Many clinicians and public health leaders falsely believe the reason the world has not become plant-based is that too few people have the correct information. While this may be true for some people, the real issue remains our failure to provide the resources necessary for implementation. Even if everyone worldwide accepted that they should follow a plant-based lifestyle, how many people know what that looks like in day-to-day life?

Most already know that the key to good health lies in our ability to manage several risk factors and that many of these risk factors are affected by nutrition and other lifestyle changes. Most physicians want this for their patients. The failure is in our implementation, and the proof of our failure is abundant. We continue to be overwhelmed by alarming increases in chronic illnesses. More than 38 million American adults live with diabetes, nearly half the American population has high blood pressure, and more than 40 percent of the population suffers from obesity.^[1][2][3] Since 1953, the adult prevalence of smoking has decreased by more than 70 percent; in contrast, the American Heart Association estimates that less than 1 percent of Americans consume a healthy diet.^[4] Why are we winning the battle against smoking but losing the war for healthy eating?

One challenge is that the health care system is stuck on treatment rather than prevention. As researchers and physicians in preventive and behavioral neurology, we have seen the critical need to go beyond merely treating existing patients suffering from neurological diseases such as dementia and stroke. To decrease the prevalence of these diseases, we must focus on prevention, and this focus on prevention needs to integrate not only education but also feasible implementation. In doing that, we can drastically reduce the prevalence of several devastating and costly diseases.

This is not to say that education cannot be improved. Of course, it can and should. In particular, physicians need better training. Many current physicians cannot help patients implement lifestyle changes because they have never received focused or adequate nutrition education. They are taught to focus on treating existing illnesses with pills and scalpels but never taught to partner with their patients to help their patients achieve their health goals. If anything, physicians are conditioned to be cynical about patient lifestyle change; because they never see successful behavior change in the disease-based model (hospital and clinic), many believe that patients cannot achieve such changes.

In our extensive experience working with patients, families, and even larger populations, we often see two main reasons for this failure to create change. First, there is profound chaos and conflicting information about what constitutes a healthy diet. People are constantly inundated with new takes or fad diets promising to give them their health back. In all of the noise, most of which is supported by no research, the scientific case for a whole food, plant-based diet gets lost. Second, we fail individuals, families, and communities by creating false expectations at the end of unclear paths to change. This reason is probably more detrimental than the first. Physicians can even make the problem worse by perpetuating the all-or-nothing myth with our New Year’s resolution mentality and deprivation techniques. In other words, we set our patients up to fail before they even get started.

The key to implementing dietary changes is to build healthy habits. However, even the public perception of this terminology holds a lot of misconceptions.

Habit building is more than a series of motivational steps that keep us consciously inspired while we try to exert ourselves. There are actual neurologic changes that profoundly enhance our ability to create lasting change; through magnetic resonance imaging (MRI), PET scans, and other amazing tools, researchers have identified specific areas in the brain enhanced through habit building, including the basal ganglia and prefrontal lobe.^[5] This means that changing your life is not an entirely conscious process, it is not solely about maintaining your resolve, and there are things you can do to strengthen your neurocircuitry to aid in the process. In effect, the steps you choose to build any single habit create pathways in your brain that make successful habit building likelier in the future. Finally, critically, we undermine the brain’s intrinsic capacity to build habits through simple linear successes when we see health outcomes as binary.

Consider motivation. Many think of it as a magical, heightened sense of inspiration that creates habits, but motivation actually comes from the brain’s ability to give emotions to anything. When we make specific goals and take small steps toward achieving those goals, our basal ganglia is busily creating pathways (neural connections)—effectively laying down habit tracks. In this way, good habit building is not so much an emotional process as a mechanical one. Emotions are only the aftermath of the process happening underneath. Taking small steps—rather than viewing health as an all-or-nothing choice—is essential to establishing those neural connections.

It is fairly well established that a whole food, plant-based lifestyle can significantly reduce the burden of disease, especially those diseases related to the brain; our failure to transfer this remarkable fact to the general public results from not empowering individuals, families, and communities with the tools to transform at the level of habits and the core structure of the brain. If we want to substantially change the dietary lifestyles of our patients, we need to teach them the art and science of changing their minds. After we establish a clear strategy for success, centered on specific goals, our remarkable brain will do the rest of the work for us by assigning positive emotions, which we call motivation.

Learn more about habit building and the whole food, plant-based lifestyle; learn more about nutrition and brain health from CNS’s Plant-Based Nutrition Certificate.)

References

1. Centers for Disease Control and Prevention (CDC). National diabetes statistics report website. https://www.cdc.gov/diabetes/php/data-research/index.html. Accessed June 5, 2024.
2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020.
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Overweight & obesity statistics website. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. Accessed June 5, 2024.
4. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association [published correction appears in Circulation. 2018 Mar 20;137(12 ):e493]. Circulation. 2018;137(12):e67-e492. doi:10.1161/CIR.0000000000000558
5. Yin HH, Knowlton BJ. The role of the basal ganglia in habit formation. Nat Rev Neurosci. 2006;7(6):464-476. doi:10.1038/nrn1919