This is the second in a three-part series entitled Take Responsibility for Your Own Health. Last week we defined the concept answering the question, “what does it mean to own your own health?” We focused on self-empowerment, self-efficacy, self-awareness and self-determination as essential aspects of taking responsibility for your own health. This week, we will look at how some people react to health news and choose to act or not. Possessing self-empowerment, self-efficacy, self-awareness and self-determination are all critical parts of taking responsibility for your health, but ultimately what we do is what is essential!
There are many different kinds of research study models. Some study very specific groups of people, say men between the ages of 35 and 45 with a history of smoking and being more than 40 pounds overweight. Others study the effects of a particular drug or treatment and provide a “control” or “placebo” to compare results. Others look at large sets of people across an entire population at a specific point in time. These are called cross-sectional studies and provide data looking at an entire population as a whole. All types of studies can provide reliable data if the researchers control their own bias and look to answer a question rather than substantiate a hypothesis that they have already determined as true or false.
A large cross-sectional study is a great tool to look at a large population of people. One of the best ones on the planet is the National Health and Nutrition Examination Survey (NHANES). This is a program of studies designed to assess adults and children’s health and nutritional status in the United States. The survey is unique in that it combines interviews and physical examinations. Although no data collection is entirely flawless, the NHANES is agreed among researchers to provide reliable data on a very consistent basis.
I recently ran across a brand-new article published in the Journal of the American Board of Family Medicine just this month dealing with what behaviors people change once they become aware that they are prediabetic. The article is entitled Association of Prediabetes Status Awareness with Behaviors and Perception of Health and is a secondary analysis of the 2015 to 2016 NHANES data.
Lifestyle modification can significantly reduce the risk of developing diabetes. There is no debate about that. But do we get to the point where we are willing to take action? It’s easy to say that “if they only knew that they were at risk, they would do something about it.” Is that true, though?
In 2015, another study relying on an analysis of 2007-2010 NHANES data determined that people aware of their prediabetic status had increased odds of engaging in physical activity and weight management behaviors. That is what I would guess was true as well. If people know their condition certainly, they would act and do something about it, right? This 2021 study of 2015-2016 NHANES data found something different and it has implications for what we are discussing.
In their introduction, the research authors state that; “the Health Belief Model, which is commonly used to explain and predict health behaviors, suggests there are six constructs that influence the adoption of health behaviors: perceived susceptibility of an illness, perceived severity, benefits of action, barriers to action, self-efficacy and cues to action. Research has shown that a perceived threat of illness correlates positively with engagement in preventive health behaviors.” That says that if we know we have a severe medical condition, and we know and believe that we can benefit from an action, and nothing is preventing us from acting, that we will act, or based on all of that data, our actions can be predicted.
Researchers divided people into two groups; those that were Prediabetes Aware (had been told that they were prediabetic) and those that were Prediabetes Unaware (had not been told that they were prediabetic.) From nearly 10,000 responders, the researchers’ included 389 participants that were Prediabetes Aware and 410 participants who were Prediabetes Unaware but had an HbA1c that was “borderline” for diabetes (between 5.7 percent and 6.4 percent). Not surprisingly, “a higher percentage of the Prediabetes-Unaware group felt their general health status was excellent. In the Prediabetes-Aware group, 67.1 percent felt they could be at risk for diabetes compared with 24.9 percent in the Prediabetes-Unaware group. A higher percentage of the Prediabetes-Unaware group felt their general health status was excellent or very good (41.4 percent) compared with the Pre-diabetes-Aware group (32.2 percent). More of the Prediabetes-Aware individuals considered themselves overweight (69.3 percent vs. 51.4 percent).” So those in the Prediabetes Aware group felt that they were overweight, in less than excellent health, and at risk for diabetes.
That would seem to predict that the Prediabetes Aware group would be more likely to engage in some preventative activity if not outright lifestyle modification, but here is what the researchers found.
“We found that patients who were aware of their prediabetes diagnosis were more likely to report being at risk for developing diabetes and were more likely to see themselves as overweight. However, those who were aware of their prediabetes status were not more likely to engage in healthier dietary or physical activity behaviors compared to those who were unaware.”
Those in the Prediabetes Aware group participated in less daily activity. They walked or biked less, did moderate exercise less, did vigorous activity only 1% more than the Prediabetes Unaware group and reported sitting more than the Prediabetes Unaware group.
That surprised me! All people that are diagnosed with prediabetes are provided with at least some basic information. Still, as patients, that information and the warnings are not translating into action on our part. The researchers use the Health Belief Model and postulate that “this may be due to a lack of perceived severity of diabetes, a lack of self-efficacy, a lack of benefits to action, significant barriers to action, a lack of cues to action or social factors.”
I would say that the Prediabetes Aware group that failed to act was failing to own their own health. They seemed to be somewhat self-aware but did not engage in self-empowerment, self-efficacy and self-determination. Just being self-aware is not enough!
This is very recent data and it is important to know that all of us may be at risk of this very same behavior. People right around you may be engaging in inactivity, don’t let that be you!
My buddy Bruce has it right!
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
– Bruce Lee
Have a great week. Next week we look at owning your own heath; my own personal implications given my recent health crisis.
Here are the references for today’s Healthy Eating Tip:
Li E, Silverio A, Cunningham A, LaNoue MD, Mills G. Association of Prediabetes Status Awareness With Behaviors and Perception of Health. The Journal of the American Board of Family Medicine. 2021 Jan-Feb;34(1):224-230.
About the National Health and Nutrition Examination Survey. National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed 2/26/2021.
Gopalan A, Lorincz IS, Wirtalla C, Marcus SC, Long JA. Awareness of Prediabetes and Engagement in Diabetes Risk-Reducing Behaviors. American Journal of Preventive Medicine. 2015 Oct;49(4):512-9