Thursday, February 3, 2011

Healthy habits are hard to maintain - even if you know what lies ahead

"It's about that time of the month," a physician colleague of mine said to me a few days ago, "when our patients start to let go of their New Year's resolutions." That is, all those well-intentioned promises we make to ourselves year after year to eat more fresh fruits and vegetables, to spend 30 minutes in the gym each day, or to start a walking program. Breaking unhealthy habits and starting healthy ones is hard, and most people require several attempts to succeed. As I discussed in a previous blog post, there's good evidence that even multiple intensive lifestyle counseling sessions led by trained professionals are only mildly helpful.

Compounding matters is the fact that every individual is different. You probably know people who’ve lived to ripe old ages in perfect health despite having eaten eggs every day of their lives or not exercising. My great-grandfather smoked cigarettes for 80 years, but died peacefully in his sleep in his late 90s. (Maybe he would have made it to the century mark if he'd quit.) Some researchers have suggested that a more effective way to motivate patients to change their lifestyles could be to give them personalized information about their risk for common chronic conditions such as cancer and heart disease. Others, though, have worried that this knowledge could encourage complacency among those who learn they’re at below-average risk. Why quit smoking, for example, if you think your genes will protect you from lung cancer?

Two recent studies have investigated. The first study, published in the January issue of the Annals of Family Medicine, randomly assigned about 4,000 primary care patients ages 35 to 65 to either a Web-based tool that used patient-provided health and family history information to give tailored lifestyle recommendations, or a generic prevention message. After six months, those who received the personalized messages were more likely than the generic-prevention group to consume five or more servings of fruits and vegetables daily and exercise for 30 minutes at least five times per week. Perplexingly, the personalized intervention actually made patients less likely to get their cholesterol level checked, and it had no impact on whether they quit smoking or got their blood pressure or blood sugar levels measured.

The second study, published in the New England Journal of Medicine, took a more high-tech approach to understanding whether giving patients a glimpse of what may lie ahead could help quash bad habits and inspire healthy ones. About 2,000 adults were offered the chance to purchase a genome-wide health risk profile of a saliva sample at a significantly discounted price ($150 as compared to a typical retail cost of $500 to $2,000). So they provided their DNA and completed standard assessments of anxiety symptoms, dietary fat intake, and exercise at the time of study enrollment and again three months later. The researchers found no changes in their anxiety levels, lifestyle behaviors, or their use of screening tests between the two periods. And only 25 percent of participants said they shared their test results with their physician.

For me, as a family physician, the take-home message of these two studies is that providing personalized health information to my patients based on the “old fashioned” collection of family history data is likely to be at least as good, if not better, than sequencing their genomes. A potential reason for why participants in the New England Journal study weren’t able to change their health habits is that high-tech genetic profiles can’t substitute for personal contact. Much of the training primary care physicians receive is geared toward learning how to help people make good decisions about their health. So if you fear that your New Year’s resolution may be falling by the wayside, I encourage you to make an appointment to see your family doctor to discuss small, realistic steps that you can take to get back on track. Obviously, your doctor can only do so much by outlining your personal health risks and suggesting ways you can reduce them. The rest is up to you.


The above post was first published on my Healthcare Headaches blog at