It has been argued that the willpower of our citizenry hasn’t measurably changed during the decades in which our nation’s waistlines have measurably expanded. I agree, and I’d also submit that a weakening of political willpower and a lack of moral courage among those of us called to leadership is the more disturbing culprit. A case needs to be made that what we know and believe as a profession is most readily measured by what we permit to happen.
Perhaps you have heard the quip, “you can’t outrun your fork.” Cliché’s endure when they contain at least a kernel of truth, and having heard this quip for some time now, I believe it rings true in weight management. Whether you are a reader specializing in weight management or a health education generalist like me who works across the spectrum of social, mind and body health issues, everyone agrees that these three areas are inextricably and inexorably interrelated. An unusual few, like gymnasts, rowers or thru-hikers, will parse through precise decisions about food as fuel and commit exercise-abetted weight loss for competitive advantage. But for the clear majority of us, weight management has more to do with what we eat. To be sure, exercise matters. But food is to weight like books are to knowledge, the quantity and quality of one directly impacts the other. If you binge on comic books, it is simply less likely you’ll solve the Tversky Intelligence test,[i] and no amount of extra thinking about what you’ve read will burn away the end result. This idea that improving the quality of the food we eat is more effective for weight loss than counting calories is affirmed again in a fascinating weight loss study published this week in the Journal of the American Medical Association.
Discovering the most effective combination of exercise, nutrition and medication assistance for weight and diabetes management will remain of serious interest to researchers and practitioners for years to come, as it should. I expect we’ll learn even more about how the best mix should vary according to individual attributes, and I’m sure there will be an app for that! Still, the current action in health promotion is less about diet, activity and drugs and more about the right mix of head, heart and feet. That is, we are testing the interaction effects of education and attitudes against culture and environment and assessing how these variables influence motivation and action. Could it be the “heart part” of the health promotion profession is the next frontier we’ll need to examine and improve if we are to solve for the most intractable contributors to the world’s obesity trends? For an edifying personal exercise in assessing how you connect head, heart and feet, visit Harvard’s “Social Cohesion” project.[ii] Limiting access to foods that are bad for you is a policy issue fraught with resistance from powerful organizations, not to mention many of your friends, neighbors and work teammates. Efforts to reengineer our physical environments spawn arguments about convenience, independence and the vapid economics of public transportation.
The Undoing of Culture
Those cynical about the value of health education and health promotion commonly say, “Everyone already knows what they should do, they’re just not doing it.” It is a preamble to their predictable recipe for success that is about tapping into an individual’s intrinsic motivation alongside building a culture of health. I have no doubt these are essential ingredients though I’d add that the missing yeast is the moral courage needed to lead sustainable culture change. Closely related to this, what can one make of the glib observation that knowing hasn’t translated to doing in health promotion? Education, as defined by those with much more depth of understanding than I, is only partly about imparting knowledge. Serious teachers don’t see their jobs as transmitting content from their lecture pages into the notebooks of their students. Authenticity in education is about changing minds, challenging beliefs and transmitting values that drive positive social action. Respecting this definition, I’d ask whether someone actually “knows” how to improve their health if they haven’t successfully applied their learnings? I mean no irony when I ask, if we know how to change organizational cultures, why are so few changing? To be sure, there are many organizational leaders who have done the hard, often unpopular, work of changing tobacco or food policies. Sadly, there are almost as many examples where those policies go unsupported or are outright undone by administrators who followed them.
Federal and State political leaders have presided over decades of waxing, waning, weakening or reversals of tobacco taxes, highway speed limits, motorcycle helmet laws and farm policies that would advance public health. Community and school leaders have advanced public transportation, biking trails, improvements in school lunch and community gardens only to leave their posts to see their efforts undone by others who acquiesce to popular opinion or commercial lobbies. The current American President has undone a growing list of executive orders of our former President that affect public health. From loosening emissions standards and environmental and gun safety regulations to undoing worker safety protections and occupational health standards, our current leader even saw it fitting to remove a bike-sharing station at the White House.[iii]
For a book that examines inspirational leadership up close, one that I promise will spark many reflections on the connection between head, heart and feet, read “The Undoing Project: A Friendship that Changed Our Minds” by Michael Lewis.[iv] Based on in-depth interviews with Daniel Kahneman, a Nobel Prize winner in economics, and deep research into the life of his lifelong collaborator Amos Tversky, a MacArthur “genius” awardee, Lewis crafts a fascinating story about the intellectual and biographical influences that informed their “Prospect Theory.” The two friends used “Heuristics” to show how judgement and framing (head) influence preferences and beliefs (heart) and, ultimately, choices (feet).
Read on for my Full Editorial on “Head, Heart and Feet in Weight Management.”
[i] Johah Lehrer, “Why Smart People are Stupid.” The New Yorker, June 12, 2012.
https://www.newyorker.com/tech/frontal-cortex/why-smart-people-are-stupid (accessed 1/12/18)
[ii] Harvard College Social Cohesion Exercise, From the Harvard College Social Innovation Collaborative. https://harvardsic.wordpress.com/2013/02/21/the-head-heart-hand-exercise/, Dated Feb. 21, 2013, (accessed 1/12/18)
[iii] Philip Bump, “What Trump has undone.” The Washington Post. Posted Dec. 15, 2017. https://www.washingtonpost.com/news/politics/wp/2017/08/24/what-trump-has-undone/?utm_term=.6c907acaaec6 (accessed 1/13/18)
[iv] Lewis, Michael, “The Undoing Project: A Friendship that Changed Our Minds” W.W. Norton and Co., New York, London, 2016.