The old adage used to be: “an ounce of prevention is worth a pound of cure”. Meaning it typically is more cost & time effective to try to prevent something versus fix something that has gone wrong.
I want to write this because there are a lot of changes coming in health care. Personally they are not welcome changes- but my beliefs are not apart of this. This is about fact. Fact is – health care is now becoming a business. For some of us, we are going to see our premiums rise, and percentages of coverage dwindle. We will be seen more and more as a number in a long line of patients versus as an individual.
This is sad. But it is true- not in every case, but in most cases.
So back to my original point of prevention/risk reduction. I see people each day that have at least one chronic disease: Diabetes. A majority of my patients also have high blood pressure & high cholesterol, and are overweight and inactive. Again a generalization.
Nowadays that obesity is considered a “disease” along side such diseases like diabetes, heart disease, high blood pressure, etc. But it wasn’t too long ago that obesity was considered a CAUSE to these things- not something that sat alongside these other diseases as being a “chronic equal”.
So what is “obesity”? Cause or chronic illness? Let’s say for now- both. Just because the AMA says something to be true, does not mean it is- what I mean by this is- I do not feel like doctors are equipped to manage “obesity” either as a chronic illness or a causal factor….
So how about this riddle? Is obesity a CHOICE? Or an ILLNESS? Now we have gotten into the real debate. And again- let’s say both. This debate will continue to be a controversy for years to come. But it’s important to understand the role weight has in the grand scheme of health- at least generally.
The bottom line is healthcare is an awkward turtle transition between focusing on preventative care and care that “fixes” an existing problem. A huge reason why is coverage. It can be expensive to go the doctor. But if you think that’s bad ask your insurance about coverage to visit a dietitian. Especially if you don’t have anything wrong with you…… WELL WHAT IF YOU WANT TO MAKE IT SO NOTHING BAD HAPPENS TO YOUR HEALTH?! This is the sticky situation we currently need to deal with.
A general rule of thumb in terms of our health- it’s in everyone’s’ best interest to think in terms of prevention and reduction of risk factors. There are some things (such is life) that we cannot change: our age, our sex, our ethnicity, our genetics. There are somethings we are able to change/influence in regard to our health: harmful behaviors (smoking, excessive alcohol use, substance abuse), physical activity (or lack thereof), stress, sleep, diet.
A good place to start with all of this is assessing our levels of risk- a good place to start is looking at your own personal history, and your family history. Any heart disease? Diabetes? High blood pressure? Ok. Now let’s expand our scope- and look into our ethnic background. Some ethnic populations are at increased risk for certain diseases- i.e. Caucasian males and prostate & colorectal cancer, Native Americans and diabetes- most specifically the Pima Indians.
Obviously we cannot change any existing illnesses we already have, nor our family history or ethnicity, but we can assess what we are at risk for. Then we can go about changing behaviors we can control
1) Cessation of harmful behaviors. Yeah we all know the smokes and the booze are are bad for us, but in real talk if we have high blood pressure, heart disease or it is in our family- it’s time to consider ditching the smokes and cutting down on the booze
2) Stress & sleep- I’ll lump these two together, because they essentially go hand in hand- when one of these is out of sorts, typically the other will follow. We all sleep like crap when we’re stressed, which perpetuates the stress, and poor sleep. Another thing to keep in mind is these two things are hormone driven- so when they get severely out of whack it can start an unfortunate cascade of events that can perpetuate into worse problems. So catch yours zzzz’s, and do some yoga, hey- light a damn aromatherapy candle
3) Weight management- remember weight is not the end all be all of risk factors, but it’s important. What is more important than just having too little weight or too much weight or your BMI is where specifically an individual carries their weight (central weight or extra weight around the waist versus the hips and bottom is a significant risk factor) in terms of weight if you are advised or feel your weight may be an issue you want to focus on maintenance at the very least and moderate reductions- versus gains
4) Physical activity/inactivity- Inactivity is a heartbreaking risk factor. In terms of my patients- I use the recommendation from the American Diabetes Association- they recommended 150 minutes of physical activity per week. I think this applies for all people. And I genuinely believe that ANYONE is able to be active in one way or another- in fact I see plenty of patients who have rheumatoid arthritis, osteoarthritis, and other pain problems – even some who are in wheelchairs – there are plenty of activities that can be done and recommended such as arm, and leg exercises. And physical activity doesn’t need to be strenuous- but it should be exercise.
5) Diet- because this entire blog is essentially about nutrition- a majority (if not all) healthy eating tips and advice can be modified and adapted to anyone with very little risk. But here are the basics: 1) Don’t drink your calories with the exception of milk (reduce sugar sweetened beverages) 2) Use other sweeteners in moderation (zero calorie sweeteners can be great to reduce weight- but 2 liters of diet coke with is still wayyyyyyy too much. 3) Stop buying pre-packaged processed foods and do more cooking and baking 4) ditch your salt shaker 5) Have a balanced plate (remember the carbs, and fats, and proteins, and veggies? Have those at meals, snack on fruit and yogurt, indulge in a treat now and again. 6) limit frying opt for more baking, grilling, broiling, and steaming 7) don’t want to buy fresh fruits and veggies? Buy frozen.
So how does weight and health tie into this. Well a lot of time the focus is only placed on weight, or BMI, etc and while weight can be issue- but it is not the only thing to be concerned with. People can be healthy at any size, provided the above factors are kept in check. While it is important to keep in mind that have just one risk factor such as a very poor diet is really not enough to say “give someone diabetes”. However, poor diet, combined with family history, inactivity, sleep/stress disturbances, and other problems like high blood pressure- well that is not just “poor diet” anymore that breaks down to quite a few significant risk factors.
Don’t dwell on what you can’t change, and help get educated and get help with things you can change.
You can always check with your insurance regarding coverage to go to an nutrition class- but unfortunately there is still not a great deal of coverage if there is no medical diagnosis to be educated for.
Also consider taking advantage of any workplace wellness initiatives that are offered to you if possible, or look into local workshops regarding nutrition and wellness- just make sure they are conducted by legitimate medical professionals (MD, DO, RD, RN, etc – NOT a nutritionist or a “trainer”).
Additionally sources such as this blog- are evidenced based (not all blogs are)…. I use sources like the American Heart Association, The American Diabetes Association, American Association of Diabetes Educators, National Institutes of Health, American Cancer Society etc.