There’s always a lot of talk in the media and the blogosphere about patient education. Everything will be better if we just had better education. This belief assumes that a) patients are listening; b) they have the ability to follow your directions; c) they always do what’s best for them and they always do what you say. I’m a doctor. I’ve been educated within an inch of my life. That doesn’t mean I’m going to remember to take my antibiotics faithfully until they’re gone. Or exercise moderately 30 minutes every day. Or reduce sodium. Or whatever medical wisdom is saying right now.
People do what they want to do, and immediate gratification will trump future rewards every single time. An example: http://well.blogs.nytimes.com/2011/02/16/after-menu-labels-parents-and-kids-order-same-foods/. This is not a recent article, there’s another more recent that I can’t find right this minute, but you get the idea. The gist of the article is that even if you post the caloric content of every food on the menu right there in front of the consumer, it doesn’t affect ordering choices. If your education at the point of decision-making doesn’t change behavior, then problem is not the education. Human behavior is much more complicated than that. Say you walk into a McDonald’s. Which you shouldn’t do, because the minute you walk in the door you can smell those fabulous fries. New York to Hong Kong, those fries smell and taste the same. You want them. You can’t help it. Your pleasure centers are overwhelmed by the smell and proximity of those fries. A sign in front of the register telling you those fries have 800 calories and 60 grams of fat or whatever is not going to penetrate that mix of brain chemicals one little bit.
Despite this, the Affordable Care Act is going to require calorie content to be posted in all fast food restaurants. OK, it’s a good thought. It might help in neighborhoods in which affluent women who just came from the gym where the girl on the bike next to them was thinner than them. Those women might hesitate when they see that that blueberry scone at Starbucks has 500 calories in it. And even then, they might say “the hell with it, those scones are darn good” and go right ahead. Because it’s pleasurable. It tastes good. We want it now. We can have it now. Those facts make it very very hard to change behavior.
Here’s another NYT post: http://well.blogs.nytimes.com/2013/06/27/how-carbs-can-trigger-food-cravings/?src=me. In this article, the author describes the ways in which carbohydrates can cause people to gain weight by causing cravings. The thing is, ingesting certain foods causes actual chemical changes in your brain that make you want those foods. Again the pleasure and reward centers are lighting up for the fries and the scone. Your frontal cortex, which influences behavior, is no match for those feel-good brain chemicals.
Some people say they get a dose of those feel-good chemicals from exercise or doing good or helping old people cross the street. And you can. You can get a dose of feel-good chemicals when you graduate from college or finish a great project or get praise from your piano teacher. But that dose of chemicals has come after a whole lot of overriding of the pleasure centers for a long time. We are not really wired this way. That’s why healthy weight can be as hard to achieve as a college diploma. And that’s why you’ll eat those fries. Because they are there. They are good. They are available. Now.