Skip to main content
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Clinical Diabetes

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • Quality Improvement Sucess Stories
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
  • Advertising
  • Reprints/Reuse
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Submit Cover Art
    • Instructions for Authors
    • ADA Journal Policies
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Clinical Diabetes
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • Quality Improvement Sucess Stories
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
  • Advertising
  • Reprints/Reuse
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Submit Cover Art
    • Instructions for Authors
    • ADA Journal Policies
Commentaries

Doesn’t Everybody Want to Be Healthy?

  1. Jana L. Wardian
  1. Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, TX
  1. Corresponding author: Jana L. Wardian, Jana.L.Wardian.ctr{at}mail.mil
Clinical Diabetes 2020 Jan; 38(1): 96-97. https://doi.org/10.2337/cd19-0017
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Recently, I was talking with someone and picked up on a common judgment that I often hear that implies that adopting healthy behaviors is simple; therefore, when someone is not engaging in a healthy lifestyle, there must be a lack of desire to be healthy. She stated that people with diabetes “just don’t want to be healthy—push away from the table and get some exercise!”

I internally winced and engaged this young woman, sharing with her that I start with some basic assumptions that help me to avoid judgment. She was listening as I stated, “I believe everybody wants to be healthy.”

She rolled her eyes and I could tell I was on the verge of losing her. I persevered.

“We may not necessarily do what leads to health, but we aren’t trying to be unhealthy,” I said.

She reflexively nodded. In fact, we discussed our own behaviors inconsistent with optimal health. For example, I eat dark chocolate nearly every day. I mused, “I can make a solid case that dark chocolate is a vegetable!” She was disarmed and laughing. She became more empathic when confessing her own actions that pull her away from making healthy decisions. Exactly!

Even though we all want to be healthy and may even have sufficient information, we tend to do things that are inconsistent with health promotion and even defend our behavior. This is the heart of cognitive dissonance, which describes the discomfort we feel when our cognitive beliefs do not align with our actions (1). This kind of thinking is relatively common and is often unacknowledged. Consider the thought process when you are trying to lose weight but nonetheless find yourself eating a doughnut (not the heathiest choice) and justify this behavior by telling yourself, “It’s just one doughnut. It won’t hurt me.” Or you may think, “I deserve a treat. I worked out really hard this morning.” This common type of rationalization is natural and human. Recognize it, but try not to be too hard on yourself (or others) when it arises.

Haidt (2) offers another compelling hypothesis about why we struggle to engage in healthy behaviors. He suggests a metaphor to better understand the relationship among rational cognition (rider), emotional appeal (elephant), and environmental factors (path) (2,3). The rider and the elephant may want radically different things, and the significant size differential between them can be difficult to manage. If there is disagreement, the elephant is likely to overpower the rider. The path can contribute to the complexity of the decisions depending on the difficulty of the route the elephant and rider must take to reach the destination. The key to sustained behavior change is continual concordance among rider, elephant, and path.

The American Diabetes Association suggests that while diabetes self-management education is important, ongoing support is also valuable to enable patients to overcome barriers to making healthier lifestyle choices (4). Support may be in the form of local community health promotion programs such as those offered through the YMCA, church groups, the TOPS (Taking Off Pounds Sensibly) program, or online virtual support groups such as Diabetic Connect (5) or Facebook groups.

My hope is to help you understand what may be happening when you are tempted to be judgmental toward patients using cognitive dissonance to rationalize their behaviors or wrestling with their rider, elephant, and path. Perhaps we can all engage in a bit more empathy for those struggling to improve their health and understand the human frailty inherit in us all. I’m not saying it’s okay to keep engaging in behaviors that are adversely affecting health. I’m just suggesting that we all extend a little grace and understanding to those who are struggling. Maybe humor will allow crucial walls to come down and expose the need for genuine consistency between knowledge and behavior.

Acknowledgments

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

Disclaimer

The views expressed in this commentary are those of the author and do not reflect the official views or policy of the U.S. Department of Defense or its components.

  • © 2019 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.

References

  1. 1.↵
    1. Harmon-Jones E,
    2. Harmon-Jones C
    . Cognitive dissonance theory after 50 years of development. Zeitschrift für Sozialpsychologie 2007;38:7–16
    OpenUrlCrossRef
  2. 2.↵
    1. Haidt J
    . The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom. New York, N.Y., Basic Books, 2006
  3. 3.↵
    1. Heath C,
    2. Heath D
    . Switch: How to Change Things When Change Is Hard. New York, N.Y., Broadway Business, 2010
  4. 4.↵
    1. Powers MA,
    2. Bardsley J,
    3. Cypress M, et al.
    Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educ 2017;43:40–53
    OpenUrlPubMed
  5. 5.↵
    1. Diabetic Connect
    . Diabetic Connect home page. Available from www.diabeticconnect.com. Accessed 1 July 2019
View Abstract
PreviousNext
Back to top
Clinical Diabetes: 38 (1)

In this Issue

January 2020, 38(1)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by Author
  • Masthead (PDF)
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Clinical Diabetes.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Doesn’t Everybody Want to Be Healthy?
(Your Name) has forwarded a page to you from Clinical Diabetes
(Your Name) thought you would like to see this page from the Clinical Diabetes web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Doesn’t Everybody Want to Be Healthy?
Jana L. Wardian
Clinical Diabetes Jan 2020, 38 (1) 96-97; DOI: 10.2337/cd19-0017

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Doesn’t Everybody Want to Be Healthy?
Jana L. Wardian
Clinical Diabetes Jan 2020, 38 (1) 96-97; DOI: 10.2337/cd19-0017
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Acknowledgments
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Early-Life Trauma and Diabetes Management: An Under-Recognized Phenomenon in Transition-Aged Youth
  • Taking Control Of Your Diabetes: An Innovative Approach to Improving Diabetes Care Through Educating, Motivating, and Making the Connection Between Patients and Health Care Providers
Show more Commentaries

Similar Articles

Navigate

  • Current Issue
  • Papers in Press
  • Abridged Standards of Care
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Diabetes Care
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Clinical Diabetes Print ISSN: 0891-8929, Online ISSN: 1945-4953.