Playing the Cardiac Blame Game

One day, at the end of his cardiac rehab session, I heard a patient say to another, “ya know, having a heart attack is one of the most positive things that ever happened to me”. I looked up in astonishment wondering if he was serious. He continued to say, “since my heart attack I’m exercising, eating better, I’ve lost a little weight – I feel better than I have in years”. “Wow” I exclaimed, “we don’t hear that very often”. Unfortunately, not everyone can see the positive side of surviving a heart attack and, in my experience, many really struggle to adapt to their new situation as a “heart patient”. I find that heart attack survivors already feel guilty, defeated, and the idea of making positive lifestyle changes an overwhelming concept.

One of the saddest things I’ve witnessed as a cardiac rehab nurse is when a well-meaning wife or loved one tries to force a person to “eat healthy” after they’ve had a heart attack. They don’t realize the psychological distress that this can put on a person who has already gone through a very frightening and dramatically life-changing experience.

It seems that from the moment recovery begins, so does the blame game.

I’ve seen it my entire career as a cardiac nurse and have been guilty of it myself. We, as “health professionals”, think we must explain how or why the heart attack happened when the truth is, nobody can really say for certain what actually caused an individual’s heart attack. We think we can just barge in on someone’s life when they need support and encouragement the most and say, “your heart attack was caused by all that red meat, salt, and cholesterol you eat so you must completely change your diet, or you’ll have another heart attack. In other words, it’s all your fault and you better do something about it”.

I used to teach a class on Risk Factors for Heart Disease and though there are some situations that have been scientifically shown to increase a person’s risk for cardiovascular disease, the fact is, these are risk percentages only – no one can pinpoint which behaviors did or didn’t cause any particular heart problem.

The fact is, that diet probably has very little to do with a person’s risk for coronary artery disease.

Today we have very good scientific evidence to back up the way we treat heart disease and great medicines and practices that we know help to prevent a second heart attack. However, the idea that diet contributes to a person’s heart disease risk can never be proven scientifically. Studying what a person eats is far too subjective to be scientific. There is too much guess work and too many confounding factors to come to any real scientific conclusions about the effects diet has on developing coronary artery disease. Certainly, we’ve determined that some foods have more nutritional value than others, but guidance about “healthy eating” should be given as recommendations to help people feel better, not mandates for disease prevention.

So why are we constantly beating up people and making them feel guilty about what they eat?

I heard of a man whose wife refused to cook anything but “heart healthy” food after his heart attack which he hated. Though not overweight at all, he had always enjoyed fried food, pizza, hamburgers – you know, the things we all enjoy but rarely admit to in front of the PC diet police. His wife absolutely forbade him to eat anything that she considered “bad for him” and would not even consider compromise. In revolt, the man stopped eating entirely which caused him to lose weight and become very unhealthy.

Changing lifelong behaviors such as eating certain foods can be very difficult for some people. More often than not, food provides much more than fuel and nutritional sustenance but pleasure, security, comfort. It is part of our culture, our social make-up – we grew up loving certain foods and hating others – what we eat is very personal, and I feel, should not be subject to criticism by others.

If you love someone and want to help them lead a healthier lifestyle, be a support to them, understanding how difficult changing can be so that rather than tear them down you can build them up with the confidence they need to be successful.

Behavioral change is a process that can go from total resistance to the idea of change, to actually being ready to make the change. We have to help our loved ones believe they can change, that its easier than they think, and that the change will provide a value to them rather than blame them for getting sick. We can do this by encouraging them to make small changes like having a leaner cut of steak or smaller portions of the foods they love.

Giving guidance to help people make healthier choices can be a good thing but it should never be used as a weapon. If our desire is to help someone transition from heart attack survivor to healthy person, we must not victimize them again by playing the blame game and demanding unrealistic change but provide the encouragement and support they need to see the benefit of change for themselves.