A Nepali adult is more likely to die from non-communicable diseases than any other medical conditions, including Covid-19 pandemic. The STEPS survey conducted by the World Health Organization (WHO) in 2013 revealed noncommunicable diseases (NCD) as the number one cause of disease burden in Nepal. However, several initiatives aimed at controlling NCDs by the Nepal Government – including the Tobacco Product Control and Regulation Act 2011, National Policy on Regulation and Control of Alcohol 2017, and Nepal Food Act 1966 – have not yielded remarkable results.
Factors such as increasing levels of unhealthy lifestyles, globalization of fast-food chains, air pollution, unethical marketing, low literacy, increased poverty levels and shifting demographics have further increased the burden of NCDs in Nepal. Ways to reduce the risk factors contributing to NCDs are well known i.e. increase in physical activity, high consumption of healthy diet, and abstinence from tobacco and alcohol. Yet, only a handful of people and even healthcare professionals follow the rules of the game.
This signifies that the real problem does not lie in designing robust guidelines and protocols, but in finding ways to create and maintain sustainable habits that are easy to follow. The NCD Nepal Study, published in The Global Advances in Health and Medicine in April 2020, is an innovative framework proposed by US-trained health professionals to diminish the risks and consequences of cardiovascular diseases in rural settings. This article demonstrates how evidence-based psychological maneuvers can be harnessed to achieve sustainable outcomes.
Consumption of a healthy diet
Consuming junk foods can be quite addictive and enjoyable due to their easy availability and great taste. Since our environment shapes our behavior, it is almost impossible to follow a strict diet plan nowadays since unhealthy foods are available everywhere. However, according to researcher and Professor Brian Wansink of Cornell University, healthy eating can be made easier through practical strategies like using smaller plates to serve food, keeping healthy foods in larger quantities and unhealthy one in smaller quantities. In addition, keeping healthy foods such as water, fruits, and nuts in places where they’re easily visible and accessible can prevent us from making bad choices.
The New England Journal of Medicine 2007 study found that obesity spreads through social ties. For instance, if your friends or family members are obese, you are also more likely to be obese. To prevent unhealthy eating, the person responsible for preparing meals in the home should take lead responsibility and buy only healthy foods for the whole family. Brushing of teeth immediately after dinner also helps to minimize the consumption of junk food late at night. Remember that eating healthy meals even once per day or week is better than nothing at all.
Increasing physical activity
Increasing the level of physical activity is a great way to reduce stress and boredom, and reduce the risk of getting NCDs. There are different kinds of physical activity that one can do to improve health and well-being such as jogging, brisk walking, push-ups, yoga, squats, weight lifting, gardening, mowing, etc. The key is to choose an activity that you enjoy doing in the long term.
Start small and increase the intensity and duration of the exercise gradually. If you love push-ups, for instance, start doing five the first day, and then add one push-up each subsequent day. When you get to 30, you can choose to perform 15 push-ups in the morning and 15 in the evening. Breaking your workouts into small, easier sets helps to reduce the mental burden and makes the process more enjoyable. The whole idea is to create healthy habits that are easier to follow.
According to research done by Northwestern University in 2012, people who increase their physical activity are also likely to adopt other healthy habits like reducing the consumption of unhealthy foods. This is referred to as the “domino effect”. Doing one good habit can lead to doing several other good habits. Domino effect applies to bad habits as well, i.e. laying down on the couch can lead to watching TV and eating junk foods.
Tobacco cessation and reduction of alcohol intake
“Habit substitution” is key when trying to stop smoking or drinking. It refers to replacing bad habits with good ones, e.g. running when smoking urge strikes, or replacing beer with sparkling water. The other option is to stop buying alcoholic drinks for storage at home. You can also quit smoking or heavy drinking gradually by having one less drink or smoke daily. Delaying drinking or smoking time by at least 30 minutes when the urge hits can also help. Another approach is to cut the trigger of your bad habit. For example, if you like smoking while drinking tea in the morning, cut the tea totally or replace it with another drink. The key here is to change your environment, so it becomes easier to change the outcome.
Pairing up with supportive friends who want to quit the same bad habit also reinforces the action by making each of you accountable to the other. Visualize yourself succeeding in quitting smoking, drinking less and building a new identity.
Reducing stress
The easiest way of building a new habit is by stacking it on top of current habits. This is called “Habit stacking.” The essence of this phenomenon is to incorporate a series of lifestyle changes in your life that you can follow easily. For instance, getting up early, running for 5 minutes, followed by 3 minutes of meditation, etc. Doing a chain of healthy activities repeatedly makes it easier to follow. The shorter the activities, the easier and more enjoyable they’ll be to perform. Activities like meditation, exercise, making art or spending time with loved ones can make a huge difference in your mood.
Overall, changing public behavior through orientation, social mobilization, and mass communication alone cannot help in the fight against NCDs. However, incorporation of psychological techniques, a deviation from the traditional approach of “eat better” and “exercise more,” by front-line healthcare workers in NCD management, can go a long way in lessening the financial, psychosocial, and healthcare burden of noncommunicable diseases in Nepal.
The article was drafted by the coordinators of NCD Nepal study, an initiative of non-profit Health Foundation Nepal.
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