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Change or Die

(Formula for Life-Altering Change)

If you were given that choice, for real, could you change? Alan Deutschman asks that question in his book Change or Die (Regan, 2007). Unbelievable as it seems, he says the odds are nine-to-one that you would not change. He gives facts and figures to back up his assertion—and then lays out a three-part formula for beating the odds. He calls it the 3 Rs: “Relate, Repeat, and Reframe.” In plain terms, “new hope, new skills, and new thinking.”

Deutschman gives many excellent examples, but the two that interest me most involve heart disease and his own struggle against obesity. His distressing odds ring true in both cases. It is well known that over 90 percent of people who lose weight gain it all back, and usually more. Weight loss, of course, is rarely a near-term life-or-death situation. Heart disease, however, is another story.   

Deutschman says patients will not change their lifestyle after coronary bypass or angioplasty surgery—even if their life depends on it. Citing Edward Miller, MD, dean of the medical school and chief executive officer of the hospital at Johns Hopkins University, as his authority, he explains that such surgeries “are no more than temporary fixes.” They relieve the patient’s pain, but only for a while. “The bypass grafts often clog up within a few years; the angioplasties, in only a few months,” he tells us.

Doctors tell their patients that they must “switch to a healthier lifestyle” if they want to keep the pain from coming back, avoid repeat surgery, and stop the disease before it kills them. Nevertheless, few change.

“If you look at people after coronary bypass grafting two years later, ninety percent of them have not changed their lifestyle,” says Dr. Miller. “Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason they can’t.”

Amazingly, people won’t even keep taking a pill which has a good chance of saving their life. A study of 37,000 patients who were prescribed statins found that nearly everyone took the pills for a month or two, Deutschman relates, but by the third month about half had stopped, and one year later only “one fifth to one third” were still taking the statins, “which they were supposed to keep taking for the rest of their lives.”

“Facts and fear,” no matter how soundly based, don’t work. ”The real key is to give people hope, not facts,” says Deutschman. There’s more to it, of course, but that’s the crucial first step. Dr. Dean Ornish’s program for heart disease sufferers is an inspiring example. You’ll have to read the book to get all the details, but here’s a thumbnail sketch.

The Ornish Team Approach

Unfortunately, doctors know from their own clinical experience and research literature that the history on patient compliance is not good--dismal really. “After performing the miracle surgeries and prescribing the miracle drugs,” Deutschman writes, “the doctors remind you [that] you’ve got to start living in a healthier way,” but “they really don’t believe you can change.” (Emphasis mine) “Their lack of conviction, betrayed by the look in their eyes or the tone of their voice or their body language, takes away from the impact of their words.” 

What distinguishes Dean Ornish, MD, a professor of medicine at the University of California at San Francisco, is that he believes in lifestyle change--and has the experience and research to back it up.

After a series of smaller, and successful, trials starting in the late 1970s, Ornish and his colleagues in 1993 identified 333 patients who suffered from “severely clogged arteries” and had qualified for bypass or angioplasty surgery. In many cases, these patients were suffering from crippling disease and needed immediate relief. The Ornish group persuaded 194 of the 333 to forego surgery (which would practically guaranty immediate relief) and try lifestyle change instead.

“Staffers helped them quit smoking and switch to an extreme vegetarian diet that derived fewer than 10 percent of its calories from fat,” Deutschman relates. “The patients got together for group conversation twice a week, and they also took classes in meditation, relaxation, yoga, and aerobic exercise, which became part of their daily routine.”

After one year, when the  program ended and they were on their own, one would expect them to lapse into an unhealthy lifestyle. Actually, conventional wisdom would expect most of them to drop out of the rigorous program before the end of the first year. “But three years from the start,” Deutschman writes, “77 percent of the patients had stuck with these lifestyle changes—and safely avoided the need for heart surgery. They had halted—or, in many cases, reversed—the progress of their disease.”

What allowed the Ornish team to reverse the odds, and inspire almost 80 percent of the patients to stick with the program and transform themselves?

Briefly, Dr. Ornish’s team took the time to sell the patients on the idea that they could change; they gave them hope and made them believe in themselves. Next, they helped them learn and practice new habits and skills. Finally, they encouraged the patients to think about their disease in a new way, to help themselves.

Deutschman contrasts the Ornish approach with the conventional strategy which relies almost entirely on the doctor, who tells the patient the facts of their case and that he or she must change. As noted above, the doctor doesn’t really believe the patient can change. Both the doctor and the patient believe that surgery and drugs are the only viable option.   

The Ornish approach uses a team of professionals, including a cardiologist, psychologist, personal trainer, chef, and a yoga or meditation instructor, who all “fervently believe patients can change.”

The approach also offers another powerful motivator: dramatic results. In all of the Ornish trials (Deutschman describes four), the frequency of chest pains fell by 90 percent or more within the first month. “The rapid improvement helps to sell the patients on the program and inspire them to stick with it even though it’s a very demanding change,” Deutschman emphasizes.

Motivated by dramatic early success and a full year of practice (exercise, yoga or meditation, support group, and meal preparation) under the watchful eyes of the team of professionals, the patients are instilled with the understanding and belief necessary to continue on their own. 

You are probably thinking that the team approach sounds expensive. You’d be right, $7,000 per patient, but that’s far less than $46,000 for bypass surgery and $31,000 for angioplasty. Apparently, the cost efficiency is finally getting through to the powers that be: In 2005, Deutschman reports, Medicare decided to cover the costs of the Ornish program.

Now, let’s move on the author’s weight problem. We’ll focus mainly on the first part of the formula, relate or new hope, because that’s the key to change.

Author Overcomes Obesity

Alan Deutschman says obesity “snuck up on me.” At 25, he was about 160 at almost five-nine, and still slender. Two years later, however, he found himself weighing 200, and it got worse from there.  At 30, he had to fudge on his weight to get health insurance. At 31, he weighed 222 and was so fat that his editors at Gentlemen’s Quarterly recruited the chief personal trainer at an upscale gym to help him lose weight. The personal trainer was a former Mr. America, which turned out to be problem. “[He] was entirely amiable, but I could never see him as a role model,” Deutschman relates. “No matter what I did, or how hard I tried, I knew that I would never look anything like him or be like him.” 

What’s more, he says, “the place was filled with beautiful people—I was much too self-conscious and felt out of place.”

To make a long story short, he lost about six pounds at the start, but gained it all back, and soon gained six more—“which brought up my weight to its all-time peak of 228.” At 33, he moved to another city, where he joined a fitness center within walking distance of his apartment; but he couldn’t make himself go to the gym regularly and had no better luck getting his weight under control. “I was nearly resigned to the idea that I was an obese person and I simply wasn’t going to change. It was becoming my identity.”

Happily, that was his low point. The gym that he rarely went to closed down unexpectedly and, prodded by his girl friend, he “joined a small, friendly gym” nearby. The membership entitled him to two free sessions with one of the gym’s personal trainers. That’s when things really started to look up. The new trainer, an energetic young woman with “an infectious enthusiasm for exercise,” turned out to be the key to solving his weight problem.

“I bonded with Claudia partly because of our similar backgrounds and interests and partly because I was intrigued by our differences,” Deutschman writes. “Unlike ‘Mr. America,’ Claudia wasn’t from another planet—she was from my planet, which made a big difference. She was like me in so many ways that it made me believe that I could be like her in the other ways—that maybe I could become fit and vibrantly healthy.”

He could relate to her; she made him believe.

Within months, his weight dropped to 188, and has stayed there for five years and counting. “I went from dreading the idea of running a one-quarter mile lap around the track to looking forward to going out and running three miles on my own.”

More important than the actual process of losing weight and becoming fit (which, of course, is important), Deutschman explains, is “having a relationship with people who believe in you and whom you believe in as well….One of Claudia’s great gifts is that she truly believes and expects that her clients will learn to love exercise, even if they haven’t worked out much in their past.” Her belief helps her clients to believe in themselves.

That’s the take-home message. In my own case, I believe that’s why many people relate to me now who didn’t relate to me when I first appeared in Muscle & Fitness. I was younger and lean, but not young enough to appeal to guys in their 20s. But now that I’m older--and still lean--and they’re in their 40s, it’s another story entirely. They identify with me now—and relate to my message. They can see themselves benefiting from my example and perhaps following in my footsteps.  

“When you find the right relationship,” Alan Deutschman proclaims, “anything is possible.”

Remember, relate (believe), repeat (practice), and reframe (think anew).

You’ll find many more details and examples, in medicine, science and business, in Alan Deutschman’s book Change or Die. I urge you to read it.

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