What's the one thing you can do to get people to change?
Anyone of any background, who've experienced any thing who actually wants to change. Their desire to do so is key, of course. But after that, what can you do?
Lead with empathy.
Pregnant women often feel vulnerable, anxious and isolated enough as it is without a doctor telling them all the things that they aren't doing right for their baby. So perhaps this is why when I read Pregnant, Obese and in Danger an editorial by Dr. Claire Putnam in the NYT last week, I lost control a bit.
Overweight women, "even" pregnant overweight women, are usually self-aware enough to know they are overweight. And let's give them the benefit of the doubt, too, that they also know (or have a strong idea) that their extra weight may complicate or endanger their baby. However, it's too simple, and frankly ignorant, to chalk up the issue to "frank talk on obesity", as Putnam suggests, lecturing on "better exercise and nutrition" and debunking the "eating for two" myth. When any healthcare provider approaches a conversation with that kind of blaming and shaming, you can guarantee a shutdown. And THAT may be the offending reason why some women leave their providers, not that the conversation comes up and is upsetting to patients, as Dr. Putnam suggests.
If you really want someone to change, lead all of your actions and words from a place of empathy.
Start with active listening. If empathy is the car, active listening skills are the driver. Active listening is engaged. It's a practice where you pay attention to someone with your whole body, not just occasional eye contact as you're taking notes. There isn't any lecture. There's a dialogue that two people feel part of and have a stake in. It involves talking with someone, not at them. Together, you figure out what's getting in their way, according to their assessment (they're the expert on themselves, remember?) not your own.
What do Michel Martin, Bill Clinton and Oprah have in common? They're all exceptional active listeners. They reflect on what you're saying and reframe without asking yes/no questions that can shut things down. They actually allow you to talk. And when they're talking to you, you feel like the only one in the room because they are compassionately focused on you.
After the active listening, still leading with empathy, we need education. Both the hoper for the change (Dr.Putnam) and the intended adapter of that change (her pregnant, overweight patient) need education. Do they know, for example, that physical and sexual abuse endured as children dramatically increases the risk of obesity and also diabetes? (1) That physically and sexually abused girls actually had higher BMIs as girls and that this gap grew even wider as the girls aged? (2) That's significant. We also know that 1 in 3 women will be physically, sexually assaulted or stalked in their lifetime and 4 out of 5 women will have children. This is a lot of pregnant survivors and mom survivors. Dr. Putnam and other healthcare professionals must be informed about the long-term affects of abuse and neglect suffered as a child and as adults. (Incidentally, this is the topic of my When Survivors Give Birth training.) Of course women must be educated too. She should have the access and resources to understand how past trauma impacts her health.
"Let's talk birth control!" said the ob/gyn to the new mom in Dark Side of The Full Moon. The mom who was at her six-week checkup feeling suicidal and desperately hoping for a conversation about her mental health but was greeted, before even "hello" or "how are you?", with a conversation about (frank, to be sure) birth control instead. Imagine how that mom felt. Maybe you were there too. We can all do better than shutting someone down by not seeing what's right in front of us. We can all lead with empathy. Our job, then, is to do better and demand better. We deserve nothing less.
1, 2: Abuse in Childhood & Adolescence as a Type 2 Diabetes Predictor in Adult Women. American Journal of Preventative Medicine 2010 Volume 39, Issue 6 sited by KKT in her webinar, Why Child Abuse Makes People Sick.