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Harm Reduction

Harm Reduction

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I’m sure we’re all familiar with the phrase “the lesser of two evils”. A typical example being on one hand I could go to the dentist to alleviate this massive toothache right now, or I could wait for a few months until it becomes infected, necrotic, and becomes a much bigger and more expensive problem. Going to the dentist now, one would say, is the lesser of two evils in this context. This phrase can be applied to a myriad of situations, but overall it deals with a play on the concept of “harm reduction”. 

Harm reduction, as known by most, deals with a set of policies aimed at choosing the lesser of two (or more) distinct “evils” in relation to drug use. A common iteration of harm reduction has to do with needle exchange programs in which a person receives clean needles to avoid transmitting otherwise preventable communicable diseases within a particular population. Yes, in a perfect world, especially according to those far removed from the more stigmatic addictions (drugs, alcohol, cigarettes, etc.), the people suffering from addiction should merely abstain from the behavior using some abstract sense of mental toughness. Obviously, to anyone even remotely tuned in to how addiction works on a chemical level in the brain, knows that this isn’t an option. Thus, the preferred route is one of harm reduction, to choose the lesser of two evils, until the necessary outlets and support systems are in place for a more permanent solution.

My usage of the term “harm reduction”, however, is centered more around things in my professional wheel house. The harm reduction approach can be helpful for people trying to navigate a consumer world literally engineered to exploit our innate human frailties. In regards to exercise and dietary patterns, one is faced with many choices every day. Many opportunities to choose one thing over another. Many potential pitfalls to avoid. Sometimes choosing the lesser of two evils today may be a good starting point in adapting to more healthy behaviors for tomorrow.

Harm Reduction in Exercise

One of the most common questions that I field on a regular basis, is one that is more layered than the person asking it usually cares to know. “What kind of exercise is the best?” Wow, talked about a loaded question! If the person asking it had an entire day to devote to understanding the answer, or at least a fraction of it, I’d be happy to engage in a discussion. The unfortunate reality, though, is that the mental bandwidth required to both explain and interpret the answer is beyond what most human beings are typically able to commit to. This reality has forced me to adapt my answer to one that is more succinct. One that won’t leave the inquisitor absolutely regretting that they ever asked in the first place. Drum roll please, the “best exercise” is the one that you have the best chance of doing regularly and enjoy the most. If I had a microphone, I would consider dropping it at this point. Of course, this answer is both exactly what the asker wants because of the one-liner nature of it, and also what the asker hates; it’s loaded with more ambiguity than an M.C. Escher painting.

“Relativity” by MC Escher

Now, if you wanted to dive a bit deeper into this question, I’d be happy to elaborate as to which kind of exercise is best for whatever the desired outcome is, and sometimes the more ambiguous answer will lead to a more detailed subsequent line of questioning. Best exercise for getting your heart rate up? It depends, but probably something rhythmic in nature utilizing a series of large muscle groups and coordinated movements for a prolonged period of time. Best exercise for strengthening your core musculature? Again, it depends, but probably diaphragmatic breathing cues followed by a simple plank or plank variation would be a good start. The answers to most of these postulated questions are ambiguous and nuanced because there is no one-liner solution to something as broad as “what kind of exercise is best?”

That being said, if you’re just starting to exercise regularly, go first with what has the least amount of obstacles for completion. It would help immensely if you also actually enjoyed it, or at least combined it with something more enjoyable. An example of this would be going for a walk with a friend once a week. Maybe you dislike walking for exercise, but pairing it with a friendly conversation with a close pal is going to be good for not only exercise adherence and regularity, but for your subjective enjoyment of the exercise. Gamifying exercise is a great way to make it more enjoyable as well. Someone may not like running by itself, but combine it with a weekly basketball game with neighborhood friends and voila! Sure, as a fitness professional, I’d love to see a person engaging in at least 150 minutes/week of moderate intensity exercise, two to three sessions of some form of resistance training, and more overall movement throughout the day, but it doesn’t have to be all or nothing. Therefore, when it comes picking the “best kind of exercise”, it may come down to a harm reduction approach. First and foremost, choose the exercise that you have the highest likelihood of completing regularly and that you enjoy doing the most.

Harm Reduction in Dietary Patterns

When it comes to healthy eating patterns, or trying to adapt one’s current eating pattern, the concept of harm reduction is omnipresent and can really be an effective strategy when trying to change one’s deeply ingrained taste preferences or consumption habits. Sure, in an ideal world, someone trying to “eat healthier” would just switch overnight to a diet consisting mostly of whole foods (vegetables, fruits, whole grains, nuts, beans, seeds) most of the time. Obviously, that is like a traditional economist’s view, one that doesn’t account for natural human tendencies having to do with emotion, inertia, and pain avoidance. If one was faced with one of two options, to radically change everything about their dietary pattern overnight, or just stay the same, most people would be placing bets on that person to stay the same. Not only do changes like these happen gradually, but there is a lot of emotion and inertia tied to the initial dietary pattern, not to mention the perceived pain of not being able to have what one has been accustomed to having.

In comes the “lesser of two evils” hypothesis, where instead of suggesting someone just “tough it out and eat more healthily because it’s good for them” we make some realistic compromises. If this line sounds familiar, it’s because previously our “non drug addicts” made this preposterous recommendation to the “drug addicts” for getting sober. Here we come full circle in our realization that some addictions are in fact more stigmatic, and just because society views them differently doesn’t mean we, as individuals, have to assume that someone simply lacks the willpower to stop smoking any more than another lacks the willpower to stop eating donuts for breakfast instead of oatmeal. If a person has been prescribed by their doctor to start eating more vegetables, a harm reduction recommendation might be to have a bowl of carrots and green peppers with some greek yogurt dip. Sure, in a perfect world, the person would just “toughen up” and eat the vegetables because they are good for them, but that isn’t reality. Our relationship with food is about as layered as an onion so approaching dietary behavior change with tact and compromise is a great starting point.

Photo by Victoriano Izquierdo on Unsplash

Through these small compromises, adding a more healthy food here and there, we are not only benefiting from adding something good in, but also benefiting from removing something not so good. Choosing the lesser of two evils can over time turn out to be better and better for our overall health outcomes.

The Bottom Line

Whether it’s eating a salad with ranch dressing instead of pizza, playing an active video game instead of mindlessly scrolling through social media, or needle exchange programs instead of communicable diseases rampantly spreading through certain at-risk populations, the concept of harm reduction can be applied to many different aspects of life. Get creative out there, help each other, and choose the lesser of two evils. 

Prevention over treatment,