How To Talk To People Who Make Bad Health Decisions

It’s frustrating when your friend — or, worse, a stranger on the internet — is making ill-advised health decision. Maybe they smoke, or eat terribly, or buy everything Dr Oz endorses. Maybe they refuse to vaccinate their kids. Here’s how to get through to them.

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It’s OK To Distance Yourself (But That Doesn’t Count As Helping)

It’s fine to ask the smoker to step outside (or stop inviting them over), or to cancel play dates with kids who aren’t vaccinated. If somebody’s bad health decisions may affect you, you have every right to protect yourself. And if you don’t want your social media feed full of infographics about how essential oils can cure every ill, go ahead and unfriend (or, more diplomatically, hide) the person who won’t shut up about it.

But don’t confuse distance with help. Nobody says “Hm, that person unfriended me — I better take stock of my flaws and fix them all.” They say “What a jerk. Good riddance.” Especially if the bad decision maker is a family member or close friend, you’ll want to find a way to support them without alienating them. After all, one day they might decide they want help to quit their bad habits.

Why Shaming Doesn’t Work

“I’m not quite sure that being told that you’re a moron is actually very helpful when you’re actually confronting something you believe is a life-and-death issue for your own child,” said NPR’s social science correspondent in an interview about anti-vaxxers.

In fact, health messages of all kinds can backfire, especially if the person you’re trying to convince is part of a tight-knit group (as many anti-vaxxers and natural health folks are). Facing criticism from what they see as the mainstream can lead them to reject mainstream advice more strongly, and seek solace in their group’s echo chamber.

There’s an argument, made recently on Gizmodo, that shaming a movement leads people to avoid it. If it’s true, you’re playing a very long game. Smoking has been vilified for decades, but more than 17 per cent of Americans still smoke. This really isn’t your best tactic.

Why not? Tara Haelle at Forbes quotes David Ropeik, a former director of risk communication at the Harvard Center for Risk Analysis:

“When group views are challenged, if we go against the group, that feels threatening,” Ropeik said, pointing out that humans, as social animals, have evolved to rely on their social group for protection. “Rather, we come to the defence of the group,” and in this case, the “group” is other non-vaccinating parents.

Shame even backfires when the message isn’t directly aimed as an attack. In a study published in the Journal of Experimental Social Psychology, overweight women read an article that described overweight people as undesirable to employers, who see them as “weak-willed”. Afterwards, compared to a control group that read a different article, they felt more frustrated, less in control of their weight, and ate more snacks in the next phase of the experiment. Experts from the Rudd Center for Food Policy and Obesity at Yale agree, writing in an in-depth review article: “[S]tigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts”

Harsh messages do occasionally work, but that depends more on the person than on the message. But here’s the thing: those messages already exist. You’re not the first person to suggest that somebody quit smoking, start exercising, or vaccinate their kids already. They have heard the message, and it didn’t work.

What Does Work: Highlighting Benefits

Once you’ve given up on shame, the next logical tactic should be fixing the misinformation that led your friend to believe something harmful. Unfortunately, this doesn’t work either.

It’s been called the deficit model because it assumes they just have some missing knowledge. You fill the gap, they become enlightened, end of story. But humans hold fast to cherished beliefs. We have a confirmation bias — we remember and believe things that fit with what we already understand, and reject the rest as flawed or unimportant.

Public health experts debate what the best ways are of reaching people with health messages, but one idea that seems to stand out is to frame behaviour changes in terms of the benefits they offer. Think of it as the Doctor Oz approach: sell them on how their life will improve if they make the leap.

For example, someone who quits smoking will immediately begin experiencing benefits: within minutes, their blood pressure drops; within months, their lungs function better. Eating well and exercising improves markers of heart health as well as psychological factors like self-esteem, even without weight loss. If you want to help friends or strangers, try focusing on benefits.

Meanwhile, don’t jump to conclusions about the person’s motivation. All anti-vaxxers aren’t alike, for example, and while some are die-hard opponents, many lie on a continuum where they may have some concerns that, for the moment, are being addressed by skipping or delaying shots. An anti-vaxxer’s ultimate goal is the same as any other parent’s: the health of their child. Compassionately helping them understand how vaccines help, not hurt, that goal is a much better tactic than shame or information overload.

Asking the person about their motivations can be a great way to approach the topic, so long as you keep your questions respectful. This approach has two benefits: you get to find out what problem they’re really trying to solve, and why; and sometimes the person may realise they have to address gaps in their understanding — like these anti-GMO activists who can’t explain what GMOs are.

Ultimately, It’s Their Life

Respect is key, not just because it helps people to trust you, but because it’s their life, not yours. Take a look at the top tips from the American Cancer Society on helping a friend to quit smoking:

• Do respect that the quitter is in charge. This is their lifestyle change and their challenge, not yours.
• Do ask the person whether they want you to ask regularly how they’re doing. Ask how they’re feeling — not just whether they have stayed quit.
• Do let the person know that it’s OK to talk to you whenever they need to hear encouraging words.

Even somebody who knows the facts and wants to change may not take the first steps right away. Beating an addiction (or even a bad habit) is a complicated and difficult task. If you’ve never been through it, you may not realise how much mental effort it takes; even if you have been there, it’s easy to forget.

What’s more, willpower is a finite resource. A fast-food junkie may be stopping at McDonald’s again because they truly didn’t have the time to pack a healthy lunch, the know-how to make something delicious, or the foresight to go food shopping a few days ago. They spent their effort on other things in their life that needed attention more urgently. If somebody is going through a stressful time, they’re less likely to be successful in making a big lifestyle change. They may just have to wait.

If they ask for your help, you could assist them in building systems to handle the decisions they need to make (for example, sharing recipes and time-saving tips with the fast-food junkie; distracting the smoker when they get a craving). You can also share your own story if you have an experience similar to theirs: “I questioned vaccines myself, but ultimately decided to get them for my kids and here is why.”

Persuading someone is hard, but it’s a skill you can learn. No single tactic is guaranteed to work, but by respecting the other person and helping rather than shaming them, you have a better chance of convincing them to be a healthier person.

Lifehacker’s Vitals column offers health and fitness advice based on solid research and real-world experience.