July 31, 2010
   
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What We Know about Unhealthy Behaviors and How You Can Change Them
Dean D. Krahn, M.D.
 
We pride ourselves on our intelligence but we still engage in many unhealthy behaviors — eating and drinking to excess, smoking, abusing drugs. Can doctors and therapists help us stop these unhealthy behaviors? The answer appears to be yes. But, and this is an important factor, whether you can be helped depends on how you answer when your doctor asks you how you've been.

Two explanations have been offered for unhealthy behavior. The first is that some people lack knowledge about the harmful effects of substance abuse, smoking and obesity. The alternate explanation emphasizes that people engaging in unhealthy behaviors do not correctly weigh the health/lifestyle pros and cons regarding participating or not participating in these behaviors.

While some obese people differ in their energy metabolism from thin people, it is also clear that some of the obesity in America is the result of eating foods considerably in excess of the amount which Americans know is healthy for them.

Virtually all women and most men recognize that lowering weight is desirable, so a lack of knowledge isn't the problem. While some obese people differ in their energy metabolism from thin people, it is also clear that some of the obesity in America is the result of eating foods considerably in excess of the amount which Americans know is healthy for them. The attempt to control food intake by dieting is nearly universal at some point in the lifetime of American women. Studies of incoming college freshman women show that only 8 - 13% of women are non-dieters.(1) With the median age of onset of dieting close to age 12,(2) it is unlikely that the message is not getting to young women or is arriving too late. Yet the average American weight continues to go up. So why do people who know better continue to eat too much?

Why We Do What's Not Good for Us: Mixed Messages and Impulsiveness

In the area of substance abuse, there is, perhaps, even better data documenting that knowledge isn't the problem. Studies of several school-based substance abuse prevention programs found that these programs definitely increased students' knowledge regarding the health risks of these substances but, unfortunately, had no effect or, sometimes, even increased the rate of substance use. So, once again, it seems quite unlikely that a simple lack of knowledge is what prevents people from avoiding harmful behavior.(3)

Anti-substance use and anti-obesity messages do not occur in a vacuum. Young people at the age when they begin using drugs (and all of us in general) get both anti- and pro-smoking, anti and pro-drinking, and anti and pro-drug use messages every day. Our cultural airwaves carry the message that smoking is sophisticated and associated with sexuality at the same time that they offer reports about its terrible effects on one's health. Similarly, competing messages occur regarding the potential pleasure and risk associated with alcohol drinking and cocaine use. Perhaps an even more intensely contradictory message is delivered via food ads — we hear how creamy and good tasting certain foods are, promising a positive experience, while, at the same time, the dieting, health, fitness, fashion and entertainment industries present us with images and information that being thin is to both desirable and healthy.

So, in each case, we receive two distinctly different messages. A positive message about the short-term benefits or pleasures of the use of cigarettes, drugs, alcohol and rich foods and a negative message about the long-term problems associated with these behaviors.

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