Influence of a New Diabetes Diagnosis on the Health Behaviors of the Patient’s Partner

Health behavior change--whether for one-time actions like preventive screenings, complex habits like staying active, or achieving challenging distal goals like weight loss--does not happen in isolation of our social surroundings. Schmittdiel and colleagues offer striking new evidence of this in the July/August 2018 issue of the Annals of Family Medicine. Partners of patients newly diagnosed with diabetes were more likely to participate in weight management programs, and achieve clinically meaningful weight loss, than partners of patients without diabetes. One explanation is that patients, once challenged to make healthy changes after a new diagnosis, encouraged their partners to do the same. Conversely, partners may have changed their own behavior in solidarity or as a role model for patients. Or partners could have been inspired to take care of their own health. Any of these is plausible, which speaks to the broad influence of relationships on health.

Social support (and sabotage) for healthy behaviors operate in the most mundane moments of family life. Will my spouse avoid "treating" me to desserts I can rarely resist? Will they suggest a weekend bike ride instead of a sedentary movie? Will they take the kids to the dentist, so I can attend my weekly exercise class? The accumulation of otherwise unremarkable interactions like these can translate into meaningful effects on health. Indeed, our own work has shown that women with overweight or obesity were more likely to achieve clinically significant weight loss if they had frequent family support for physical activity (1).

The "teachable moment" of a diabetes diagnosis is an opportune time for clinicians to foster family-level behavior change. This may require tools to assess levels of family social support and sabotage for healthy behaviors; systems to ensure clinicians are aware of changes in family members' health; and resources for making timely referrals to preventive programs when patients and their families may be most receptive to them.

Clinicians' ability to foster behavior change also requires sensitivity to culture and gender. For many women (and indeed, the partners in Schmittdiel and colleagues' study were mostly women), it may be critical to negotiate with family members around household and caretaking duties--of which they often bear the lion's share (2)--to make room for new healthy behaviors.

Clinicians have unique opportunities to both leverage and investigate social influences on health (3,4). We urge continued work to translate novel observations into effective interventions.

References

1. Kiernan M, Moore SD, Schoffman DE, et al. Social support for healthy behaviors: scale psychometrics and prediction of weight loss among women in a behavioral program. Obesity (Silver Spring). 2012;20(4):756- 764.

2. Lachance-Grzela M, Bouchard G. Why Do Women Do the Lion's Share of Housework? A Decade of Research. Sex Roles. 2010;63(11):767-780.

3. Cene CW, Southwell BG. Introduction to the Special Section: Networks and Health Care Outcomes. Transl Behav Med. 2018;8(4):527-530.

4. Stange KC. In This Issue: Teachable Moments for Patients, Practices, and Systems. The Annals of Family Medicine. 2018;16(4):286-287.

The following funding sources supported this commentary: grants K01 099404 (PI Brown) and R01 HL128666 (PI Kiernan) from the National Institutes of Health (NIH).

Competing interests: None declared