What can physicians do to promote healthy, life-extending lifestyle changes?
A pivotal paper published in Europe more than a decade ago entitled “Healthy Living Is the Best Revenge” found that practicing just four simple, healthy lifestyle factors compared to none could potentially have a strong impact on preventing chronic diseases. We’re talking nearly 80% less chronic disease risk, slashing diabetes risk by 93%, dropping heart attack risk by 81%, and cutting stroke risk in half and cancer risk by 36%. Think about what that means. The potential for preventing disease and death is enormous. In the United States alone every year, there are a half million first heart attacks, a half million first strokes, a million new cases of diabetes, and a million new cancer diagnoses. The message is clear: Practicing a few healthy behaviors can have a huge impact.
What are those four fabled factors?
- never smoking
- not being obese
- averaging about a half hour of exercise a day
- following healthful dietary principles, including a lot of fruits, vegetables, and whole grains, and less meat
Follow those four simple rules and boom! Enjoy nearly 80% reduced risk of major chronic diseases.
What does that mean for mortality risk? As I discuss in my video How to Increase Your Life Expectancy 12 to 14 Years, a similar combination of four healthy behaviors predicted “a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y[ears] in chronological age,” meaning the individuals were dying at such a reduced rate that it was as if they were 14 years younger. “Finally, a Regimen to Extend Human Life Expectancy,” proclaimed a commentary in reference to a study that had made a similar analysis of the impact of healthy lifestyle behaviors on life expectancies. But this time, it looked directly at the U.S. population, which is particularly important, since Americans have a shorter life expectancy compared to people living in nearly all other higher-income countries. The researchers concluded that a healthy lifestyle could substantially reduce premature mortality and increase life expectancy in U.S. adults. Okay, but by how much? They estimated that adhering to a low-risk lifestyle could extend life expectancy at age 50 by 14 years in women and 12.2 years in men. So, if you’re 50 right now, instead of only living to 79 if you’re a woman and 75½ if you’re a man in the United States, taking even just basic care of yourself could propel you to an average life expectancy of 93 if you’re a woman and 87½ if you’re a man.
The bottom line is it’s never too late to turn back the clock. A midlife switch just to the basics—at least five daily servings of fruits and vegetables, walking 20 minutes a day, not smoking, and maintaining a healthy weight—leads to a substantial reduction in mortality even in the following few years. We’re talking a 40% lower risk of dying in the subsequent four years. Indeed, “making the necessary changes to adhere to a healthy lifestyle is extremely worthwhile, and…middle-age is not too late to act.”
As an aside, when I realized the 12 to 14 years of added life expectancy were based on data from health professionals, I got excited about all the potential ripple effects. If health professionals start getting healthier, they can become role models for more healthful living and potentially save more lives than just their own. But that may have been wishful thinking. Practicing what you preach can sometimes backfire. Evidently, “displays of excellence can paradoxically turn off the very people they are trying to inspire.”
It’s reasonable to assume that not being a hypocrite and trying to walk the walk would lead to positive consequences, inspiring confidence in others. Don’t you want a dance instructor who can dance, a music teacher who can play, and a health professional who’s healthy? But “this simple intuition fails to take into account the concerns about devaluation than an expert’s superior behavior elicits in others”—that is, that may make people feel inadequate. For example, you know how vegetarians often become targets of ridicule and hostility? That’s because they may come off as morally superior and make other people feel like they’re being looked down upon.
There was an elegant demonstration of this phenomenon in a study where “principled deviants who take the high road threaten others’ moral self-worth.” Participants were asked to complete “a racist task,” and those “moral rebels” who refused to do so were cheered on by observers but disparaged by their fellow participants who had done the task. Why? Because the rebels’ stance was “an implied indictment of their spinelessness.” Isn’t that interesting?
So, when doctors portray themselves as “the picture of health,” patients might think they’re being holier-than-thou, which can unintentionally alienate those who need the doctors’ help the most. It’s easy to imagine how someone with a weight issue might feel threatened and judged by a physician triathlete. But what are we supposed to do? We want healthy practitioners. Physicians who smoke are less likely to tell their patients to quit smoking, physicians who are overweight are less likely to advise about weight loss, and physicians who don’t work out are less likely to talk about exercise. What doctors can do to make patients more comfortable is emphasize that their role is to help people meet their own personal health goals, whatever they may be. Studies show that when doctors take this approach, it increases the appeal of “fitness-focused” physicians to overweight patients. So, doctors can then display model behavior without inadvertently alienating those who would most benefit from their counsel.
Doctor’s Note
For more on lifestyle medicine, see related posts below.
