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The Role of Self-Image in Chronic Condition Care

By Lisa McCormick, FNP-BC, RD, CDCES

I spend so little time looking at myself in the mirror these days. Everything I see is a reminder of cancer. So, I don't usually look. But today I did. Looking out from lashless eyes, I saw peeling skin. And scars on my arms and back. And tubes coming out of my chest. And weakened legs and a bald head. I no longer saw the strong outdoorsy person I once was.

There is so much visible evidence from this fight. And it is a fight — I am fighting to survive this cancer. And if I do, I have to believe that these scars will no longer be ugly to me, but will be a beautiful reminder that I won.

The above reflections are from March 2022, during my one-and-a-half-year fight against acute myeloid leukemia (AML), where I spent nearly three months in the hospital and underwent a donor bone marrow transplant. Now in full remission, I’m hiking again. And my hair is growing back, although salt and pepper, not the dark strawberry it once was. It looks cute, but different.

As a nurse practitioner who has dedicated my career to the management of cardiometabolic disease, I am an expert in lifestyle change, medicines, and screening tests for obesity, hypertension and diabetes. But I never spent time thinking about how a chronic condition impacts patient self-image and identity until I was diagnosed with cancer.

My self-image took quite a hit during my fight with AML. I was never vain, but like the rest of us, I cared about what I saw when I looked in the mirror. Unsurprising to me, it's estimated that 20 to 40% of women are dissatisfied with their bodies, even without the presence of illness.

When I first emerged from acute illness I was in a state of cognitive dissonance. I respected the scars and baldness as proof that I survived a life-threatening battle, and yet, I just wanted to look like myself again (with my pretty hair), the way I was before.

This has all led me to think about the power of self-image and self-esteem in relation to physical health. Specifically, how do society’s beauty standards impact how we see ourselves when we’re ill, and potentially impact how we manage our chronic conditions?

Chronic conditions impact self-esteem, self-esteem impacts outcomes

During my time as Senior Director of Clinical Services at Omada, I’ve witnessed the roles self-image and self-esteem play in managing one’s health.

At Omada we care for hundreds of thousands of people either at risk of, or already dealing with a long-term condition like diabetes. We know people often carry guilt over having a chronic disease. They may feel embarrassed, or that their behavior choices, or their weight, led to this outcome.

One’s feelings and thoughts about themselves can impact their confidence in their ability to improve their health. A survey from the U.K.’s Mental Health Foundation found that 50% of adults with a health problem or disability said their body image negatively affected their self-esteem, compared to 36% of non-affected adults. And research has shown that positive self-esteem enhances the ability to cope with disease and post-op survival, including after a bone marrow transplant (which is of great interest to me).

So we know that positive body image has been linked to better well-being and quality of life, but it isn’t always easy to change how we think or feel about ourselves.

How to turn self-esteem into self-efficacy

Many joining Omada want to feel better about their health. Members frequently share with us their inner narrative of feeling overwhelmed and the lack of belief that they can change their health situation. In these cases our Care Team provides support and shares clinically-backed resources that help them understand the relationship between their thoughts, feelings, and behaviors.

Our goal is to help members change their mindset and increase their self-efficacy one goal or action at a time using data-empowered, personalized and evidence-based strategies rooted in behavioral science.

The interconnectedness of our thoughts, feelings and behaviors are well-illustrated in the Cognitive Triad (used in Cognitive Behavioral Therapy). By working on any side of this triangle, we can impact the others.

How we feel and think shapes how we act, so if we’re feeling unconfident and thinking negatively, it can be more difficult to make healthy choices. At the same time, if we are successful in one small behavior change, it builds confidence and may influence our entire outlook.

Our Care Teams help our members build self-efficacy (one’s belief they can successfully achieve a goal) in many ways. In a very common example, our Care Teams help members realize the impact their food choices and activity make on their glucose. Through setting small, attainable goals, over time the member sees the direct impact of these behavior choices on their glucose. This leads to a boost of confidence that they have control over their condition.

Omada does this in a virtual care environment, in the spaces between in-person visits. We have countless “touch points” where our Care Teams address patterns, elicit member's thoughts and provide feedback accordingly. This when-you-need-it support helps build self-efficacy, leading to better health outcomes.

Across the board, we see a 10-15% improvement in Members’ health behaviors once they start receiving personalized interventions, and that, in turn, results in an additional 10% relative increase in weight loss — a positive health outcome in Omada’s cardiometabolic programs.

When I think back to March of last year, I remember how my thoughts and feelings influenced everything. When I first came home from the hospital, bald and weak, I couldn’t walk without help, felt shy in my baldness, and my self-image was at an all time low.

Rather than lie in bed feeling miserable (like I had in the hospital) I decided to start walking, beginning slowly and increasing a little each day. The first time I was able to walk outdoors unassisted I started to think maybe I could do this. Get back to myself. These changes in my behavior soon altered how I felt about myself. They changed what I saw in the mirror.

Fast forward a few months and I was out hiking again - still bald - but self-assured and seeing the beauty in my returning strength and health. My big takeaway here, as I consider my own experience and my work at Omada, is that it’s clear how self-image can influence our health behaviors, and ultimately, our health outcomes.

This Proof Points edition was originally published on LinkedIn on 5/23/23.