For example, how much of a difference can primary care docs make on smoking in a 6 minute visit? And when smokers resist the temptation, what is the impact on the rest of their health?

“There is no question that smoking affects the epidemic” of obesity, said Dr. Neil Grunberg, a psychologist and neuroscientist at the Uniformed Services University of the Health Sciences in Bethesda, Md.

Smokers who quit, he noted, gain about 10 to 12 pounds on average, in part because they crave sweet foods and carbohydrates. In addition, Grunberg said, smokers’ metabolism slows after they quit.

Which brings us to an interesting perspective on willpower published in the NYtimes:

Interestingly, restraining our consumer spending, in the short term, may cause us to actually loosen the belts around our waists. What’s the connection? The brain has a limited capacity for self-regulation, so exerting willpower in one area often leads to backsliding in others. The good news, however, is that practice increases willpower capacity, so that in the long run, buying less now may improve our ability to achieve future goals — like losing those 10 pounds we gained when we weren’t out shopping.

The brain’s store of willpower is depleted when people control their thoughts, feelings or impulses, or when they modify their behavior in pursuit of goals. Psychologist Roy Baumeister and others have found that people who successfully accomplish one task requiring self-control are less persistent on a second, seemingly unrelated task.

The implications for healthy behavior are really startling in a world where temptation abounds…unless we become almost puritanical in developing our abilities to resist temptations, healthy behavior that requires willpower will become increasingly displaced. There are two messages that emerge from this:

1. There will be a select few that will engage in healthy behavior because they have massive willpower
2. Healthy behavior needs to become increasingly easy, as the rest of consumer purchases/activities have become easier/more available/more personalized.

I’m betting that #2 is the right approach, meaning that focus on marketing/ distribution/ personalization of healthy behaviors to make them so visible and easy that no willpower is required. Existing approaches requiring a Puritanical work ethic are likely to continue our slide into obesity and chronic illness. Making it easy (or even helping folks to recognize existing good behavior) would be a method of improving health while conserving willpower.

Langer and Crum took several measures of the women’s basic fitness levels, which indicated that they, indeed, had the poor health of basically sedentary people. Then just over half the women were told an unfamiliar truth: cleaning 15 rooms daily — pushing recalcitrant vacuum cleaners, scrubbing tubs, pulling sheets — constitutes more than enough activity to meet the surgeon general’s recommendation of a half-hour of physical activity daily. The researchers even provided specifics: 15 minutes of scrubbing burns 60 calories, 15 minutes of vacuuming burns 50. The basic message and the details were then posted in the maids’ lounges in the hotels where the 44 women worked, to serve as reminders, while a control group was left in the dark.A month later, Langer and Crum checked back with the women to find, as they reported in the February issue of Psychological Science, remarkable results. The average study-group maid had lost 2 pounds, while her systolic blood pressure had dropped by 10 points; by all measures the 44 women “were significantly healthier.” Yet there were no reported changes in behavior, only in mind-set, with the vast majority of the women now considering themselves regular exercisers.

I know in my increasingly time-crunched world, that exercise is harder and comfort food is easier. Switching the equation to help me tap into the fun of participating in sports and being active will reverse that equation and help me bring a carrot into the pursuit of good health, and may help reduce the stress of knowing I should be taking better care of my health.

The thought was triggered as I was reading the NYTimes article on sleep drugs. The title was: Sleep drugs found only mildly effective, but wildly popular.

American consumers spend $4.5 billion a year for sleep medications. Their popularity may lie in a mystery that confounds researchers. Many people who take them think they work far better than laboratory measurements show they do.

The analysis said that viewed as a group, the pills reduced the average time to go to sleep 12.8 minutes compared with fake pills, and increased total sleep time 11.4 minutes. The drug makers point to individual studies with better results.

Subjects who took older drugs like Halcion and Restoril fell asleep 10 minutes faster and slept 32 minutes longer than the placebo group. Paradoxically, when subjects were asked how well they slept, they reported better results, 52 extra minutes of sleep with the older drugs and 32 minutes with the newer drugs.

So why are people willing to spend $3.50/ pill on sleep meds when they’re discouraged by $10 co-pays to take other, potentially life-saving medication? In the end, it comes down to being able to take action at the time they want to change something. It might not work well, but at least people are addressing that issue in the moment. This is very similar to being able to address their kids’ cold with a cold remedy (that the FDA may be taking off the counters).

Consumers want to be able to bring to bear a solution whenever they have a problem– it may not have to be 100% effective, but it does allow them to regain control over an issue. As we’ve seen with the rapid adoption of retail clinics vs. the more “effective” but signficantly less convenient office visits, consumers want to be in control and the bar for good enough is something that many in medicine find easy to trip over. As the world begins to revolve around the consumer, professional views on what are good for them may just find themselves a dollar short and confined to the ivory tower…

Unfortunately for consumers, that number really doesn’t tell you anything. Weight consists of a couple of factors: Lean body mass (including water) and fat (not water soluble). Knowing what percent of your body weight is fat (and its distribution) can be really useful information. Having a number solely based on weight is extremely misleading (to individuals, as BMI was made for populations) especially to track progress from a new diet and exercise plan.

In med school, I was horrified when a patient had come to tell us her story of getting a gastric bypass operation when her diet and exercise program “didn’t work” because she was losing inches, but not pounds (i.e., she was lifting weights, gaining muscle, and losing fat…the best outcome you can get from starting an exercise program).

The WSJ has an article this week on new ways for consumers to measure their body fat. All may at some point be coming to a weight-loss clinic near you…