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In Practice

Sharing patients’ top five health tips

Dan Page for the Boston Globe

At an airport crowded with holiday travelers, I indulged in my usual pre-flight trip to the “Women’s Interest” section of the newsstand. I’m an anxious flier, and I find the glossy pages of O, More, and InStyle soothing. I rarely read these magazines while earthbound, but at 38,000 feet, I can’t get enough of them. I loosen my sweaty grip on the armrests and float through the clouds contemplating $2,000 purses, monogrammed sheets, and, especially, tips that promise to transform my health from “before” to “after.”

When the wheels touch down, though, the spell is broken. Such pearls of wisdom as “eat off smaller plates” and “park farther from the mall entrance” seem more like platitudes than keys to boundless vitality.


It’s not that these tips and similar ones offered so frequently in newspapers, magazines, and, yes, doctors’ offices, especially at this time of year, are invalid. Many studies have shown that small actions — such as walking 10 minutes three times a day, and replacing even a few servings of sugary, fatty food with fruits and vegetables — can, if repeated regularly, help prevent cardiovascular disease, Alzheimer’s, and many other conditions.

But the problem with most health tips is that they emphasize the “what” over the “how.” My patients already know they should eat less and move more, reduce stress, and get adequate sleep. What they (and I) find difficult is acting on that knowledge consistently.

I do have patients who have maintained weight loss, reduced their cholesterol levels, normalized their blood sugars, and weaned themselves off medications, all by changing their behaviors. I always ask these patients what keeps them on track, so I can remind them of their answers if motivation flags later. I pass along their successful strategies to other patients and I’ve adopted many myself.


Since ’tis the season for lists, here are my patients’ top five health tips:

Lower your expectations  I’ve noticed that my patients who have made lasting improvements in their health and fitness are not the same ones who say self-castigating things like “I was bad” or “I cheated.” They recognize that change is a messy, nonlinear process that doesn’t start on a Monday morning (or Jan. 1) and proceed seamlessly. One woman lost 20 pounds with regular exercise. She kept the weight off for a few years and, though still obese, felt much better and lowered her cholesterol. When a family illness threw off her routine and she gained back a few pounds, she didn’t blame herself. Why should she? She regrouped and, slowly, started exercising again.

Make it interesting   One school of thought argues that it’s easiest to stick with a diet and exercise program that involves few choices, little variety, and minimal pleasure. Many see meals and treadmill time as self-maintenance rituals, like brushing your teeth. My most inspiring patients, though, don’t ascribe to this philosophy. They view their healthy lifestyles as sources of fun and even self-expression. One stays in shape so she can scuba dive on exotic vacations. Another took up competitive rowing at 50 with a new group of friends who share her passion for the sport. Yet another gave up meat and made vegetarian cooking her new hobby.

Make it easy  So often a healthy choice is dictated by convenience. Patients frequently tell me that they’re too tired to hit the gym after work or too rushed to grab anything but takeout at lunchtime. “Every day I tell myself I’ll try harder to do better,” a woman said recently, “and every day I fail.” But instead of trying harder, why not make the goal easier? Many of my patients have figured out that with a little preparation, the path of least resistance is the healthier path. Some exercise by walking to and from the train station as part of their commutes. Some arrive home to a hot meal ready in a slow cooker. I find if I take five minutes in the morning to pack my lunch and a couple of pieces of fruit, I’ll definitely eat well during the day. If I arrive at work empty-handed, I’ll definitely visit the candy jar my colleague keeps on her desk.


Make it important  Someone tells me they’re about to embark on a new diet or exercise program. They’ve signed up for the classes, bought the packaged meals, outfitted themselves with a heart rate monitor and copious Spandex. “I really mean business this time,” he or she announces. But when I ask why, I’m often surprised at the vagueness of the response. “I want to get healthy” or “I need to lose weight” may not be enough to get you out of a warm bed to exercise on a cold morning or forgo an extra piece of cake. Several of my patients have altered their lifestyles hoping to avoid a second heart attack or a cancer recurrence. One lost weight so she could donate a kidney. Less dramatic goals work too — as long as they’re specific and meaningful. And the meaning doesn’t need to be tied to fitness only. A couple in their 80s have walked together daily for decades to maintain their relationship as much as their health. Personally, exercise helps me think and write. The benefits to my arteries and bones are nice, but not what get me out the door.


Expand your definition of health I once had a patient who ate a perfect diet and exercised daily. She meditated, took vitamins, flossed. But she wasn’t happy in her work. When she changed jobs, she looked and felt 100 percent better, even though her new schedule meant she had to cut back on her workouts. Stress and social isolation are strongly associated with illness. My patient who left an abusive marriage, the older couple who downsized their home, and the man who closed his business to fulfill a lifelong dream of being a teacher all improved their health — and none of them lost an ounce.

Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. Read her blog on Boston.com/Health. She can be reached at inpracticemd@gmail.com.