Are You Sick Enough?

There really is no end to the number of questions I have had about health, getting into shape, and issues of performance and body shaping. Fairly, I have always tried to be direct, honest and give someone the best answer based on experience and other sources such as school or other reading. Often, I “nail” the answer. What that means is that I know exactly what answer they need; I have experience with the realm of the answer and am sure it will work for them.

It boggled my mind for the longest time on why someone seemed in such need of an answer but is unwilling to follow through sometimes with the simplest of tasks.

Some examples include:

1)To put more muscle on the upper chest, change the grip and lower the bar slowly.

2) To relieve your back pain, do this 4 minute stretch each morning.

3) To keep your muscle while dieting, add a 25g protein shake daily to your diet.

4) To stay asleep between 3-5am, take 3g of Ester C at bedtime.

 When I would follow up, they would say that they haven’t implemented it yet.

The examples of advice ranged from nutrition, workouts and various lifestyle adjustments all in the name of health.

After a while, I felt that maybe I was missing something. Why was anyone barely using my well intentioned and time-tested advice? Should I just charge them for the information instead of nicely giving it away for free?

I decided to ask a lot of people and see if I could gain some insight. The answers they gave moved me along to what I believe today.

I asked a friend who is a chiropractor and he identified with my frustration. He said that people do not act because they lack a certain amount of education. Education… I thought about this one for a while. It is true that certain things need a base of education for the new information to be understood. In my experience, this was a minor influence. A good coach could make any advice relatable even to the very uneducated. I gave this a 5% or less.

I asked an attorney friend what he thought about people not implementing the advice given to them. He said that it is a question of ego. Ego… I certainly thought this explanation cast a wider “net” on the problem but felt the significant reason was still elusive. I gave this 10% or less representation.

A while later I asked a personal training client of mine. He was very smart and had a slew of medical issues. This man listened to me, implemented my suggested strategies, and many of his aspects of his health changed. So, when I asked him why people don’t listen to me and implement my strategies, he told so matter-of-factly…

“Michael, it is simple. The people are not sick enough.”

The phrase “sick enough” really hit me smack in the nose. In fact, I still hear those words many years later as the real and figurative angles of that phrase can be debated over and over again.

I have heard people tell me that despite their four medications for their heart, they are healthy, people with over a hundred pounds overweight tell me the doctor says they are fine, etc, etc. Sick is as much as a medical diagnosis as it is a system of beliefs or opinions.

At some point, I once again stumbled on to a piece of academic research. Fairly, I really had never thought academia could have the answer to such a real-world problem.

The Transtheoretical Model 

Sometime in the 1970’s there were some studies done on smoking cessation. With no surprise, those that were ready to quit had the best chance of success. After much observation, a handful of steps or mindsets were observed. Here is what they learned along with some comments.

Precontemplation: In this stage, people are not even aware that there should or should not be a change. They are not fact gathering and assume everything is OK the way it is. If trying to persuade this mindset towards action, working to create awareness is the goal. Perhaps this is the point where my chiropractor friend said that following advice was about education. It is thought there will be no action performed by this mindset in six months or more.

Contemplation: There could be a problem and there is a lot of fact gathering in preparation of change. At this point, people may question you all day and not ever do anything. Could this be ego like my attorney friend suggested? Perhaps it could be. If trying to influence this mindset towards action, working to reduce ambivalence is key. This person may be ready to make a change within six months.

Preparation/Determination: In this stage there is a plan forming. There could be some more fact gathering but the mindset is already made up that change is going to happen. If trying to influence this mindset towards action, working to promote key strategies is essential. Perhaps this is the stage my client was alluding to when he said “…The people are not sick enough.” It is thought that this person may decide to act within thirty days.

Action: They are acting on the decision to change. At this point, there are some bumps in the road as new decisions often come with bumps. There plan is not 100% but they are in. If trying to influence this mindset, help to eliminate those bumps. With that elimination, the chance of relapse reduces.

There are other steps such as recurrence and maintenance… As maintenance is ongoing action and recurrence is falling backwards out of action and into the previous mindsets.

These stages of change can reasonably be identified when someone asks a question. Before you answer, you simply ask if they are about to do the new “thing”.

As an example…  

Frank: “Hey John, how many times a week do you have to workout to get in shape?”

John: “I workout 4x a week and it seems to work. Hey, when are you thinking of starting to work out?”

Frank: “John, I didn’t say I was ready to workout yet.”

Frank in this example, is probably in contemplation. John, in this example obviously believes in workouts and is action/maintenance. The direct approach to John is not to get him into the gym right now; the goal is to get him to like more of the idea of the gym as Frank probably has a degree of ambivalence.

John: “Frank, you know since I started working out, I just feel so much better. I have even lost a few pounds around my waistline. I can’t see myself quitting any time in my future.”

Frank: “Oh that is interesting. So you do really like to work out.”

Keypoint: To find out how to give a push to someone in the decision process, know where they are first. Trying to move someone more than one mindset is not a good goal as these steps are emotional along with logic.  

Interestingly, the perspectives of the lawyer and the chiropractor probably had more to do with the mindset of their customers in their timeline of the experience.

As for a hypothetical scenario for the chiropractor, it seems likely to me that a customer could come in and complain of back pain. The chiropractor might go through a series of stretches and adjustments that are standard in the profession to relieve the pain. After that is done, I am sure that the dietary prescriptions, the stretch routine, and some supplements may draw a look of “Huh?” Although obvious to the chiropractor that other efforts are needed, it may not be so obvious to the patient. Could a lack of education be a problem in this scenario?

For the lawyer, could there be lots of phone calls to the attorney asking about potential business? Would the attorney suggest a multi thousand retainer to go forward? Could the client have a potential objection to this or ego issue?

When someone walks into the gym, they are either in preparation or action. Generally, they are in action but may want to check out a few different clubs before they join.