Mind the Gap
My office is humming. So many of my patients are just now coming in to see me for their checkups, having shelved their medical issues to get through the worst of Omicron. In some cases, they’re limping in for the first time in two years.
I get it! It’s easy to neglect our underlying health during a global pandemic. The medical, logistical, and emotional challenges of the pandemic are enough to bring anyone to their knees. Burnout is widespread. Working, parenting, and caregiving during the pandemic has, for many people, thrown our routines (and self-care) out the window.
So when patients apologize for not coming in, I remind them how normal they are. I’m just happy—relieved, actually—to see them. It’s never too late for a tune-up and to think broadly about our health. And, as we all now know, the best ways to prevent poor outcomes from COVID-19 are 1) vaccination and 2) caring for our baseline health.
And I don’t just mean checking cholesterol levels and hopping on the scale. I mean thinking about our everyday habits—how we eat, sleep, move, and manage stress. I mean connecting the dots between our thoughts, feelings, and behaviors. I mean examining our relationships with food, alcohol, work, and other people.
Indeed, health is about more than the sum total of my patients’ lab test results. It’s about more than the sliver of time in my office. Health is about the 364 days a year they’re not there. It’s about empowering patients with tools, nuanced guidance, and agency to manage everyday health risks. It’s about preventing disease and despair in tandem.
So when I’m talking to patients and helping them dig out from the rubble of the past two years, we talk quite a lot about routines. For so many people, the contours of regular life have been erased, making healthy habits harder to prioritize and to stick with. We talk about “minding the gap” between intention and execution on various behaviors. For example, most people want to eat three healthy meals a day, sleep 7 hours a night, and exercise regularly; it’s just a heck of a lot easier said than done.
The “gap” between knowledge and practice is what interests me most about people. Why? Because examining it can be the birthplace of insight and, ultimately, needed behavioral change. For example, many of my patients have gained weight during the pandemic. Not surprisingly, the combination of relative inactivity, gym closures, haphazard eating, and stress has conspired to add pounds and send diabetes and inflammation markers soaring.
Many of my patients also admit to drinking more alcohol than they’d like during COVID—in order to “take the edge off” or simply to mark the end of the at-home workday. As a result, patients report their sleep is less efficient, weight is creeping up, and bodily systems are awry. Alcohol also promotes elevations in blood pressure, diabetes indices, and liver tests when a habit becomes more of a crutch.
My job includes helping overweight people lose weight. For unvaccinated patients in particular, obesity is a major risk factor for poor outcomes from COVID. But helping people with weight loss isn’t about telling them they need to lose weight. They know! For most people, the challenge isn’t a knowledge deficit. And the solution isn’t rigid adherence to unsustainable and strict diets. The solution lies in first understanding the patient’s relationship with food and arming them with the tools to reasonably make sustainable behavioral changes.
My job also includes helping people manage their relationship with alcohol. Similarly, I don’t help anyone by shaming and blaming. Rather, I help people find a realistic and long-term way of putting themselves in the driver’s seat of their habits—like drinking. Whether it’s quitting altogether and joining AA or simply cutting back their intake to weekends only, there’s no one-size-fits all recommendation for these complex issues.
At the end of the day, helping affect behavioral change is the hardest—and most interesting—part of my job. Whether it’s starting an exercise routine, leaving an unhealthy relationship, or quitting smoking, change is hard for most people. It doesn’t usually just “happen.” It usually requires structure and support. It usually requires having a trusted guide.
Regardless of what it is we want to change in our lives to be healthier and happier in this New Year, behavioral change begins with “minding the gap” between intention and execution. It starts with understanding the roadblocks—emotional, physical, financial, and/or logistical—between what we want to do and we actually do.
For so many people right now, the biggest barrier to establishing healthier habits—whatever they may be—is the absence of time and resources. It takes time to get exercise, chop veggies, and get adequate sleep. It’s also expensive to eat healthy, pay a babysitter to take a brisk walk, and carve out time away from work for oneself. Heck, just getting to the doctor for many of my patients took two years!
So before we beat ourselves up about gaining weight, indulging in too much holiday food, or just leaving ourselves last on the list, let’s each take a moment to ponder:
What are my broad health goals? How can I better—and realistically—meet my basic biological needs of eating nutritious foods, getting regular movement, prioritizing sleep, and managing stress?
What lives in the “gap” between our best intentions and our ability to follow through? Is it a lack of time or resources? Is it fear of failure? Is the absence of support or knowing where to start? And how could I try to solve these problems? Is it less time on Twitter (Who, me?) Is it curbing the wine habit? Is it simply making an appointment with the therapist whose business card has been lurking in the bottom of your handbag for months?
What is a reasonable and sustainable way to eat healthy, get the sleep you need, and exercise a few times a week? Hint: the “Keto” diet, “Intermittent fasting,” and any extreme way of eating are interventions, not lifestyles. I’d much rather my patients lose weight gradually and in a sustainable way than yo-yo and turn up remorseful next year when they’ve gained back the weight they lost. Another hint: instead of setting a goal to exercise every single day or vowing to run a marathon after a period of inactivity, consider setting a more reasonable and attainable goal (like brisk walking three times a week) to set yourself up for success.
How could I add more structure and support? Whether it’s an app, trusted friend, support group, therapist or doctor, most people need more than willpower alone to make even the smallest changes to their daily routine. Asking for help is a strength—and is often the catalyst for change.
Who knew that two years into a pandemic we’d still be witnessing widespread death and destruction from COVID-19? Who knew that “flatten the curve” would be more than a few months of life interrupted?
Well, here we are. Sometimes it feels like we’re stuck in 2020. Sometimes it feels like Groundhog Day. But on Wednesday, as Punxsutawney Phil emerges from his hole in the ground, perhaps we, too, can take better control of our next six weeks—even if it means burrowing back under the covers.
I will see you next week. Until then, be well.