Rule Rage

Changing health guidelines prompt dismay and resentment.

By Richard Lovett, published on November 01, 2003

Last fall, when health experts doubled their exercise recommendation from 30 minutes a day to 60 minutes, Aimee Ward knew what to expect. The fitness specialist with Providence Health System in Portland, Oregon, was quite aware that motivating people to exercise is a constant battle. Now, clients struggling to fulfill previous guidelines will feel like the rug is being pulled out from under them. Many people find change discouraging, she says. “They think they’ve finally got it—and now they have to do more.” Few researchers have studied the way people react to changing health advice, but the media have found growing resentment and despair among people who just can’t imagine squeezing in more time at the health club or giving up another favorite food.

Daniel Jones, a physician and member of an American Heart Association committee that oversees blood-pressure guidelines, believes immediate availability of information helps feed this resentment. Years ago, changes occurred slowly, but now research is published online, instantly drawing a barrage of media attention. That’s helpful for people who desire the most up-to-date information but not for those who want health recommendations to be simple. Adding to this, says Christine Bruhn, director of the Center for Consumer Research at the University of California, Davis, is the fact that guidelines can be too broadly applied. “Many are designed for 40- to 50-year-old men with histories of heart disease,” she says. “They aren’t relevant to my 92-year-old mother.” Studies show that savvy consumers prefer individualized health programs, Bruhn says.

The backlash may also be related to the “If I don’t know it, it can’t hurt me” attitude that causes some people to avoid doctors. Many people are just resistant to change and cling to the familiar, says Lawrence Perlmuter, chair of the department of psychology at Chicago Medical School. When health advice changes, many of us think, “Gee, I lived the old way without any problems. From my point of view, nothing’s changed.”

Resentment may also arise from a feeling that the rules have been “unfairly” changed—as though somebody altered your job description in the middle of a project. Perlmuter compares it to the feelings that football players would have if someone moved the goalposts in the middle of a game.

People who react badly to guideline changes may be thinking too categorically, adds Howard Leventhal, a professor of health psychology at Rutgers University in New Jersey. Most people tend to view themselves as either healthy or not healthy, even though guidelines often involve risk factors that can vary individually.

But not everyone becomes angry when a rule changes. As recently as the mid-1990s, health guidelines permitted the weight gain of several pounds among the middle-aged. Now, scientists believe this isn’t healthy. One researcher who was on the panel that recommended the guideline change noted that he had just reclassified himself from “normal” to “overweight.” His conclusion: It wasn’t the new guideline’s fault; he really did need to lose a few pounds.