The Bare Minimum

We are considering implementing a Diabetes Prevention Program in our clinic. Based on clinical research demonstrating reduced progression from pre-diabetes to diabetes among participants in this group visit model, we thought this would be both useful and beneficial to our population. In the limited survey of patient interest so far, the response has not been as positive as we anticipated.

“I don’t think I’d want to do that. I already know what to do.”

“No, I don’t think so. I don’t need to hear that stuff again. I know what I’m supposed to be doing, I just need to do it.”

I find this surprising. I am aware that there is a lot of education out there about how to practice a healthy lifestyle. In fact, while eating breakfast yesterday morning, I noticed that the cereal box had a panel devoted to weight loss that outlined a five point plan. It was pretty good patient education and I was tempted to make it into a patient handout.

That said, many people do not do what they know they should do - myself included sometimes. I thought that a support/education group would be a welcome way for patients who are at high risk of developing diabetes commit to and follow through on needed lifestyle change.

What I think it boils down to for many of us is trying to find the bare minimum. The bare minimum amount of exercise needed so that you can still fit into your jeans. The bare minimum number of meals you actually have to prepare yourself in order to keep your consumption of salt, fat, and sugar in a reasonable range. The bare minimum amount of calcium, water, fruits, vegetables, or whole grains you need to eat in order to be “healthy.”

I see this in my own house. Every Saturday, I go through the bare minimum cleaning routine with my kids. I start out at 9 am telling them to clean their rooms. By 3 pm, I tell them just to make sure everything is off the floor so that we can vacuum. My husband, the chef in our family, tries to make healthier meals. One way to accomplish this is to add whole wheat flour to bread and pizza dough. It doesn’t taste the same as dough made with the ultra-processed flour. We are trying to find the bare minimum amount of whole wheat flour we can add and still consider it a whole grain.

Trying to convince my patients to go beyond the bare minimum in terms of lifestyle change remains a significant challenge. It is difficult to motivate someone to reach farther than they have to in order to improve his or her life. Just as it is challenging to try to convince a four year old why she needs to clean the top of the dresser “since you don’t vacuum up there.”