Taking Control of Your Future Health
by Ray McBeth, PhD
We know that only a very small percent (10-20%) of our health is a by-product of what occurs when we visit our family physician or go to the hospital. We also know that chronic diseases consume a huge amount(1) of our health care budget. Why are these chronic diseases so prevalent? They are, for the most part, “lifestyle” diseases. Diseases like obesity, hypertension, adult onset diabetes, heart disease, COPD, depression, and the like, including some cancers, are largely preventable. If not prevented, these diseases are readily treatable, especially if identified early.
There is a long list of reasons why we suffer from “lifestyle” diseases…
…“Bacon tastes so good.”
…“You can’t have coffee without donuts, and coffee is essential.”
…“They don’t call it ‘comfort’ food for nothing.”
…“Smoking makes me feel good and look cool.”
…“Exercise is boring and hurts.”
…“I don’t take my medications because I don’t like the way they make me feel.”
It’s not so much that we are choosing to be sick as we are choosing not to be well. We neglect to consider the long term consequences of our lifestyle choices.
No one plans to need an oxygen tank to breathe, or to use a walker or wheel chair to get around, or to be unable to leave their home because of physical or mental diseases. However, especially as we age, we find ourselves in these circumstances more and more often. This happens because of the choices that we have made and continue to make.
If our family physicians could see every choice that we make and could help us understand the implications of each one, we would probably make different choices (at least some of the time). Many of us recognize some of the poor choices that we are making as we make them. Sometimes we make poor choices and aren’t even aware that they are poor choices; this is especially true regarding what we choose to eat.
Why do we make the choices we do? Inertia is hard to overcome and the habits of a lifetime, which are like old friends, are hard to break.
How could it be different? We are entering an era where assistance is more and more available that will allow us to meet the personal goals we have and to live the life that each of us wants to live. While we can’t change the past and the consequences of our past decisions, we do have the power to change the present and future, if we choose to. And choosing to is key.
Why would you want to? For example, I am well past the traditional “retirement” age, but I am still working for Emtiro Health both because the work is interesting (it keeps my mind active) and provides some more social interaction (which is necessary for both mental and physical health). Both of those things are important to me so I choose them even though I could choose to go to the beach (which I also choose to do, some of the time).
I know that giving up smoking is difficult, but at least one person I know did so because she did not want to have to carry an oxygen tank. That was her motivation. And while she gave up smoking she did not give up nicotine and continues to use an eCigarette. She has chosen a harm reduction approach that works for her.
But what about genetics, we can’t do much about that can we? Well yes and no. I have a family history of colon cancer. My father’s father had it; they found it and were able to successfully treat it and he lived into his 90s. My father ignored that possibility; they did not find it until after it had metastasized; even with aggressive treatment it killed him when he was 8 years younger than I am now. Do I get regular colonoscopies? You bet! Colon cancer is 100% preventable with appropriate screening. Genetic screening is now readily available and relatively inexpensive, and many have used it to help prevent potential cancers and other illnesses.
We all need help in order to do the things that we want to do. While my family physician cannot be there to provide ongoing guidance (and frankly, I don’t think that I would enjoy that level of oversight), I do see a future in which technology and apps will, for example, track my glucose level (my doctor tells me I am pre-diabetic which I’m sure is due to some of my own lifestyle choices) and if it gets too high, it will suggest that it is a good time for a walk (since I don’t want to be a diabetic with all that entails). There are “wearables” to track my vital signs and/or activity level. I receive texts reminding me of my upcoming appointments with my health care team. I want to do the things that I want to do and if technology can give me 24/7 support regarding sleep, medications, diet, and physical activity based on my own desired outcomes, then I am all in. There are also tools that can track my mental health, ask me how I am feeling, and suggest activities that I know will make me feel better, including getting more direct help.
So what is your motivation and what will help you to maintain it? It may be technology. It may be a friend to do things with. It may be a coach (perhaps even a virtual one). It may be some combination or something altogether different. Sometimes that motivation could be negative (e.g., I don’t want to be diabetic; the woman who doesn’t want to carry an oxygen tank) and sometimes it could be positive (e.g., those who want to be able to enjoy their grandkids; those who want to enjoy life again). In any case, you and only you know what you want from life and only you can choose to get where you want to be.
But, I am sure I can guess what some of you are thinking…
…“That’s easy for you to say.”
…“If you can go to the beach, you obviously have reliable transportation and the means to use it.”
…“You probably live in a neighborhood where it is safe to walk.”
…“You probably have easy access to a grocery store that has healthy food and reasonable prices.”
What if those things are not true for me? If I have to choose between what feels like survival and health, then survival wins every time. While it is more difficult to make healthy choices if you live in an unsafe neighborhood, a food desert or swamp, in poverty, they are still possible.
There are food assistance programs (e.g., SNAP, WIC) that are available for some and food pantries that frequently often provide not only free food but also tips and classes on how to prepare low-cost nutritious meals. For many the time needed to shop for and prepare food is a significant barrier, but today even fast food restaurants provide calorie counts and healthier alternatives. Good nutrition is essential to good health and good health leads to better educational outcomes for children and better employment opportunities for adults.
Exercise is also essential for health and walking is one of the easiest and most productive forms of exercise. Even in “bad” neighborhoods it is possible to walk safely: Don’t walk at night if you don’t have to and, if you do, find the most well-lit path. Walk with others; not only is there strength in numbers, but you’ll get to know your neighbors better and it will be more enjoyable. Moms could share childcare duties during their walks with one watching the children while the others walked and then rotating the childcare so that most were able to walk most days.
Other forms of indoor exercise are also possible that require no equipment (e.g., push-ups, sit-ups). No weights? That’s okay, you can use cans of food or other heavier objects. If walking is not physically possible than there are many chair exercises that require no special equipment. YouTube has many examples of exercise routines, but even if you don’t have access to that technology there are other free resources to assist.
In the past when we tried to do things like eat better, exercise more, lose weight, or drink less we were pretty much on our own. Trying to change a lifetime of behaviors is difficult, especially if you are on your own. In fact, there are lots of forces working to keep you from changing that behavior such as super supersized meals, all you can eat buffets, friends who invite you to tail gate parties, streets that have no sidewalks for walking, no place to buy high quality food, and most importantly a bias to maintain the status quo (i.e., a tendency not to change unless the incentive is very strong). Today, there are more and more supportive options and the list is growing every day.
What will you choose?
(1) The Centers for Disease Control (CDC) estimates that 75% of health care spending is for chronic diseases. It is even worse for the poor, with 83% of Medicaid dollars, and for the elderly, with 99% of Medicare dollars spend on chronic diseases. It is probably just as bad for the uninsured. It is expected to get worse with nearly half (49%) of all Americans expected to suffer from at least one chronic disease by 2025. To put that in perspective, we spend over $3 trillion dollars a year in this country on health care and $2.25 trillion plus of that on chronic care alone. The CDC also estimates that eliminating three risk factors - poor diet, inactivity and smoking - would prevent 80% of heart disease and stroke; 80% of type 2 diabetes and 40% of cancer.
The Growing Crisis of Chronic Disease in the United States https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf