On World Obesity Day, Dr. PK Sethi, a renowned Neurologist explains how doctors should be focusing on helping patients make mindset changes in order to achieve success in their lifestyle interventions. 

The last decade has seen a great shift from communicable disease to non-communicable disease. We are now increasingly focused on heart disease, strokes, demyelinating disease, and autoimmune diseases. Diabetes, hypertension, hypercholesterolemia, obesity, and other metabolic syndromes are more in focus now.

Also, lifestyle changes are rightly getting emphasised as one of the solutions to help deal with these problems.

Commonly advised lifestyle changes

• Exercise every day and be physically active
• Choose good nutrition- a healthy diet is one of the best weapons to fight metabolic disease
• Lower blood pressure and cholesterol
• Aim for a healthy weight
• Manage diabetes
• Quit smoking
• Reduce stress

Nobody doubts the value of these lifestyle changes. Question is:

How many in our society can accomplish lifestyle changes?

This question invariably took me back to an incident which my wife narrated to me a few years ago.

Dr. Sethi remembers..

My wife was working as child-specialist in Majedhia Hospital those days. She used to drive through GK-II in New Delhi, rather than Khandpur, as she felt that this route was less crowded. But when turning near Alaknanda to the right, she felt huge difficulty. She used to get very nervous as she found endless cyclists, pedalling down on the main road going from Tughlakabad to Chandni Chowk for their daily work. One day she expressed her fear to me.

On a lighter mood, I asked, “Do you ever realise what those cyclists might be thinking?” They probably feel more nervous and terrified seeing a lady driver hesitantly coming from the right side, getting more scared of being run over by a car.

The next day, while attending a meet on “Lifestyle Changes” I suddenly thought of these cyclists. In a large country like ours, many of my countrymen, probably lead such a life. Can they afford to change their lifestyle?

Common responses to proposed lifestyle changes from low-income groups

• Exercise: If you advise them regular exercise to avoid heart attack and strokes, he may turn around and tell you, “Doctor I cycle daily from Tughlakabad to Red Fort, a stretch of several kilometres every day and I do the same exercise while going back to my house. In fact, I get so tired exercising that it is a relief to reach home and remove my shoes/chappals. My whole body is usually paining and tired. Each muscle is tired and aching.”
• Diet: Next lifestyle change is that of a simple diet. The poor guy carries his lunch box with a few chappatis, some onion, and a simple katori of dal, and occasionally, a rare luxury of some seasonal vegetable, which is possible if he can afford it.
• Stress: One can imagine the stress cycling down on such a hazardous road, full of cars/buses/trucks/bikes. Chances of accidents are so high and so is daily stress. If you suggest that he should change such a stressful job, he is incredulous. With great difficulty and recommendation, he has got this job, and he is supporting his family on this minor salary.

In other words, the majority of the people are in the low-income group, and cannot simply afford to change their lifestyles even if they wanted to.

What about the middle class?

A lot of people are moving out of the poverty line to middle class, all over the world including India. Can they afford to change their lifestyle?

They can be made aware of the benefits of changing their lifestyles. They may attend classes for lifestyle changes. They may seem like the right group to target for teaching the benefits of lifestyle changes. Surprisingly, the effect of all this is short lived.

For regular exercise, they may feel making two rounds of the colonies they live in are enough. During this period, they are on their phones talking to clients or friends discussing schemes to make more money and getting more stressed. Much of their time is spent getting their children admitted to the right school. Booking in right schools starts even before the wife delivers the child. When children are grown up, a large part is spent on getting their child into the right college.

In Indian society, most people spend restless nights to get right matches for their children. So, there is no time for regular exercise. Life is full of stress. They don’t have the luxury of making lifestyle changes. I know many of my patients have anxiety, sleeplessness, and depression because they are constantly worried about their daughters’ not getting married. This stress is always eating them.

A patient experience that comes to mind

In my long career as a doctor, I have seen only one person truly changing his lifestyle. Mr. Vijayan, CEO of a leading British company in Delhi. He had a very lucrative job with plenty of perks. One day he consulted me, I found he had had a stroke accompanied by a lot of other risk factors like diabetes, hypertension, and hypercholesterolemia.

He was put on medication for the same. He even went to Europe, consulted a leading Neurologist. His diabetes, blood pressure, and cholesterol were difficult to control. Every time in addition to medicine, I emphasised, he make lifestyle changes. I had known that as a CEO of a large company he was working very hard and going through a lot of stress.

My patient was lost in follow-up, until one day he suddenly reappeared. He looked very happy and contented and showed me his medical records. His BP was normal, and diabetes and cholesterol much in control with minimal medicine. He said he followed my advice literally and changed his lifestyle completely. One day he quit his job, went back to Kerala, where he had plenty of farms/lands and a big house. He lived on his cultivated land, employing a lot of farmers and lived his life without stress, and with no competition.

It then struck me, that he could change his lifestyle because he had enough assets to fall back on. So, lifestyle swaps are only possible for a few who can afford to make these radical changes. It is easy to advise, but difficult to follow.

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