Q&A with William Polonsky, PhD, CDE: A view into diabetes and behavior change

Recently, SurroundHealth caught up with William Polonsky, PhD, CDE, Founder and President of the Diabetes Behavioral Institute. The Institute is the first and only non-for-profit organization totally dedicated to addressing the unmet emotional and behavioral needs of people with diabetes.

William Polonsky, PhD, CDE, Founder of the Diabetes Behavioral Institute

SurroundHealth:  Why was it important for you to start the Institute?

Bill:  While type 2 diabetes is a worldwide epidemic, what’s rarely appreciated is the critical emotional and behavioral side of diabetes.  We know, sadly, that an enormous number of people struggle with that and have poor outcomes despite the technology and medicines available. We wanted to make sure that people everywhere had the strategies and tools to be successful.

SurroundHealth:  In a recent survey, SurroundHealth members identified one of their top challenges as helping people understand the importance of taking action to improve their health. What perspective do you have on this challenge?

Bill:  If someone is interested in managing their health better, we need to start with questions before educating.  For example, I would ask, “For you, Mr. Smith, to be successful in staying healthy over the rest of your life, what are the top 2 or 3 things you think you should be doing to help you get there?”  In other words, let’s hear it from the individual’s perspective first. It is easier to correct or challenge people’s beliefs than it is to start lecturing people about what we think is important.  Very few people with diabetes are uneducated about diabetes.  The problem is that too many are profoundly mis-educated. When they come to see us, they are not blank slates. Our challenge is to talk about what they do believe and what they think is true; then, we can try to shift those beliefs if they are misconceptions. That’s why you want to start with asking questions and not just providing information. 

SurroundHealth:  How do you typically help shift beliefs?

Bill: I use the Bang for Your Buck principle. For example, I might agree with someone that says, “The most important thing I can do to stay healthy is drink more water every day.”  However, if the person has a high A1C and is overweight, I might say: “Yes, that’s true. If you list the 100 things you could do to take care of your diabetes, drinking more water is one of them. But if we put them in order of priority in terms of how much bang for the buck you are going to get for taking that action, I might put drinking more water near the bottom of the list.  There are things you could also do that are easier for you and provide more value.” By putting it that way and teaching the top 5 actions to take, it is a much more powerful way to help people make a change. In diabetes, there is too much for people to do. It gets overwhelming. What we need to do is boil it down to the top 2 or 3 things that people can do.  We need to help people understand the priorities and potential benefit of their actions.

SurroundHealth: How do you help people with diabetes better understand the seriousness of their condition?

Bill: In diabetes, surveys suggest that people with diabetes do understand the seriousness of their disease and that it can be harmful to their health.  The problem may be that people do not understand this is an urgent disease.

SurroundHealth:  But, how do you create a sense of urgency without using fear and scare tactics?

Bill:  Actually, fear tactics can work to get people’s attention.  I think providing people with sobering messages is very valuable as long as you can link it with something they can do about it. Diabetes is such an invisible disease. We need to talk with people in a very tangible, personal way about their numbers and what they mean.  For example, if a person’s A1C is 9% or blood pressure is 160/100, we need to say more than the number is high.  It is better to say unsafe or you are not in a safe place. This makes the point without sounding judgmental.  Then, use relevant imagery to talk about what that means in your body.  For example, we might say, “At this moment, there is a fire burning in your body.  We have the tools and technology to help put that fire out before any more harm is done.  But, that fire is burning right now and causing harm and we want to get the fire out now.”  That is often a powerful way to get people to get engaged with action. So that combines a sobering fearful message with a message that there is something you can do about it now. 

SurroundHealth:  One of the things members have talked about in SurroundHealth, is where each person as a professional turns for inspiration. I know you inspire so many people within the diabetes field.  Where do you turn?

Bill: I am so inspired by my patients. I learn something new from them every day – either how they struggle with diabetes or by teaching me about what works for them. 

I also have a couple of close colleagues who I stay in close connection with.  What I have learned over the years is that if my work gets too isolating, I can’t do it anymore.  But, I feel very lucky to have found a few colleagues who I talk with almost every day to talk about concepts, articles we have read, and patient issues we have faced.  To me, that has made all the difference in the world.

Interview and blog by SurroundHealth blogger, Susan Eno Collins, MS, CHES, RD.  Susan is a Community Leader of SurroundHealth — a social network where health professionals from different backgrounds come together to learn from one another’s expertise and to share knowledge and resources. Members of SurroundHealth share a passion for improving the health and well-being of communities and individuals.


About Susan Collins, MS, CHES, RD, SurroundHealth Blogger

I am Community Leader for SurroundHealth (www.surroundhealth.net), a social network where health professionals from different backgrounds come together to learn from one another's expertise and to share knowledge and resources. We share a passion for improving the health and well-being of communities and individuals. I am also a registered dietitian and certified health education specialist.
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2 Responses to Q&A with William Polonsky, PhD, CDE: A view into diabetes and behavior change

  1. I am considering for my national adult education organization a Roundtable on healthcare and literacy. I also have a strong personal interest in how narrative medicine can contribute to better healthcare, both for the patient and the caregiver. (See my poetry website for its sections on narrative medicine, loss and healing, and adult education.) So I very much appreciate this blog, which I have just discovered. I look forward to future postings and comments.

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