A few weeks ago, I was presenting at a conference in a symposium and oriented to doctors and clinical staff whose work is related to people living with obesity. It was remarkable to note how most clinicians introduced their respective talk with something along the lines of: “We have to deal with frustration and relapses from the patient who lives with obesity. Regardless of our indications, they are not fully engaged with our recommendations when it comes to adopting healthy habits”. In the end, they were describing a reality they live in every day and, in a sense, this message is justified since this is a fact they see constantly. However, according to us, if this is something common, it is not because of something intrinsic to the patient who lives with obesity, but a byproduct derived from the intervention addressed to the patient. In this post, we will expose the main shortcoming of the biomedical approach when it comes to promoting motivation to adopt healthy habits.
First, it must be clear that all the problems raised by the Medical staff were related to the patient’s motivation; a tremendously misunderstood concept by most clinicians. Those who claim that doctors must be prepared given the relapses they experience from patients, tend to think that it is the patient’s fault; that they are not motivated enough. From here, it derives a reductionist misunderstanding about motivation. Doctors are not aware of the complexity of being motivated. Instead, they usually think that the patient is either prepared to change or not. However, far from not being motivated enough, the patient tends to experience an overwhelming feeling of Ambivalence. To understand this, let’s describe an example.
A patient with a new diagnosis of obesity presents with a daunting list of indications and recommendations that promote lifestyle changes:
– Eat more vegetables and fewer carbohydrates.
– Decrease your fat intake to manage better lipid levels and weight.
– Increase your physical activity.
– …
The volume of new information and changes is usually overwhelming and causes stress to the patient. Not only given the discomfort they feel with their own situation, but also because of all the demands, they must accomplish. To such distress, we must add the phenomenon of ambivalence. Ambivalence can be understood as the dichotomy people have when they have the will to change, but to also have some resistance to the current state of affairs. The status quo is familiar; it is what we are used to, what is familiar to us. However, when the patient decides to go visit the Doctor, they now face a new scenario. On the one hand, the patient wants to be healthy and knows that change is needed. On the other, he sees some discomfort in adopting different habits that require lots of effort. Metaphorically speaking, ambivalence is like having an internal dialogue between two different persons: some are saying it is urgent to change, while others are more conservative and opposite it. For this reason, it is usually the case that a patient is at first ambivalent and stressed out with all these new habits that must be adopted. This by itself is already conflicting. However, we must add another ingredient: the directive approach from the Doctor.
When patients are told what to do (or when the doctor advises the patient), it is because the doctor expects the patient to obey certain demands. This dynamic in which the patient is a passive agent who has to act according to the voice of the expert is doomed to fail on most occasions. The reason behind such non-compliance is that the patient, as ambivalent as it is, is sometimes paralyzed and not ready to change yet. The patient needs to explore more to act according to the goals and objectives. When this doesn’t happen, professionals are frustrated and do not understand why someone who is motivated does not change for the better. Hence, the key to success is not having such a directive approach, but rather evoking the patient reasons to change; the professionals must guide the patients to find their motivations to change. This way, the probability of having a successful treatment increases.
This approach and change of direction can be easily implemented by following the Motivational interviewing style of communication, which puts the relevance on the patient and their reasons to change; empowering them to find their own sources for enhancing their personal motivation. From here, it is thought that instead of motivating the patient, what ought to be done is to encourage the patient to find autonomously their reasons to change.
About the author
Pol Herrero is a Pre-doctoral psychologist researcher graduated with the Cognitive Science Master’s Degree from Universitat de Barcelona. Currently, he is working at the Vall d’Hebron Instute of Research in Barcelona, Spain, involved in the SOCRATES project.