THE HEALTH CONVERSATION, Chapter 4: Key Tools To Tame Your Health

Key Tools for the Book

Like any plan of action in life we need a combination of luck, skill and preparation. Thankfully you are just reading a book and so I would hope that the first two are not needed in too much abundance. The final one, preparation, is what this next part of the book is about. In the next few pages I want to tell you about three key tools that I want you to try and apply to yourself as you go about reading this book. These tools are (1) The Knowing-Doing Gap (2) The Cycle of Change and (3) Self-Motivational Interviewing. Now yes, I would like you to digest these three tools applying them to your own life as your browse this book but I also want you to remember that you can apply these to any part of your life – not just your health. Consider how they may be useful in work or with your family and friends. As promised there is no whale music featuring in The Health Conversation so you can blow out the joss sticks and turn off the meditation CD for now.


Tool One: The Knowing-Doing Gap

The “Knowing-Doing” gap is one of my favourite principles. It makes me smile just to think about it and its simplicity actually. Remember, simple is good. Now, I want to share it with you, not just because I clearly have a literary crush on it but because it frames the very ethos of The Health Conversation. In doing so, it help make sense to you as to why some of this book is just so bloody simple and straightforward.

Now I first read about the “Knowing-Doing” gap in a business book. Much to my disappointment and frustration I still cannot remember what the book was called. But anyway, let me still share with you the story within it. Picture a packed, high-profile glossy, no-expense spared conference centre in North America. The conference centre is packed full of high-flying executives, most of whom were at the top of their respective companies – CEOs, CFOs, CMOs, and the ‘Who-knows’. They were all there waiting to receive the invitational key-note speaker of the conference – the executive of executives who conveys an almost God-like presence. Forty-five minutes later this executive deity finished his speech.  Unfortunately for the paying delegates however, he had just spent that 45 minutes telling the packed conference centre of experienced executives exactly what they already knew about running a company and how to behave in business. Naturally the delegates sat there feeling slightly short-changed. It’s like asking for a Sunday Roast Dinner – and getting a corned beef sandwich instead. Disappointing to say the least. Of course being a room of alpha-male and female personalities, someone put their hand up and brazenly asked the question that everyone was thinking: “Thank you, Sir, for a wonderful talk. However with respect, don’t you think we knew all of that?” The key-note speaker just smiled his deity-like smile and replied, “Now, be honest and show me the evidence that you actually DO what you KNOW you should do in your business.” The penny had dropped. This was no message from a higher-being; this was just someone saying how it is:

We know what to do – but more often than not, we don’t do it.

What a wonderfully powerful, yet simple message.

The reason I wanted to share this with you is because it translates as readily to your health as it does to the above business example. What you will read in this book you may already know a lot of – which is brilliant. All I am trying to do is highlight that fact. In doing so, I want to prompt you to actively think “I know this – but maybe I just don’t do this”. In essence I want to make you aware of your own “Knowing-Doing” gaps. This is the first step to realising that change can and is possible.


Tool Two: The Cycle of Change

This leads us nicely onto the Cycle of Change. Now I wanted to introduce this principle to you because we are all, whether we like it or not, in it. You may knowingly be trying to change or perhaps stuck stagnating on the Cycle of Change because you have not even considered changing a habit or lifestyle choice. That’s the beauty of it, it covers all bases.

To explain further, I want you to think of the Cycle of Change as a journey. It starts with a thought (or actually even before the thought) and proceeds along a journey over days, weeks, months or years to an action. It is this action that elicits a change in some part of your life. Even then your journey is not over, for we sometimes either needs to make efforts to maintain that change or sometimes we simply relapse and need to begin again at a point further back down the Cycle of Change. The points along your journey to change have specific sign-posts. What we’re going to do now is briefly touch on each of the sign-posted stages so that you can go away and consider where you are on the cycle for various things you may wish to change in your life.

First in the Cycle of Change comes pre-contemplation (Stage 1). Here you have not even considered changing something. For many of us there may be elements of our life which we should consider altering to improve our health but we simply haven’t reached a point in our lives where we need to or can even think about doing so. When we do however, we enter the second sign-post on the journey – contemplation (stage 2). Here you are considering a change but you have not yet planned or acted upon it. As this contemplation and resolve to enact upon your new desire grows, you are led nicely to the third stage – preparation (stage 3). This stage is all about preparing for your change to happen. It may be that you seek out who will support you on your decision to change or you are planning what elements of your life may need to change for it to be successful. You can only advance to the next stage successfully (unlike Monopoly, you don’t collect £200 when you pass GO) when all of the preparation stage is complete. If it is, then you can happily proceed to the fourth stage –action (stage 4). This is the stage where the change takes place. It is often the most high risk stage as it calls upon those two elements I asked you to have earlier – patience and hope. From this stage two eventualities usually happen – maintenance or relapse (stages 5). Both are equally important to the process of change and you can definitely learn from either. In a maintenance stage you reinforce your change and thereby further concrete it for life. In a relapse stage you will have experienced a hiccup and broken that change. That’s ok though – we are human after all! Besides, we learn the most when we are failing. If this does happen, all you need do is get up and dust yourself off, and move back to the preparation stage of the Cycle of Change again. From there its simple – you proceed forward again, this time with some added wisdom!



Tool Three: (Self) Motivational Interviewing

The final tool I want to share with you is what those in the medical profession sometimes refer to as motivational interviewing. Now if Lord Alan Sugar springs into your head with his sturdy finger pointing at you as he grumbles “You’re fired!” then you can relax. It actually has very little to do with interviewing. In fact, come to think of it, I have no idea why they even bother calling it that – though I’m sure somebody with a bigger brain will correct me after this is published. Instead I want you to think of Motivational Interviewing as a conversation. Now this may often be a conversation between you and somebody in the healthcare profession such your GP, a specialty doctor, or you and your personal trainer, for example. That is all great, don’t get me wrong. However what I want to say to you is that perhaps, for those of you who are maybe a little bit shy, don’t want to speak to a health professional right now, that Motivational Interviewing can be just as much about having a conversation with yourself. Hence, Self-Motivational Interviewing. I love it and do it all the time.

So what’s the conversation about? Well since it’s your conversation, it can be anything you want it to be about. As a guide for you, I like to think of mine incredibly simply and ask myself questions like:

  1. What is my health goal?
  2. Why is this health goal? (After all this is what is fuelling it, right!)
  3. What is stopping me from achieving my goal?
  4. How can I overcome these barriers to my goal?
  5. How can I break the actual goal (not the barriers) down into bite-size achievable chunks?

The final point is really important as some goals can just feel utterly insurmountable. And you know it is of course a very personal issue. For example, for one person, losing 5 pounds of body weight may seem like a terrifying and unachievable proposition. For someone else however this may be easy and yet they have instead blinded themselves with the enormity of setting a self-imposed 5 stone loss target. The trick with any goal is to agree bite-sized goals. They will after-all add up to that final goal; the one that you’ll finally turn to, your head at slight angle and a Wild-West Clint Eastwood squint in your eye, and growl  “Huh, you ain’t so scary after-all”.

So there you go, three tools to have in the back of your mind as you read this book: The Knowing-Doing Gap, The Cycle of Change and (Self) Motivational Interviewing. As we now amble onto the twenty one health conversations for twenty first modern living please don’t be afraid to flick back to these to refresh your memory. Alternatively you may find it useful as you go through the book to take a time out with a piece of paper and a pen when something really grabs your attention or sparks an idea.

Remember, like that friend we talked about earlier, this book is not on your Christmas card list!

Chapter 5 will be out next week! Follow me if you like at @drnickknight on Twitter!


The Health Conversation, Chapter 3: What is Health?

What is Health?

“Healthy citizens are the greatest asset any country can have” [Winston Churchill]

Health is individual. It’s also a chameleon, constantly changing its appearance as we move through our lives. And for these reasons, my health is most certainly different to your health; that’s not only in terms of our interpretation of what health personally means to us but also of its current state and its future state. So with so much variability you may begin to realise that it’s pretty bloody hard to define. Of course, by define, I don’t mean the textbook definition – I mean to define to you.

With all that in mid, what I want to attempt is to help build a really simple four pillar building in your mind. The four pillars represent physical health, psychological health, social health, and spiritual health. Try and picture this building. Each pillar is an equally important structural component to support that roof which is called ‘total health’. Without a weak pillar, the roof collapses.

Pillar One: Physical Health

I thought we should start with the most obvious, yes? Now I tend to think of physical health as referring to the health of our physical make-up. That’s from your skin, to your internal organs, to the millions of cells that exist within our body. These all work in an awe-inspiring dynamic, ever-changing, ever-adjusting synergy that allows us to manage the environment we exist in. Not only that but it helps to manage what, we ourselves, do to our body from the food we decide to consume to the illness we acquire or injuries we sustain. It is often the component of health we all most readily associate being ‘healthy’ with. It is also the one that we positively associate with being able to function in society with. What I’ll show you next is that you can achieve an even more brilliant feeling of total health when you refocus on the three other pillars of your building.

Pillar Two: Psychological Health

Now because I felt that psychological health, or mental health if you prefer, is often the elephant in the room when in comes to health, I wanted to introduce you to a formal definition by the World Health Organisation (WHO). The WHO state mental health as a subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualisation of one’s intellectual and emotional potential, among others. Bit wordy isn’t it. Basically it is a sensation of feeling good about life and positively engaging without yourself and those around you. And you know our psychological health is such an unbelievably important pillar to our total health roof. I say this in the context of a society where subclinical and clinical depression is on the rise, and life dissatisfaction, stress and apathy permeates at all levels. We all deserve a state of psychological wellbeing where we are not only free of mental disorder and disability but also free of unacceptable levels of stress in our life. It is crucial to allowing ourselves to have good, balanced total health.

Pillar Three: Social Health

We are social creatures. Now yes while, it is true that some are (much) more social than others, craving the limelight and social butterfly status, we all to a greater or lesser degree want to socialise. It is, as I am sure you will agree, an incredibly important and powerful component to our total health; to live in isolation without social contact has been shown to be detrimental to your overall health. After all, no man is an island. We are happier when we socialise, when we engage with people, when we laugh, and off-load stories and stresses. In the process treat and alleviate many burdening psychological health problems we may have and stop them from pathologically growing from seed into some horrible venus flytrap, eating away at our health. Friends are the best medicine. This pillar is being powerfully affected by modern life. While many of us may argue we have fantastic social access (although concerning this is increasingly ‘online’), we are also seeing an elderly generation facing years of increasing isolation and loneliness. This is an unresolved and emerging tragedy that we must tackle.

Pillar Four: Spiritual Health

This for me is the one pillar of my building that I am still in desperate need to use and learn about more. I tell you that because I think it’s pretty ignorant and unfair of me to jump on my literary soap box (I don’t think that the literary scholars will be hailing The Health Conversation as the read of the decade somehow!) and state how important spiritual health is when I am still learning to appreciate it more myself! Spiritual health will mean different things to different people. To be honest with you, I’m not even that sure how to define it. Then again, it’s like Louis Armstrong said, “Man, if you have to ask what jazz is, you’ll never know”, and so perhaps it’s not possible to properly define spiritual health. You just know it when you have it. So with that in mind, you may knowingly have it in your life already, or after reading this realise that you unknowingly had it in your life. Perhaps however, this is entirely new. So what could spiritual health mean? Religion? Possibly. Mindfulness? Could be. Or meditation and spiritualism? Maybe. In fact I guess that it could be any connection you have with an outside force or being that is in some way linked to religion or a spiritual way of life. People often associate its importance with when at the end of their lives but I am increasingly seeing its value through every stage of our lives as a key element to attain total health.

So what influences all of these different components of health? Well, to be honest, you know the answer already. Go on, think. I bet if you had a piece of paper and pen, you could right down a list of things in your life that influence the four components of your health. Broadly speaking we can divide them into internal and external factors. The internal factors pertain to what happens to your body naturally without your active engagement. The external factors pertain to what we do to our body and how it then reacts. These, as you might guess, are the more problematic issues like smoking, calorie rich diets, no exercise, sedentary living (yes that is a different problem from no exercise) and excess alcohol consumption. But we won’t dwell on these here as we’ll talk about these later. All I want you take away is the concept that there are four pillars to your health: physical, psychological, social and spiritual. To achieve the best possible roof that holds your total health, you need to pay attention to all four pillars. Equally.

Chapter 4 of the Health Conversation will be posted next week!

Dr Nick Knight @DrNickKnight

THE HEALTH CONVERSATION: Chapter 2 – Modern Living and Health De-Railers

Modern Living

“Unlimited choice is paralysing” [Susan Orlean]

There’s no doubt that modern living is pretty damn good. We are overloaded with a glorious abundance of choice and opportunity that excites and motivates many of us. What I want to highlight here in this chapter is that perhaps, just perhaps, the living has gotten a smidgen too good. We now have too much choice and too much opportunity. As a result, a number of problems (often related to our lifestyle) have crept-up upon us in the cold light of day with outrageous brazenness and are now systematically de-railing our health. After much self-debate, scribbling and whisky, I have narrowed down my top 5 health de-railers.

Health De-Railer One: We Hurry but Go Nowhere

Life has gotten significantly more fast-paced. We want financial security and cash faster, satisfying calorie-rich food faster, success in work faster and attention faster. It seems to have crept up insidiously over the past 50 years and transformed the way we perceive life and its now infinite possibilities. The ongoing technological revolutions have of course happily fuelled this desire for the ‘instant’. As a result, life, for many, is now an online process. We shop online, date online, work online, communicate online and socialise online. While some of you may think this is great news, please, please do think again. This online life and desire for the instant now means that for many of us, our lives are spent sitting on our fat-laden bums providing a suitable cushion tapping away at our keyboard or smart phone. As the quote above suggests, unlimited choice has paralysed us. Sadly it is a voluntary paralysis. Are we now held hostage to technology? More on that later.

Health De-Railer Two: We Stuff First and Question Later

Ourselves that is. But look, don’t worry because you are not alone slowly sinking in your own world of gluttony. For as a stern society we have slowly and collectively slipped into this way of life. We now all find ourselves treading water in a sea of sugars, fats and salts trying not to give in to them. It is truly a battle of will. Even those of us who try to eat healthily slip-up since many of these so-called healthy-option ridiculously expensive ready meals often contain more salts, sugars and fats than the cheaper unhealthy options! We are all facing this steep and uphill battle since he supermarkets don’t seem to be helping us; Instead of healthy meals and foods, we are seduced, teased and tantalised with deals for all of the foods that we probably shouldn’t be gorging on; the crisps, the microwave meals, the pizzas. Ask yourself, when was the last time you saw a bloody green-leafed salad on promotion by the check-out desk? Perhaps it is time to bring back some collective responsibility.

Health De-Railer Three: We Seek Gratification without the Graft

Let’s be honest, we all like an easy life. If we can get our personally sought after life-rewards without doing much work, then many of us will happily collect them in this manner. This, rather than get it through hard-work. Now don’t get me wrong, there are perhaps a time and a place for this (after all, it is efficient). The problem however is that the mentality of seeking the path of least resistance has leaked into our daily mind-sets. Our previously impermeable brain defences that protected our desire to work hard, to study at school, to climb the career, and to work for that healthy body have well and truly been breached. As a result the inverse has now happened and many of us object to matters of effort like being physical active, cooking healthy low-fat meals or building careers. As for that final one, building careers, it terrifies me the amount of teenagers in school who seem to be seeking out instant fame over an actual career

Health De-Railer Four: We Brush Stress Management under the Carpet

Stress is a killer on our health. Directly, it saps our body of energy, makes us a bag of nerves and has the potential to make us feel utterly physically and mentally drained. Indirectly, it sends us down that less promising path that is plagued with losing focus on the fundamental elements of life that keep us healthy (like sleep, balanced diet, being active and avoiding excessive vices like smoking, drinking and drugs). Instead we look past these now blurry fundamentals and instead focus on the elements in our life that provide instant gratification and thereby unburden us of our, even if just for a little while. So forms do these instant gratifications come in? Well although it has many disguises I am sure at least some of the following will trigger a small, subtle nod of acknowledgement: excessive smoking, drinking alcohol, binging on fast food and late nights. The sad reality is, as much as that period of stress relief is nice, it is still temporary and once over, you will still need to deal with it.

Health De-Railer Five: We’re Blind to the Boozing

So I am sure I’ll get a few angry reactions to this next comment but I will crack on all the same – the world would be a better place without alcohol. Now as you know I enjoy a whisky but that said I still stand by my statement. While yes you can argue the few benefits of alcohol (which we talk about later) the damages of alcohol excess overwhelmingly outweigh them. We as a society have become complacent to the excess of alcohol and it has now insidiously and successfully permeated into our daily evenings and weekends without us even realising it. Nowadays, if we are honest with ourselves, not many of us actually keep track of how much we drink in the week, or the typically more heavy weekends. I know I don’t. What I can assure you of though is that it will in all likelihood exceed the national recommendations on consumption. That short-term gain of social lubrication is brutally countered with accidents, violence, hangovers, relationship breakdowns, empty wallets, addiction and damage to the body and the mind. It’s sad but it’s true. I’ve seen it first hand.

So for all of modern living’s spoils and glory it has, it seems, led-us by the hand cunningly into an unhealthy trap. All of these de-railing issues (sedentary lifestyles, poor diets, stress, vices and laziness) are responsible for the bulk of lifestyle-diseases like obesity, type two diabetes, high blood pressure and heart disease that now dominate our GPs and NHS services. These more pressingly cripple our health. In this trap we are not caught up in some fictional spider’s web, nor are we to be rescued by some handsome prince or Zena Warrior princess (whichever you prefer). In fact we have trapped ourselves and our only saviour therefore will be ourselves. Now, being ever the optimist, I will tell you that there is hope and if you are patient (remember – hope and patience!) then you can and will be your own saviour.

After all isn’t that partly why you picked up this book?

Next Week’s Chapter 3 is on TOTAL HEALTH @DrNickKnight