Is perfect the enemy of good enough when trying to change our health behaviours?

How many times have you set out to change your behaviour and within a few weeks, maybe a few days, or even a few hours you realise you’re back to square one? I would feel confident in saying this is an experience most people are familiar with, especially following the 1st of January. It can be disappointing and demoralising.

After the clock strikes midnight, a wakeup call from a health professional, or a particularly motivational TED talk, idealistic thinking can creep in and we think of course we can stop drinking alcohol entirely/climb a mountain/detox sugar tomorrow (feel free to insert your own goal here). I’m all for aspirational thinking and empowering ourselves to make positive changes in our lives, but how helpful is it when these changes are not sustainable?

To take an example from my area of research; quitting smoking is extremely hard to do, but it is also uniquely deadly. Around half the people who smoke die as a result of smoking-related illness. Most people who smoke want to stop; however, it can take 30 attempts to quit successfully.  We have all met people who just woke up one day, quit cold turkey and haven’t smoked a cigarette since. However, when we look at the evidence, quitting without any support does not give the best chance of success.

Luckily treatments have been developed to help people quit smoking and we know that the best way to quit is to receive behavioural support such as counselling, as well as a medication or an e-cigarette containing nicotine (also known as a vape).  Vapes have been found to produce the highest quit rates, alongside two medicines called varenicline and cytisine.  However, through our research we have heard that some people are concerned about using vapes. In the people we have spoken to this seems to be for two main reasons: 1) they have decided that they don’t want to be addicted to nicotine anymore, and 2) they don’t want to switch away from cigarettes (a product they know to be harmful) to another product that is likely to also have associated harms.

These things are understandable, and if a person can achieve both of these goals immediately then that is great. However, for most this won’t be achievable and that means continuing along a path even further from the desired ideal scenario. This is where we begin to question ‘Is perfection the enemy of good enough?’ and could we accept a middle ground? Bearing in mind that we don’t need to stay in this middle ground for ever, but that it could be a route to what we want to ultimately achieve.

In January 2024, I conformed to stereotype and set myself a new years’ resolution. Having failed to meet my own aspirations for any extended length of time previously, rather than set bodyweight reduction goals, the amount of time I was going to exercise per week, or the weight I was going to be able to lift by March, I simply decided I was going to ‘move more’. I joined a gym and went at times that fit around my existing schedule (even though my over enthusiastic January mindset wanted me to commit to more). Instead of just doing full-on cardio and weight sessions, I fit yoga into the sparse times I could go (as I know I enjoy it and would want to show up). Lo and behold in September I am still going to the gym and I love it! I am definitely moving more (partly because I don’t drive and so have to find other ways to get there) and I am definitely fitter, stronger and my mental health is better. These have been great side effects! If I had set out in January to achieve all of these things, I definitely don’t think I would have been successful and writing this blog now.

To go back to the nicotine vape example, the evidence tells us that although they are not risk free they are less harmful than combustible cigarettes (due to the fact that they do not contain many of the chemicals present in cigarettes and their use does not require burning).  Although nicotine is one of the key substances that makes smoking addictive it is not very harmful. Using a vape to replace the nicotine in combustible cigarettes can help people to reduce their smoking by providing an alternative when cravings strike, both by replacing the addictive substance and replacing the familiar actions and sensory feedback associated with smoking.  None of this means that a person who chooses to use vapes to quit smoking has to use one forever. Research is emerging on helping people to stop vaping and this is a great next step for people who feel that there is no longer a danger of relapsing to smoking if they quit vaping.  However, vaping and other forms of nicotine replacement therapy could be that incremental step needed to reduce harm by changing smoking behaviour. This may come with other positive side effects, such as better mental health and more money to spend on other things.

Seatbelts in cars received opposition when first introduced and can cause harms in the event of an accident.  However, most people are now happy to belt up when they get in a car as they accept that the harms caused by a seatbelt are going to be minimal in comparison with the alternative. There are lots of times when we need to weigh up the risks and decide whether not accepting help leaves us in a worse off position than if we doggedly strive for perfection alone. Most of us would not decide to climb a mountain tomorrow with no training and no climbing equipment. Incremental, supported change can be our friend when setting out to make big changes to our health behaviours.

If you'd like to explore ideas like these, and many more, then our new Health Behaviour Change course is for you. Find out more about the course and how to apply here.