Storytelling’s Role in Lifestyle Medicine

Eliciting positive behavior change is perhaps one of the most challenging aspects of lifestyle medicine; storytelling could be the tool that transforms knowledge into behavioral change.

Storytelling is not just an entertaining means to capture the interest of an audience; it can be used to enhance learning and influence attitudes and beliefs,¹ and as such, it has the potential to be of value for lifestyle medicine practitioners. Because listening to a good story is an enjoyable experience, it can be an engaging tool in education and counseling that addresses cognitive, affective, and behavioral domains more effectively than other teaching methods, such as simply presenting information or “how-to” instructions.¹ It can be frustrating for health care professionals when their patients/clients or community do not follow their recommendations for lifestyle changes. Perhaps a different educational strategy is in order; storytelling could be the tool that turns knowledge into behavioral change.

Learning through stories is sometimes referred to as “narrative learning.” Narrative learning theory is based on the premise that humans have a natural impulse to create a story or theme about their lives, resulting in the development of constructs to create meaning as part of the learning process.¹ Stories can make information conveyed more believable, and requires the learner to create meaning, which makes the information more memorable. When the learner imagines the “characters” in a story, they think about the experience, motivations, and feelings of the characters, which creates an emotional response that facts alone cannot elicit. Additionally, while listening to a story, current attitudes and beliefs are “suspended,” making the listener more receptive to attitudes and beliefs that differ from their own, increasing the opportunity to challenge preconceived biases about health.

Storytelling can be highly effective in enhancing knowledge and skills of health care students and professionals. Listening to stories of patient/client experiences not only makes the information more memorable, it can also promote the development of empathy, an important skill for optimal client/patient care.^2-5

The positive impact of storytelling goes beyond the listener; it has transformative power for the storyteller⁶ that has application to lifestyle medicine. When one tells their own story, they certainly open themselves to judgment. But when a person experiences someone bearing witness to their story with empathy and compassion, the storyteller feels a sense of connection and the feeling of being alone in their experience diminishes. Additionally, the health care professional listening attentively to the story can gain better insight into the patient/client circumstances and condition, resulting in a better diagnosis and plan of care.² Thus, professionals in lifestyle medicine can actually listen to stories as a strategy to more effectively prevent and treat disease.

Sharing stories does make individuals vulnerable—to shame, blame, and judgment. It takes courage to reveal that parts of our lives are not going as expected or according to plan. But speaking one’s truth fosters connection and trust, allowing others to know they are not alone in facing difficulties. As lifestyle medicine professionals, we can use the power of storytelling as a healing source—for others and ourselves. As coeditors of this American Journal of Lifestyle Medicine special issue, we have experienced the power of telling stories related to our own health journeys: Dr Tollefson’s recent diagnosis of breast cancer and Dr Heiss’s journey with obesity and weight bias.

Dr Tollefson’s Story

During our recent American College of Lifestyle Medicine (ACLM) conference, I had the opportunity to share my story at a session on women’s health and lifestyle medicine. My copresenters and I presented our stories to showcase how lifestyle medicine can be transformational at individual, family, community, and societal levels. My breast cancer diagnosis while in the midst of preparing for this presentation gave new meaning to how a diagnosis has the power to transform a life.

Last year, I considered forgoing a mammogram, as various organizations have debated the starting age and frequency of breast screening. My mammogram the prior year had been completely normal, and I had no significant risk factors for breast cancer except for being female. I exercised at least 30 minutes a day, ate a whole food, plant-based diet, breastfed my children, had no symptoms, and felt great. Even though I knew that breast cancer is a possibility for anyone, I still had the mindset that my healthy lifestyle behaviors would protect me from a breast cancer diagnosis.

In the end, I chose to follow through with the mammogram. To my surprise, the results indicated an invasive ductal carcinoma hidden from palpation behind my nipple near my chest wall. While waiting for my biopsy results, I thought, “Why me.” I then started thinking about my lifestyle as a resident, characterized by stress and erratic eating and sleeping as I juggled 80-hour work weeks with being a new mom. Could that period of living an unhealthy lifestyle have increased my risk?

My thought then changed to, “Why not me.” One in 8 women in the United States will be diagnosed with breast cancer, and some will have had no risk factors. What do we do with this knowledge? What do we do when a diagnosis leaves us feeling powerless? I did what I believe many lifestyle medicine physicians would do—I started making my plan to tackle this diagnosis using everything that lifestyle medicine had to offer!

I ordered a premium tofu press, purchased new pink running shoes, joined the ACLM cancer member interest group, and got ready for battle. Even though I knew the basics of healthy lifestyle practices during breast cancer treatment, I sought an “all-star” team to learn the most current information. Luckily, my health system has a wellness center that offers an oncology-specific exercise program, nutrition and cooking classes, and many other treatments aligned with the pillars of lifestyle medicine. I am fortunate to have access to lifestyle medicine–focused cancer care as a physician and now as a patient.

After presenting my story at the ACLM conference to several hundred attendees, I was able to meet many individually after the presentation. I heard numerous stories of personal, loved ones’, and patients’ lifestyle-related health challenges that led to pursuing careers in lifestyle medicine. Many shared how hearing my story of feeling empowered by the capacity of lifestyle medicine to optimize treatment after a devastating diagnosis made them want to share stories of how their own health struggles brought them to lifestyle medicine.

Though I would have preferred that cancer, mastectomy, and chemotherapy were not part of my life’s journey, I feel fortunate that this diagnosis has given me a new perspective on how a diagnosis can inspire positive behavior change. We have many opportunities as providers to help patients use the power of a diagnosis to transform their health trajectory. For example, as a gynecologist, I may see a patient with polycystic ovarian syndrome and have the opportunity to help her view the diagnosis as a motivating force to adopt a healthy lifestyle that will improve many areas of her life. We can change commonplace or mundane visits into visits that inspire patients to use their diagnoses and their stories to set them on a new path toward wellness.

So often we think of lifestyle medicine’s power as being in its ability to prevent noncommunicable disease; however, lifestyle medicine is powerful when used to treat disease, too, allowing an opportunity for the patient to play an active role in the healing process.

Dr Heiss’s Story

I use storytelling as a teaching tool as a college faculty member and in practice as a dietitian/diabetes educator. One of the stories I commonly use is my own. For most of my adult life, I was a person with obesity, peaking at 260 pounds. As a dietitian with a PhD in nutrition, I felt tremendous shame about my weight and experienced blame and judgment from health professionals as well as the general public for not “practicing what I preach.” As is the case with many people with obesity, there were underlying reasons behind my unhealthy behaviors that stemmed from low self-esteem and a pattern of disordered eating from extreme dieting that began at age 11. In fact, my struggle with obesity is what led me to study nutrition.

The year I was turning 40 (2003), I was watching Oprah Winfrey’s annual January weight loss episode, and Bob Greene, exercise physiologist and Oprah’s person trainer, said on the show, “If your life isn’t working, that’s a call to change.” That statement resonated with me—restrictive dieting and punishing exercise routines were not working, and I decided I had spent enough of my life living in shame. I decided that I was a worthy human being regardless of my size.

With that mental shift, something very interesting happened. I started taking better care of myself. I stopped trying so hard to lose weight, and simply focused on adopting a healthy lifestyle. Then, over a period of 18 months, I lost about 115 pounds. Without a particular goal in mind, my weight stabilized with my healthy lifestyle, and I have maintained the weight loss for over 16 years.

In a twist of fate, I was contacted by Bob Greene to edit a book he was writing for nutrition content—someone had given him my name. After the project was finished, I told him about my weight loss journey. I ended up telling my story on the Oprah Winfrey Show in 2007 after he asked me to be on the show as an example that a person can have expert-level knowledge about nutrition, but not put that information to practice. He wanted the audience to know that eating behaviors are complex and that knowledge does not automatically translate to behavior.

After the show aired, a registered dietitian with obesity emailed me, telling me that for first time she felt that someone understood her shame. She was able to make that crucial mental shift that she was a person worthy of making self-care a priority. Over the next 2 years she lost 125 pounds by adopting a healthy lifestyle, and has kept it off over 10 years. An exercise physiologist and gym owner with obesity also saw the show. He wrote to the producers about how my story resonated with him. He got a call to be on the show, and I was asked to “coach” him in his lifestyle transformation as they followed his journey throughout the year. I did not need to do much actual coaching, as he already had the knowledge about healthy behaviors and had made the mental shift needed to make his health a priority. He lost more than 80 pounds and has maintained the weight loss as well. I am grateful that my story helped others know that there was nothing “wrong” with them and that they had the ability to transform their lives.

I often feel guilt over my years leading an unhealthy lifestyle and wonder about the consequences of those years, but somehow, I believe it served a purpose as someone who now works in a profession promoting healthy behavior change.

A New Tool for Your Toolkit

Storytelling can be another tool in your professional toolkit to promote healthy lifestyle behaviors and treat those facing health challenges. We encourage you to use storytelling (if not your own, then stories of others) when you teach health professionals, in your public health education efforts, and when you treat your clients and patients. We also encourage you to listen to your patients’ and clients’ stories so you can fully understand their history to determine the best treatment strategy and they can experience the healing power of connection and empathy.

Even if your toolkit is well-equipped with professional knowledge, passion, and experience with the latest evidence-based research, it is not complete without the ability to effectively deliver the information. Storytelling is a way to model solutions, showcase success, create community, and promote a message of hope and healing. Part of being a skillful storyteller is the ability to listen; to know your audience and how to relate to their unique circumstances. Let your patients’, clients’, or students’ stories inform the narrative of your response. By unlocking powerful stories of transformation, you can inspire and motivate the listener, giving them courage to take action. Just like in a classroom, a good storytelling approach can change what feels like a lecture into an enriching conversation. In all relationships, feeling heard creates the foundation of trust that is imperative for growth and movement.

Storytelling alone can be a powerful force to move patients from a state of precontemplation, not knowing if lifestyle change is possible, to contemplation, knowing that they are not alone and that it is possible. Because of storytelling’s ability to connect minds and missions, substantive change is within reach for health care providers and patients alike.

Over the last 4 years, the ACLM has partnered with Story Gorge to create short, compelling videos about the transformative power of lifestyle medicine within organizational, academic, and clinical settings. ACLM and Story Gorge collaborate to tell stories that evoke empathy and action while empowering others to do the same. Through partnership with ACLM, Story Gorge has been able to fulfill their mission of serving people and the planet alike. Visual stories, like those in famous super bowl commercials, have a unique ability to impact perceptions of the world and influence behavior. Using videography to tell stories with action, imagery, and music, Story Gorge is able to influence attitudes and behaviors in a particularly compelling manner. To view inspirational stories of how organizations, universities, physicians, and patients have embraced storytelling in lifestyle medicine, visit ACLM’s Lifestyle Medicine Story Project at https://www.lifestylemedicine.org/StoryProject.