Lifestyle diseases are caused by such things as smoking, poor diet, lack of exercise and poor stress management.

Individual and Environmental Factors that contribute to lifestyle diseases.

“I don’t know what to tell her; I just don’t think she has a chance,” you confess to a colleague. “She wants to lose 50 pounds. Her whole family is obese and, worst of all, they tease her when she goes to exercise. Ten years ago, I thought that if you had enough willpower, you could accomplish anything. Now I’m not so sure.She’s got a full-time job and two young children, but she thinks she can come to the fitness center five days a week. She seems really determined, but I don’t want to set her up for failure. How can I be realistically supportive without being discouraging?”

Lifestyle diseases: An American epidemic

The leading causes of death in industrialized nations are lifestyle diseases, caused in part by smoking, poor diet, lack of exercise and poor stress management. For example, while some risk factors are uncontrollable (genetics, gender, age and ethnicity), a risk of developing artery disease prematurely increases for people with sedentary lifestyles, smoking habits, high blood pressure, diabetes and high blood cholesterol. The last three risk factors are somewhat related to lifestyle, especially diet and exercise behaviors.

What can you do to stem the tide of this epidemic of lifestyle diseases? The simple answer is to improve lifestyles. Fitness professionals can attest that this is easier said than done. Lifestyle behaviors and disease risks are a tricky combination of biological, environmental and behavioral factors that can be difficult to change.

Individual behavior: Just say no

Our culture addresses the epidemic of lifestyle diseases by encouraging individuals to change lifestyle behaviors. Public health campaigns encourage smoking cessation, personal training services help individuals set up or improve exercise programs, and individual nutrition counseling and stress-management workshops are offered. The message in all of these approaches is the same: It’s your problem, and you are responsible for fixing it. When it comes to smoking and junk food, the advice is “just say no.” When it comes to exercise, we say “just do it.” It’s simple.

But is it so simple? Education and counseling play an important role in addressing the epidemic of lifestyle diseases, but educational programs designed to facilitate individual behavior change are not enough. Negative side-effects can accompany these programs, especially a tendency to blame individuals for their habits and even their diseases. This individual-focused approach can also generate feelings of guilt and low self-esteem in clients who fail to live up to high expectations.

Perhaps most damaging is that this approach can create an inability to examine and change the larger picture. Consider the client described in the opening paragraph. If she fails to get to the fitness center five times a week, and lose 50 pounds, she will probably blame herself for her failure. But is this failure really her fault? Stress-management workshops often provide great case histories of people who simply have more to do than they could ever create time for. No amount of time management, problem solving or deep breathing can fix every difficult situation.

Environmental factors

No person is an island. People are a product and a part of their environments. Environments are the worlds people live in, and include physical, cultural and sociological influences. Environmental factors strongly influence a person’s choices and options. Most people have several different environments, and may make choices differently depending upon which environment they are in. For example, a person may never smoke at work, where smoking is frowned upon, but he or she may smoke at home where other family members smoke, and where smoking is a social activity.

Consider again the client in the opening paragraph. What environmental factors have been described? A family that teases her when she exercises. A full-time job and family obligations are also environmental influences that affect the choices she makes about whether to go to the fitness center for her workout

Many fitness professionals underestimate the powerful influence environmental factors have on clients, since they tend to be dedicated to physical fitness and exercise. Many are paid to exercise, or have easy access to fitness facilities, and are motivated to maintain their fitness to enhance credibility as fitness professionals. Fitness is something they make a priority and they may think, “If I can do it, why can’t everyone else?”

If you observe people who walk through fitness center doors (and remember, these people are not even typical of the American population in general), you will notice that some can’t do it. Sticking to an exercise program is harder than it looks, even for people who are convinced that consistent exercise is essential for good health. Are these members weak-willed, lazy or stupid? Not necessarily. Sometimes life just gets in the way. Job responsibilities, sick kids, aging parents, financial problems, travel and even relatively minor hassles can pile up.

As we try to get America moving, we must consider some cultural groups in our country who can’t even imagine going to a fitness center. For some people, physical activity options are very limited. Some people can’t bring themselves to perform physical activity just for the sake of exercising. Fitness professionals must help design culturally appropriate activities for these overlooked groups of people who are often at the highest risk for lifestyle diseases.

Working with the total picture

Because environmental influences are powerful and difficult to change, it is tempting to ignore them and proceed as best you can. But there are at least three good reasons to consider environmental influences in your work.

First, you can help clients take these influences into account as you design their exercise programs. Work with existing environmental constraints (just as you work within genetic constraints) to make programs as convenient and realistic as possible. Help clients think about their particular constraints and think of some options to address them.

Second, there are many things you can do to help change environmental influences in your community. You can encourage work places to offer exercise options for employees, urge your local schools to improve physical education programs, volunteer to coach a sport, or organize a walking club for your extended family and neighborhood.

Third, remember that your clients are not to blame when they fail to live up to their noble intentions. And neither are you. Positive emotions, like forgiveness and commitment, are more likely to get you back on track.

Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith College, Northampton, Mass

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