“You Should” – When Guidelines Conflict with Reality

“You oughta wanna do better.” That sums up the feelings evoked by a disturbing number of guidelines for health and wellness. This feeling comes when the guidelines conflict jarringly with the lived reality of many or most people. When guidelines become a prompt for finger wagging, they won’t move the needle on population health in the right direction.

Breastfeeding for Two Years?

The American Academy of Pediatrics recently released a new policy statement on breastfeeding. The recommendation for exclusive breastfeeding for the first six months is nothing new. What is new, though, is advice that breastfeeding has benefits for up to two years. Of course, in the popular media, this advice translates into headlines that say the Academy is telling women they should breastfeed for two years. And that’s where the trouble starts, because many women find a sharp contrast between such a recommendation and the reality of what’s possible in their lives.

Erin Bagwell explained her experience for USA Today:

“I felt a lot of pressure to breastfeed for an entire year; I made it about eight months, but I wish I would have stopped sooner. I was experiencing debilitating postpartum depression and I was up three to five times every night, feeding my daughter who wouldn’t sleep. It put a lot of strain on my marriage to have to be the one to do all the feeding, and my daughter, who got used to the comforts of breastfeeding, wouldn’t take a bottle for six months.”

Quite literally, every person’s experience with this is going to be different. So when guidelines become a template for what a person should do, it chips away at the relevance of those guidelines – simply because they conflict with reality.

Implicit Scolding About Nutrition and Physical Activity

Guidance on breastfeeding is especially fraught, so thoughtful people may restrain their finger wagging. But this is definitely not true when the subject is nutrition and physical activity. Dietary guidelines become a template for stories about too many people eating a lousy diet. Just about nobody eats enough fruits and veggies is a rant we frequently hear. Guidance on physical activity gives birth to stories that most people don’t gets enough exercise. Tsk, tsk, tsk.

It’s worth considering the possibility that guidelines are sometimes out of line with what’s possible in the real lives of many people. When guidelines become tools for scolds, they don’t do much to promote health.

Click here for a sharp commentary on the disconnect between breastfeeding guidance and reality. For some excellent perspective on more productive alternatives to finger wagging, click here.

Dreams of Grandmother and Granddaughter, painting by Karl Bryullov / WikiArt

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July 10, 2022