We Are Family

Hope springs eternal. No matter how unsuccessful their efforts to “lose weight,” people continue to try. Laudable. Applaudable. And respectable. But, for the most part, unsuccessful.

Last week I sat in a lecture and heard the results of research showing a lack of success when patients with mild dementia (minimal cognitive impairment) were taught strategies for improved self-care. In contrast, other research showed more success when patients were made part of a conversation that also included their primary caregiver. They called this teaching unit a “dyad,” meaning that there were two people, just one the designated patient. So…if you’re starting to struggle when it comes to remembering important details about your shower, your soap, your toothpaste or your nail clippers, it’s not going to help if someone sits down and goes over it all [again] with you. But if you include a loved one, the one who is actually responsible for helping you to look after yourself day after day, it looks like that strategy may actually do some good.

These are not surprising results by any means.

Years ago, when I cared for patients in a general internal medicine practice in suburban Cleveland, I regularly observed an inspiring phenomenon. Patients not uncommonly arrived with children and grandchildren in tow, fresh from an earlier appointment across the hall at the pediatrician’s office. Bright-faced, fresh-scrubbed, engaging, chubby, usually well-behaved, American children. Pediatricians’ reminders about efforts to normalize the kids’ weights continued to be unsuccessful, and you could see on my patients’ faces how the ongoing exhortations were becoming tiresome. If they knew how to fix this problem, they told me, they already would have.

The subject changed quickly to my adult patient, who could also stand to make a few changes. Blood pressures rising, pants sizes rising, blood sugars rising. Oh boy — you wanna dance at these kids’ weddings or what?

Enter “Your Health is on Your Plate.” Stop trying to diet, I said. Don’t think about your weight. Just eat more vegetables and fruit. Stop avoiding nutritious fats. Eat avocados, scrambled eggs, olives, almonds, peanuts, anchovies. Deep-six the orange juice and switch to eating oranges. Or berries. Or apples, which are especially good dipped into peanut butter. 

Stop buying breakfast “cereals.” Why do I put that in quotes? Because cereal is a synonym for grains, like millet or oatmeal or bulgur wheat. Not Lucky Frost-o-s or Cap’n Sugar or Raisin’ Weight or Sweetest Bran or LIKE. 

There were other ideas, too: Go for a walk and get into bed at bedtime. Turn off the lights.

Well, you know the rest of this story, or at least the next page. Patients returned to subsequent appointments with improvements all around. But the surprise was that the children had experienced the same benefits. Pediatricians were delighted to see weight curves bending toward more normal ranges, so families felt less hassled. I saw those little bellies shrinking away with my own eyes.

Human beings are social creatures. We are meant to operate in communities, however defined. As long as the medical system continues to operates mostly at the level of the individual, patients will feel hassled as doctors continue to struggle unsuccessfully to add meaningfully to conversations about lifestyle.

Successful lifestyle changes will engage not just the designated “patient” but also the individual most responsible for making lifestyle-related decisions for a family system. Especially where the patient, like a child or cognitively impaired elder, has little or no say  in creating the environment of their home. Who purchases and prepares most of the food in the family? Who schedules trips to the pool, or the soccer field? Who makes time for hikes or baseball games? Who makes the medical appointments? Who chooses where to put the rugs and lights? Who decides who sleeps where, and when bedtime starts? This individual must be at the appointment, and must play an integral role in the conversation.

We can survive on our own. We can live on our own. But we cannot really thrive on our own. We need each other for that. Early on, of course. But throughout the years, too.

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