So-called biases can get in the way of a healthy lifestyle.
Yes, media messages about nutrition are often confusing and inconsistent, but most Americans know what is considered a healthy diet. I mean, does anyone really think that drinking carbonated brown sugar water is good for them? The problem is that they don’t seem to translate their knowledge into action.
Why do people have such a hard time changing their diet? While ignorance and confusion may play a role, motivation to change is probably more important. Certainly, we live in a world that pressures us to eat whatever we want, regardless of the long-term consequences. “One of the biggest problems in getting people to change their behavior is the need to get them to see the need to change.”
For example, if you ask people how much meat they eat—or how much fatty foods, eggs, sweets, alcohol, or butter—they say they eat less than the average person. Therefore, if people think they are at less risk than others, they may dismiss the advice on healthy eating, thinking they are already eating healthy. Could it be that they really are? No, people rated their diet as healthy on average, even when their eating habits were the worst. Because of this, perhaps health promotion campaigns need to make people aware of how bad they are eating. But when that was done, something strange happened. When people are literally challenged on what the average person eats, they change their answer to appear healthier than average.
When people’s positive comparisons for a risky behavior are threatened, they not only decrease their ratings of how often they engage in that behavior—“oh, I don’t eat that much meat”—but also decrease the importance of the behavior. “Meat isn’t that bad.” The same “personal myth” that smokers tell themselves. Research shows that smokers have a strong tendency to underestimate the risks associated with smoking, developing a series of delusions and false beliefs to support their choice to continue smoking.
Why do so many people continue to light up despite the harm of smoking to their health? For many of the same reasons, people continue to eat unhealthy foods. First, they convince themselves that they are less vulnerable than others who do the same. In addition to this choice of hope, smokers also underestimate how much smoking raises the risk of lung cancer, thinking that people who smoke two packs a day have only five times the risk of developing lung cancer when their actual risk is 20 times higher, as you can see below and at 3:10 in my video. Why Don’t People Eat Healthy?.Also, many smokers believe that lung cancer is primarily determined by genetics.
Many of the risks associated with the food we eat share an “optimism bias,” the same as heart disease (our leading killer), obesity, diabetes, and everything else. People can often find rational reasons to believe that their risk is less than that of others. So, perhaps public health advocates need to have the same intelligence to understand where this false hope comes from and find ways to help people get a more accurate picture of their vulnerability. All kinds of work is done to try to reduce or eliminate this bias, “but we have to consider the possibility that the reduction of bias may lead to a decrease in self-confidence and mental well-being,” if people start to see how much risk they really face and how much they have to blame themselves.
This reminds me of the tightrope health professionals have to walk, telling people how much power we have to get cancer. There is an oft-cited paper that states that we can prevent about 90% of human cancers. Although its reference to “current practices” refers to the 1960s—when this paper was published—it still applies today, more than half a century later. “Genetics are not the main causes of chronic diseases.” Using identical twins to determine how much disease risk is actually genetic, researchers found that of 28 chronic diseases, cancer has the lowest heritability—only about 10 percent are caused by bad genes. Bad habits run in families.
But if you’re telling everyone the good news about how much power we have to stop cancer, what about the people who already have it? When people are diagnosed with cancer, they often ask, “Why me? Did I do something wrong? Is this my fault?” So, you can imagine how devastating a “yeah, yeah, kinda” message can be to patients or survivors. In other words, a message intended to empower people and encourage prevention can make cancer victims feel guilty.
But the truth is still the truth, no matter how hard it is. Therefore, what doctors should do is to try to guide patients to “change the feelings of guilt to a way of ‘taking responsibility’.” They have personal control; they can make different choices from now on. Doctors need to give them a sense of agency in their lives. The best, however, is to try to take those steps before you get cancer.
Doctor’s Note
For more on personal liability, see Why You Should Care About Nutrition again Taking Personal Responsibility for Your Life.
