Has someone you care about been diagnosed with high blood pressure but is still heavy-handed with the salt, been told they have diabetes but still goes for a daily bowl of ice cream or continues to smoke even though they have COPD?
If so, you might be fighting the impulse to tell your loved one what to do out of worry or fear, but Lisa Grant, DO, says that showing support is about asking the right questions.
Support is asking the right questions
As medical director of the UW Health Center for Wellness at The American Center and a primary care physician Dr. Grant said, “We know it doesn’t work to use fear, shame and shoulds; we need to change the conversation from ‘What’s the matter with you?’ to ‘What really matters to you?' ”
So what does that mean?
In her practice, Dr. Grant asks her patients two questions:
How important is it to you?
How confident are you?
“I first want to know: Why do you want your health? What do you want to live for? When people are connected to what’s important to them, they can see that their health has meaning, that it’s a vehicle to make what’s important to them possible, and making lifestyle changes becomes motivating," she said.
Think of the grandfather who wants to gain the strength to dance at his granddaughter’s wedding, the mom who wants the energy to play with her kids or the dog lover who wants to be physically able to care for a beloved pet. Helping people define their “why” is a crucial first step.
“It’s hard to engage people in change if they don’t know the answer,” said Dr. Grant, “so it’s important to start the thinking process.” She also asks patients to rate on a scale of one to 10 how important making a change is to them. She cautions that if a person’s motivation falls below a seven, that they are unlikely to be ready to make changes and putting changes on hold might be the best thing.
If a person is highly motivated to make changes, the next question Dr. Grant asks is, "How confident are you?"
“A smoker who rates quitting smoking a nine out of 10 in terms of importance, but only rates their confidence at a five or six would prompt me to ask, 'How can I support you? What do you think would help?' " she said.
Guide, don't tell
Dr. Grant stresses the importance of a “guiding” style of conversation, rather than directing or telling.
“We know that if people can say out loud and in their own words what specific behavior changes they feel might be possible, that they are more likely to make changes,” she said.
Dr. Grant said that focusing on a small change in one area can have a domino effect on other areas of a person’s life. She refers to the domains of living the World Health Organization considers essential ingredients to enjoying whole health: Good nutrition, moving the body, ability to effectively manage stress, rest/recovery, healthy and safe environment, living with meaning and purpose and social connections.
For one person, getting more sleep could lead to better eating. For another, eating better might give them the energy to start exercising. Another person could need to address their stress and anxiety first.
All that being said, Dr. Grant said that what support looks like also depends on your relationship to the person. “It’s different if I’m trying to support my child versus my husband," she said. "My son is 13, he has a developing brain and is focused on the short-term. So I focus on role modelling, letting him seeing me make good choices and limiting screen time.”
With parents, siblings and spouses who are autonomous adults, asking guiding questions, preparing healthy foods, suggesting healthy activities like taking walks or attending a wellness class together can be appropriate ways to provide support. But if a person is not interested in making the changes you want for them, you might just need to let it go and respect their choices.
Ask your primary care provider about what resources might be available at your clinic for support, and check out the Wellness programs at UW Health at The American Center including a wellness consult with Dr. Grant, group medical visits, learning kitchen classes and more.