adherence

Now I want to take the thoughts from my last post a little further.

Just as it is true in one sense to say “guns don’t kill people, people kill people,” though only at the cost of ignoring how much easier it is to kill someone if you’re holding a loaded gun than if you can’t get one, so also I don’t want my previous post to be read as simply saying “Tech doesn't distract people, people distract themselves.” I am easily distracted, I want to be distracted, but that’s easier for me to accomplish when I have a cellphone in my hand or lots notifications enabled — thanks, Growl! — on my laptop.

Still, I really think we should spend more time thinking about what’s within rather than what’s without — the propensities themselves rather than what enables and intensifies them. Self-knowledge is good.

And along these lines I find myself thinking about a fascinating and provocative article in the Journal of the American Medical Association that says, basically, it’s time to stop studying the effects of various diets and debating about which ones are best because, frankly, there ain’t a dime’s worth of difference among them: “The long history of trials showing very modest differences suggests that additional trials comparing diets varying in macronutrient content most likely will not produce findings that would significantly advance the science of obesity.”

In short, such comparative studies are wasting the researchers’ time, because while countless studies have not told us anything conclusively about which diets are best they have told us conclusively that whatever diet you choose the thing that really matters is whether you’re able to achieve the discipline to stick with it. Therefore, “Progress in obesity management will require greater understanding of the biological, behavioral, and environmental factors associated with adherence to lifestyle changes including both diet and physical activity.”

Adherence: that’s what matters in achieving weight loss and more general increases in health. Do you actually follow your diet? Do you actually keep to your exercise regimen? And that’s also what’s most mysterious: Why are some people able to adhere to their plans while others (most of us) are not? This, the authors suggest, is what we should be studying.

The same is true for technological addictions. Some people use apps like Freedom to try to break their addictions — which is great as long as they remember to turn the app on and resist the temptation to override it. Jonathan Franzen uses superglue to render his computer un-networkable — which is great as long as he doesn’t hunt down another computer or keep a smartphone within reach. Evgeny Morozov locks his phone and wireless router in a safe so he can get some work done — which is great as long as he actually does that when he needs to.

In all these cases, what people are trying to do — and it’s an intelligent thing to attempt — is to create friction, clumsiness, a set of small obstacles that separate the temptation to seek positive reinforcement from the giving in to that temptation: time to take a couple of deep breaths, time to reconsider, time to remind themselves what they want to achieve. But in the end they still have to resist. They have to adhere to their commitments.

Which takes us back to the really key question that the JAMA article points us to: whether it’s diet or exercise or checking Twitter, why is adherence so difficult? Why do most of us adhere weakly, like Post-It notes, rather than firmly, like Jonathan Franzen’s superglued ethernet port?

I’ll have more to say about this in another post.