and money being first, of course… you pretty much have to have one or the other (or both) to lead a healthy lifestyle (which comes first, going to the gym regularly or getting enough sleep? And if you don’t have time for either, what then?)… but also family commitments, career obligations…. sure those can be “excuses” if we frame it as such, but is it? or is it just a different set of priorities, and it’s a personal question that can’t be answered objectively to say if cooking a good meal or going to see an elderly family member is more important?

      I see so many reasons why people don’t end up putting health first, and a lot of them are good reasons. When they say they “want to be healthy” but can’t make health the first thing on their list… how do we encourage and inspire them in that situation? How do we express belief and support in them, knowing that “putting health at the forefront” isn’t an option available to them given the other priorities they’re carrying?

      • lissa10279 says:

        I realize it does sound judgmental and this is where I diverge from the FA movement … I DO wish everyone put health first, but I realize that isn’t the case. I mean, I see your points as to why people don’t … but it’s about decisions. Not buying the flat-screen TV so we can get a gym membership, for example. But I do know I’m probably not the norm — to me, health IS so important, but for most people, it’s not as big a priority. And I can’t change that — but can try to lead by example.

        • Cait says:

          Whenever this gets brought up, I think it’s interesting the examples people use. One of the things that is interesting to me overall is the question of weight and class (with a secondary focus of the affect of history and food history… that with corn subsidies and advancements in processed foods, it’s now often more a problem for the lower classes in america not to have “getting enough to eat” problems but “getting healthy food to eat” problems…)

          Because of this, I notice a lot the examples people use. Whereas my example is “cook a good meal or go visit a relative” your example is “gym membership or flat screened television”.

          And when you make the example you do, the answer seems easy. I agree, a gym membership looks more important than a new television. But what if “new television” isn’t even on the table. What if the question is “gym membership or gas for the car”? Because then it’s a very different story.

          I agree with you that it’s totally about decisions. But my personal experience tells me that when you take it out of hypothetical examples, and start asking real people why other things come before their health, those decisions tend to make more sense, and the choices become much less clear-cut.

      • People throughout history have rarely “put health first”. We only make it a priority when we have lost it, and even then some people cannot manage. The only reason people talk about it so much now is that they find fatness repugnant for aesthetic reasons and it is important to remember that we mainly focus on and criticize people who don’t put health first when there are reasons that we disapprove of behind their choices.

        One good example is people who engage in high risk sports like rock climbing, paragliding, scuba diving, and mountain climbing. People who do these things are not only failing to put health first, but placing survival behind risk-taking behavior. Do we question the fact that people climb Mt. Everest and lose fingers, toes, and noses and they clearly put health behind other priorities? The same goes for people who work a lot. They place career ahead of health, but no one questions their choices because we think that making money is more important than health.

        The hypocrisy behind discussions of health needs to be discussed and considered. If health is a societal or moral obligation, than it is one for everyone, not just those who are at a weight which is considered inappropriate. If legislation is going to be put in place to encourage health, then it needs to be in place everywhere for all behaviors that are a risk to health, not just those that address food.

    • Cait & Lissa,

      It’s because of the women I work with and perhaps my own history, but I see one of the major reasons that people don’t put health first is because they feel defeated about their ability to do that. The typical advice about what they need to do to be healthy is often too hard for them — whether it’s giving up foods they love because they’re rich in fat, sugar, salt or hopping on a treadmill or the like on a daily basis. Neither of these things is necessary for health but that’s a common perception, and I believe it defeats a lot of us before we even get started.

      • Cait says:

        Oh! Interesting point! (have I mentioned recently that I’m glad you’re here?)

        We have such an all-or-nothing culture, it shouldn’t be surprising that people feel like if they can’t “do it right” it’s not even worth bothering…

        And to phrase it in terms of the earlier discussion, when we talk so much about putting health “first”, it discourages people who know they can’t put health first, but might be able to move it from 7th to 6th on their priority list…

  4. CL says:

    “. . . feelings of self-efficacy are essential to successful change. Generally, if someone doesn’t believe they can do something, they can’t.”

    This is where the HAES view can be really helpful. If someone is determined to lose weight, but keeps failing (or succeeding and regaining) she might believe, with good reason, that she simply can’t lose weight.

    But, if your goal is health — strength, energy, nourishment — you can succeed. Exercise will make you feel stronger, and eating the right foods will make you feel more energetic. You might not lose a pound, but that doesn’t mean you “failed.” If you feel better, you are succeeding and you should feel proud (and motivated to keep making healthy choice).

  5. cggirl says:

    I second what CL just said.

    Also I think that even the definition of what is healthy is not something universally agreed upon…

    I will say that it would be great to make healthy fruits and veggies cheaper for people, instead of – or in addition to – taxing junk food. But I am not sure how to accomplish this.

  6. Elizebeth Turnquist says:

    Another version of your question could be : Do we have the RIGHT to force someone to be healthy?

    There is a strong blaming quality to the obesity epidemic. People saying or thinking, “It’s your fault for being fat and it’s my right to punish you because your fat is a burden.”

    I don’t believe fat is a choice. But, if I were to run with that argument, I’d say no one has the right to dictate my behavior.

    Unless I’m doing something illegal, of course. But, to date, being fat isn’t illegal.

    All the arguments, about how much fat cost society and how much of a burden fat people are to their community, completely skips the part about how I have the right to be fat.

    No one wants to say that – because it sounds awful – but it’s true. My weight is no one’s business except my own. For that matter, my health is no one’s business except my own.

    There are health issues where public policy is put into place for the good of us all. But fat isn’t contagious or imminently mortal. If I go into a crowded theatre, I’m not going to infect people with my fatness and they’re not going to die in the next week or month from my fatness. And, if I stay at home, I’m not even going to die next week or next month from my fatness.

    Fat isn’t a public health crisis. At best it’s a private health issue.

    Now, personally, I don’t think fat is a health issue at all. But, if I were to run with that argument, I’d have to say that my weight is something between my doctor and myself.

    All these statements swirling around about how much fat people cost society are incredibly judgmental and paternal.

    And, honestly, I just don’t get it.

    I don’t understand how anyone could say fat people don’t DESERVE health insurance and equal medical care because it COSTS TOO MUCH. I don’t understand how anyone can think fat people should EARN their right to health insurance and equal medical care by loosing weight.

    If you replaced the word fat with any other condition, like cancer or AIDS, people would be in an uproar. But, when you use the word fat, suddenly it’s okay.

    Its’ very American of me to think I deserve equal rights regardless of my lifestyle choices, long as I’m a law abiding citizen. But that’s exactly what I think.

    I don’t think I should be treated like a second class citizen becasue of my weight. I deserve equal rights no matter how fat I am or how fat I get.

    • julie says:

      I’ve heard plenty of people say that AIDS patients shouldn’t get treatment, unless they’re one of the innocent ones (babies, women whose husbands sleep around and bring it home, transfusion patients). Otherwise, it’s their fault. Cigarette smokers getting lung cancer? Drinkers with cirrhosis? Heavily tattooed people with liver disease? I haven’t yet heard that people who don’t eat their fruits and veggies and exercise shouldn’t have coverage if they get cancer, but i’m sure I will eventually.

      • julie says:

        I meant to say people who don’t eat all organic fruits and veggies (and food). The way people are starting to feel about food, this is poison, that is healthy, never eat this, eat this every day, I’m starting to think that I should protest each and every one of these laws, because soon they’ll be banning my treats.

        • Elizebeth Turnquist says:

          You right. Bigotry can run across the board. I’m not trying to say that fat bigotry is worse. I am suggesting that fat bigotry is less defended.

          That is my opinion. I don’t think the medical and scientific communities are as active in defending fat bigotry as they are other conditions. And I believe Fat Acceptance is still grass roots enough that advocacy against bigoted policy comes in baby steps and is not always heard by the the general population.

          As for the issue of food, your right, food should not be the enemy. We get really confusing messages that can make our relationship with food one of trepidation and even fear. And I think that’s wrong.

          “I should protest each and every one of these laws.” With this statement you hit the head on where I was going.

          I don’t care WHAT condition we’re talking about, I don’t think it’s right to support public health policy that blames the patient.

          There are people out there who disagree with me about this and I don’t understand their position becasue saying that certain people should be punished for their lifestyle choices seems inhumane to me. It just seems wrong.

  7. vitty10 says:

    I am not sure what the point is in taxing junk food, except for increasing government revenue. I don’t think this type of thing works, unless they plan to add $5 to each bottle of Dr. Pepper. When I was a smoker I smoked when cigarettes were $4 a pack. I also smoked when they were $8 a pack. The price was not a deterrent for me because I wanted the product. What was a deterrent was feeling like crap all the time and having my clothes and hair smell bad.

    The point is, if people want something they are going to buy it no matter what the price is. It is their choice and their right to buy said product. I am not perfect so I am not one to criticize the choices that other people make, and I don’t want to be judged for my choices.

    I think that before taxing junk food scientists should have to prove that it actually does make peoole fat. And scientists should explain how some thin people eat junk and remain thin, and how some fat people don’t eat junk but remain fat.

    I think that if the motive actually is health, positive reinforcement would work better. I recently had to cancel my gym membership and stop seeing my trainer, partially for financial reasons. I would really appreciate a tax credit or some kind of work incentive to have a gym membership. And again, the choice to take advantage of these benefits would lie solely with the individual.

    Lowering the price of fruit and vegetables would be great as well. When I eat grapes at work some people comment that I must be rich because grapes cost a lot.

    • Cait says:

      First off, hooray for quitting smoking!

      Secondly, I think this:

      I think that if the motive actually is health, positive reinforcement would work better. I recently had to cancel my gym membership and stop seeing my trainer, partially for financial reasons. I would really appreciate a tax credit or some kind of work incentive to have a gym membership. And again, the choice to take advantage of these benefits would lie solely with the individual.

      is a small example of exactly the sort of thing I’m discussing with Lissa. I’m assuming you didn’t take the money you weren’t spending at the gym and use it to buy a new flat-screen, correct?

      Lastly:

      I think that before taxing junk food scientists should have to prove that it actually does make peoole fat. And scientists should explain how some thin people eat junk and remain thin, and how some fat people don’t eat junk but remain fat.

      The problem with this argument is that it rests on “fat” and “thin”. I don’t think scientists have to prove that junk food makes people fat… because I don’t think there’s any information in that statement. So what if it does make people fat. Then they’re fat. And? There’s multiple reasons for people to be fat, that one of them is (or may be) junk food is… uninformative.

      The bigger question is whether junk food makes people unhealthy. (I personally believe the answer to be yes. Michael Pollan’s writing style and classism irritate me intensely, but I am a believer in more “real” food.) If we prove that junk food makes people unhealthy… that proof will hold true for the thin junk food eater, as well as the fat one.

      • vitty10 says:

        Thanks! I quit smoking 7 years ago and never looked back. I don’t know what i was thinking back then. Ah youth . . .

        You’re right. All I meant is that people go on and on about why are people fat, what makes people fat, but they don’t usually ask about health. I would be impressed if someone asked whether or not junk food makes people unhealthy.

        And no, LOL, I didn’t use my gym money to buy a flat-screen tv. I wish! I used it to pay rent and buy groceries.

        • I vote for real food, too! There are a lot of people looking at whether junk food makes people unhealthy. And finding out it does. Surprise! Here’s an example of things they’re looking at. http://bit.ly/Tya3N

          Although the researchers appear to be focused on whether it makes us fat, what they’re researching whether they know it or not is the health impact.

  8. mamaV says:

    Hi Marsha: Thank you for sharing your personal story here. The judgements you suffered as a child are so detrimental and no doubt cause a lifelong struggle with ones own self worth, body image, and attitudes. You are a great example of a person who found a way to turn your negative experience into a positive one — for yourself and others.

    As to self-efficiacy, I believe that if you don’t grow up with parents that help you instill your belief in yourself, its a long road uphill to develop these beliefs as an adult. This is where I have total compassion for children and adults who just can not get themselves over the self esteem hump, the ones that get stuck in negative thoughts which lead to emotional overeating. Working oneself out of this mode of life is HARD, probably one of the most difficult challenges one can face. These individuals need professional help, and total, loving support from family and friends.

    This is why judging others eating or exercise habits is just not fair in my book. Further, shaming and guilt tripping no doubt have the opposite impact, as you point out, driving the person to engage in “unhealthy” personal eating and exercise habits.

    So, what would I say is a better route to take?

    Compassion. Just love and compassion. We are all the same inside. One look in the eyes of an obese individual tells you who they really are, and it a gateway to true friendship. This life is not about judging, or forcing, or dictating, or reiterating well meaning “health conscience” advice — its about just being. Just being there as a true friend who has no goals or expectations for others.

    To Lissa and Caits discussion point above — I think that it is best to keep ones own advice to another about what they believe a healthy lifestyle is to themselves (in normal life — here its ok since this is the point of the blog!) I try to my own personal eating and exercise habits low key because I have found that by stating what my personal efforts are will usually only make others feel bad about themselves, so I tend to stay mum (caveat — I am not a dieter though, and I am not trying to achieve a higher level of fitness, I am satisfied with where I am so I sit in a different position than Lissa and Roni). Hey–I am sucessfully living the HAES lifestyle!!! :)

    At the end of the day, I believe that mental health is the cause of physical disease (studies show up to 80% of disease is caused by stress/mental health related issues)….so helping friends and family become mentally healthy is my way to be a true friend (plus this is the focus for myself because it is EASY for me to slip off the mental health wagon!!)

    mV

    • vitty10 says:

      I just want to post this again in case people missed it:

      “This is why judging others eating or exercise habits is just not fair in my book. Further, shaming and guilt tripping no doubt have the opposite impact, as you point out, driving the person to engage in “unhealthy” personal eating and exercise habits.

      So, what would I say is a better route to take?

      Compassion. Just love and compassion. We are all the same inside. One look in the eyes of an obese individual tells you who they really are, and it a gateway to true friendship. This life is not about judging, or forcing, or dictating, or reiterating well meaning “health conscience” advice — its about just being. Just being there as a true friend who has no goals or expectations for others.”

      Great post mamaV!

    • Hil says:

      Beautifully put.

    • Sarah Hannah says:

      Love this comment! I agree about mental health—too many people focus only on physical health and almost completely ignore emotional/mental health, which is equally if not more important!

    • Lisa says:

      Very well said, mamaV!

  9. julie says:

    My parents are similar. I’ve lost most of the weight, but still have no self-esteem, and my emotional health is unstable. The only person whose food/eating I ever comment on is my mothers, as I’m still pissed. She’s never been overweight, but likes to pretend that all her high-fat food is low-fat, or else she so rarely eats it, and never eats cookies, salad dressing, sweets. Yet somehow, gallons of ice cream, bags of pretzels, appear and disappear. My dad no longer allows her to say anything to me.

  10. Marsha says:

    Hi, everyone. I’ve been absent from the discussion for two reasons: 1) I’ve been slammed at work (a good slam, tho) and 2) we haven’t figured out yet how to get the comments to go to my email. So when I check in to read your comments, they’re so deep, I need time to ponder. Which I haven’t had.

    I intend to read them today and over the weekend. If I have anything to add, I will! Thanks for all your thoughts!

    Btw, I know I can check the box below to get f/u comments via email but I’ve held off so I could see if we could get things fixed the other way.

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