Bulletin E-Edition:
Your lifestyle your life
Premature deaths can be prevented with a few changes in how you eat, work and play
By Markian Hawryluk / The Bulletin
Published: October 16. 2008 4:00AM PST
New York Times News Service photos
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Scientists have discovered a miracle cure that can prevent more than half of premature deaths in America. If it were available in pill form, it would surely be a blockbuster drug, the world’s all-time best-seller. So why is nobody buying?
It’s because the cure they’ve discovered consists of four simple lifestyle changes: quit smoking, lose weight, eat healthy foods and exercise regularly. And for most Americans, that has proven to be a tough pill to swallow.
Volumes of research have confirmed that the number of deaths in the U.S. from heart disease and cancer could be slashed if Americans adopted a healthier lifestyle. Yet declines in smoking rates have leveled off and the number of overweight and inactive people continues to climb. Many people are waiting until their health shows signs of decline before even considering changes. But by then the change comes at a higher literal and figurative price.
Truth and consequences
Last month, the British Medical Journal published a new study that quantified exactly how much various lifestyle factors affect the risk of death.
In the largest and longest-running investigation of the impact of lifestyle on mortality, researchers from the Harvard School of Public Health found that 55 percent of all premature deaths, including 44 percent of cancer deaths and 72 percent of cardiovascular deaths, could have been avoided with proper diet, regular exercise, healthy weight and not smoking.
The researchers analyzed data from the ongoing Nurses’ Health Study, which has sent regular questionnaires about health, diet and behaviors to female nurses since 1980.
In the two-plus decades since the study began, 8,882 of the 77,782 initially healthy nurses have died. The latest analysis allowed researchers to estimate what percentage of deaths were attributable to certain lifestyle factors.
They found that 28 percent of deaths could be attributed to smoking, 17 percent to lack of physical activity, 14 percent to being overweight and 13 percent to an unhealthy diet.
They also found that 7 percent of deaths could be attributed to alcohol consumption. Women who had one drink per day or less were less likely to die prematurely than those who drank more or who abstained altogether. (Although studies back the notion that moderate alcohol consumption can be healthy for your heart, many health experts are still wary of promoting drinking because of the high risk of other related problems.)
“Our findings suggest that the combination of lifestyle factors has a substantially larger impact on survival than any single factor,” said Dr. Robert van Dam, assistant professor in the Department of Nutrition at the Harvard School of Public Health and the lead author of the study. “Clearly, avoiding smoking is of major importance for health, but regular physical activity, a healthy diet and weight management can result in large additional health benefits.”
Life vs. death
Van Dam said the study may well have underestimated the true benefit of making those lifestyle changes because it looked only at preventing early death. Adopting healthy habits can have significant impact on the quality of life as well. Better diet, more exercise and less weight can improve the overall feeling of well-being. But more importantly, doctors say, it could reduce the negative impact of living with heart disease, cancer and other chronic conditions.
Many individuals, for example, die from their first heart attack, while others are left disabled with significant long-term health costs. Smokers often experience years of respiratory and other problems before their addiction kills them. Overweight individuals struggle with many tasks of daily life and face a crippling social stigma.
Meanwhile, making changes even after years of unhealthy living can have a significant positive impact. Van Dam said even modest lifestyle changes, such as 30 minutes of brisk walking each day, significantly reduce the risk of premature death. And while many people associate smoking with the risk of lung cancer, he said the risk of heart disease declines even more rapidly after quitting.
“It’s always worthwhile to adopt a healthier lifestyle,” van Dam said.
The study results suggest that the greatest gains from lifestyle changes could be in reducing cardiovascular deaths. Heart disease kills more people — some 650,000 Americans per year — than any other condition, and adopting healthy behaviors could prevent nearly three-quarters of those deaths.
“There’s a lot of data that shows that over 90 percent of heart disease can be explained by traditional risk factors: hypertension, cholesterol, obesity, smoking, diabetes and exercise,” said Dr. Michael Widmer, a cardiologist with Heart Center Cardiology in Bend. “That underscores the importance of prevention.”
All of those risk factors can be improved through the lifestyle changes identified by the Harvard study.
“We can make substantial differences in outcomes if we address the risk factors,” Widmer said. “And doing so is not only going to help people live longer and live better, but it’s going to save substantial amounts of money.”
Widmer said even though there are good drugs to address some of those risk factors, lifestyle changes are still the first step.
“The more compliant you are with the recommendations regarding your diet, the better your medications are going to work. And the less medication you’re actually going to have to take, the less risk you’re going to run into side effects and the less money out of your pocket,” he said.
But Widmer added many patients don’t hear — or don’t listen to — the message about prevention until their health has deteriorated. As a cardiologist, he doesn’t see patients until they’ve had a ride in an ambulance or laboratory tests identifying significantly elevated blood pressure or cholesterol.
“I don’t see a lot of 30- and 40-year-olds who are currently healthy,” he said. “A lot of those individuals don’t see physicians on a regular basis because they’re currently immortal. It is an incredible challenge to get an individual who is feeling good to undertake changes they may not want to do because it doesn’t necessarily make them feel any better.”
Early adopters
It’s an issue that gives doctors and other health professionals fits. They know if people adopted healthy habits early in life they could avoid many of the health problems they face. It’s cheaper and easier to prevent a problem than it is to treat it after it emerges.
But too few are willing to make the change on the logical argument alone. It’s not until their own mortality is staring them in the face that people find the will to change. Nothing motivates, doctors say, like a heart attack.
Eris Craven, a registered dietitian with Bend Memorial Clinic, also sees patients primarily after they’ve been prompted into making a change.
“Unfortunately it does take an event or some drastic medical incident to get them to want to put in the time and the effort,” she said.
Some patients know they have a family history of early heart disease or diabetes that motivates them, and others may begin to feel the strain of being overweight or out of shape. But for many people, even a high cholesterol score or blood pressure reading might not be enough, absent a physical symptom.
“How much are they suffering from the choices they’re making today?” Craven asked. “They’re not. They feel OK. They don’t feel bad enough to implement change and to put in the time and effort it take to be healthy. They’re not going to feel better with better cholesterol because they didn’t feel bad to begin with.”
Craven said individuals have to believe there will be a pay-off to their efforts.
“The truth of the matter is the amount of time and effort and work outweighs the benefits that they perceive they would get from making any changes,” she said. “So why would they do it?”
Craven believes the answer is for the entire community to rally around the notion of living healthy lifestyles, much as has been done with smoking cessation.
“Whether you’re not necessarily ready to make change yet and have no clue, or you’re ready to make a change, or you’re actually in the process of making the change, or you’re maintaining the changes that you’ve done — no matter where you are in that spectrum, that constant reminder, that constant exposure, to get that information from all different types of realms, how powerful is that?” she said.
Van Dam, the Harvard researcher, said efforts to promote healthier lifestyles should focus on two areas: informing and motivating individuals, but also trying to create an environment that makes it easier for people to adopt healthy lifestyle choices.
Frankie Mautie, a registered dietitian with St. Charles Bend who has studied behavior change, said efforts in the U.S. have focused too much on the first area and not enough on the second.
“In our society, we focus on people having a lack of know-ledge, so we’ll tell them and then they’ll change,” she said. “What we do not focus on is the behavioral change process.”
She said many people think of healthy lifestyles as being black and white. They make extreme changes to their diet and exercise habits suddenly, and then they can’t keep that up. So instead, they give up entirely.
“I see people who have had weight problems for years and who float between the all or nothing. 'I’m totally exercising, I’m totally doing perfect, or I’m doing nothing,’” she said. “So what I try to focus on with people is that gray area.”
Being in the gray, she explained, means you’re not necessarily doing everything perfectly, but you’re making an effort, starting with small changes and then building upon them until you reach your goals. And if they slip up one day, knowing that it’s not the end of the world and they don’t have to throw in the towel.
“People that are flexible, who can live in the gray and be OK that it’s not perfect tend to be more successful than people who flip from the black to the white, and either I’m doing everything perfectly or I’m not doing anything,” she said. “That kind of thinking leads to yo-yo dieting and frustration and leads to worse eating habits over time.”
Markian Hawryluk can be reached at 541-617-7814 or mhawryluk@bendbulletin.com.
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