This is the first of 6 questions developed by Megrette Fletcher and Michelle May for people with diabetes and their caregivers to ask. Their approach is outlined in Eat What You Love and Love What You Eat with Diabetes.
I have to admit being confused by the 6 questions when I bought the book: Why do I eat? When do I want to eat? What do I eat? How do I eat? How much do I eat? Where do I invest my energy? After a cursory read I put it on the shelf and resumed networking with practitioners and colleagues, and researched approaches that aligned with my personal approach to dealing with eating and diabetes. But then I listened to a May and Fletcher webinar on the The Center for Mindful Eating (TCME). And I got it. Megrette outlined that “What do you eat?” is one of the questions she asks but it’s 3rd on the list. Number 1 is, why do we eat?
Caregivers focus intensely (too intensely) on what people with diabetes should eat. They ask for food logs, with lists of everything eaten for a week, then review the “good” and “bad” choices. This of course is a recipe for disaster and non-compliance–it’s also unsustainable. But if clients are asked open-ended questions, there’s an opportunity to become aware of the motives underlying behaviors and then clients can decide what they want to do. Megrette barely gets past that first question because patients have almost never been asked why they eat, and they are hungry (sorry!) to uncover answers to this question.
Too often in a healthcare setting, we are told what to do by people who (with good intentions) believe they know what’s right. Caregivers see the healthy alternative/outcome just over the horizon, and they’re sure the patient’s condition would improve if only they (the caregiver) could convince the them (the patient) to agree (be compliant). But patients usually see that healthy alternative too, but the unspoken insistence on compliance, on being a “good” patient, inspires resistance rather than a desire to change behaviors. Telling rather than inquiring usually leads to frustration for both parties, plus guilt and avoidance for the patient, and maybe even for the caregiver. In the end, no one understands why advice isn’t being followed, why behaviors don’t change and why healthy outcomes remain so elusive.
This approach isn’t necessarily easier but it is kinder. And kindness is the only method I know that everyone responds to.