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The Power of Personal Choice: Harnessing Fingers, Feet and Forks

The Power of Personal Choice: Harnessing Fingers, Feet and Forks

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  • http://webmoneymaker.net/wp-content/uploads/2011/11/Make-Money-online.jpg http://www.cosmosmagazine.com/files/imagecache/news/files/news/smoking_090210_0.jpg
  • -- Bull World Health Organ. 2002;80(12):952-8. Epub 2003 Jan 23. Chopra M et al
  • Approx. 1,300,000 new cases per year www.cdc.gov/.../mmwrhtml/ figures/m846qsf.gif www.ncbi.nlm.nih.gov/ bookshelf/picrender.fcgi.. http://www.ctahr.hawaii.edu/CS/blogs/sustainable_agriculture/cdc_logo(2).jpg
  • Modifiable behavioral risk factors are leading causes of mortality in the United States. (JAMA, 2000 Mokdad et al. CDC) www.cdc.gov/cancer/ breast/statistics/ http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
  • www.cdc.gov/cancer/ breast/statistics/ http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
  • -- Bull World Health Organ. 2002;80(12):952-8. Epub 2003 Jan 23. Chopra M et al
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf
  • Fox, Caroline. Et al. Trends in the Incidence of Type 2 Diabetes Mellitus: Circulation 2006:113;2914-2918.
  • http://health.ucsd.edu/news/images/DPP1.jpg
  • In 2005-2008 11% of adults 20 years of age or older had diabetes. In 2005-2008 the percentage of adults with dm increased with age from 4% of persons 20-44 to 27% of adults 65 years of age or older http://meps.ahrq.gov/mepsweb/ Medical Expenditure Panel survey
  • http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf The prevalence of hypertension (defined as high blood pressure or taking antihypertensive medication) increases with age. In 2005–2008, 33%–34% of men and women 45–54 years of age had hypertension, compared with 67% of men and 80% of women 75 years of age and over (Table 67).
  • http://www.cdc.gov/nchs/data/databriefs/db92_fig1.png
  • http://care.diabetesjournals.org/content/early/2010/09/30/dc10-0879.full.pdf+html 2010 --AHA 2004 --States if you have 2 of characteristics =‘s 2 times risk of death from coronary heart dz, if you have 4 of these =‘s you have 3.5 times the risk? http://www.reuters.com/article/2010/10/15/us-metabolic-syndrome-idUSTRE69E5FL20101015
  • http://sas-origin.onstreammedia.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/yxirhsg6pe-ttjvtlo_uuq.gif These findings are based on 24 months of Gallup-Healthways Well-Being Index daily tracking data from 2009 through 2010, encompassing surveys with more than 650,000 U.S. adults, aged 18 and older. The resulting sample sizes for every age from 18 through 90 -- ranging from roughly 1,500 to 18,000 cases -- allow for age-specific analysis of the data.
  • Rates of obesity tripled in last 20 yrs in adolescents
  • http://xe9.xanga.com/05df647715d32268783403/m214397325.jpg http://www.ers.usda.gov/Publications/EIB33/EIB33_Reportsummary.pdf
  • http://static.howstuffworks.com/gif/michelangelo-1.jpg
  • http://pnhp.org/blog/2011/07/28/national-health-expenditures-in-2011-and-2020/ http://meps.ahrq.gov/mepsweb/data_files/publications/cb11/cb11.shtml
  • http://meps.ahrq.gov/mepsweb/data_files/publications/st359/stat359.shtml
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf
  • http://meps.ahrq.gov/mepsweb/data_files/publications/st359/stat359.shtml
  • http://www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf
  • http://www.cdc.gov/nchs/data/nhds/2average/2009ave2_firstlist.pdf Heart Disease misses the #1 spot by 12 births
  • http://www.cdc.gov/nchs/data/nnhsd/Estimates/nnhs/Estimates_Diagnoses_Tables.pdf#Table33b
  • Agouti = defect in alpha melanocyte stimulating hormone a secondary molecule increased by increasing leptin levels. Early nutrition can influence DNA methylation because mammalian one-carbon metabolism, which ultimately provides the methyl groups for all biological methylation reactions, is highly dependent on dietary methyl donors and cofactors.[ 21 ] For example, dietary methionine and choline are major sources of one-carbon units, and folic acid, vitamin B 12 , and pyridoxal phosphate are critical cofactors in methyl metabolism. The genome of the preimplantation mammalian embryo undergoes extensive demethylation, and appropriate patterns of cytosine methylation are re-established after implantation.[ 4 ] These DNA methylation patterns must then be maintained over many rounds of rapid cellular proliferation during fetal and early postnatal development. Availability of dietary methyl donors and cofactors during critical ontogenic periods therefore might influence DNA methylation patterns. [ 10 and 16 ] Hence, early methyl donor malnutrition (i.e., overnutrition or undernutrition) could effectively lead to premature “epigenetic aging,” [ 22 ] thereby contributing to an enhanced susceptibility to chronic disease in later life. Vitamin B12, choline, Vitamin B6
  • Gila Reservation Arizona Maycoba, Mexico
  • Nauru World’s smallest island country just 8.s sq miles 95% are overweight/obese and 50% have diabetes
  • Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.
  • -- compression-of-morbidity hypothesis predicts that the age at the time of initial disability will increase more than the gain in longevity, resulting in fewer years of disability and a lower level of cumulative lifetime disability.
  • --FDDP (N Engl J Med 2001;344:1343-50.)
  • http://aspe.hhs.gov/health/prevention/
  • ( Journal of the American Medical Association JAMA: 2000, Vol. 283. No. 22, pp. 2961-2967) http://www.news.harvard.edu/gazette/1999/10.21/diabetes.html http://www.reuters.com/article/healthNews/idUSTRE53E71N20090415?feedType=RSS&feedName=healthNews http://www.nature.com/bjc/index.html http://www.ncbi.nlm.nih.gov/pubmed/18599492?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
  • In fact in studies regular exercise has been proven as effective as antidepressants and anxiolytics in controlling mild-moderate depression
  • Must be high enough to actually see gains Studies demonstrate must at least be at 40% of max to see increases in cardiovascular endurance….. Moderate intensity is 64-76% of HR max http://www.mehn.org.au/images/stories/mehn/Ex_RPE_Scale.jpg http://lh4.ggpht.com/_hbZ_aIisSu8/Sj4dT9_2kPI/AAAAAAAAAbo/r-Hmqox_oJs/Table_thumb.jpg http://www.cvtoolbox.com/cvtoolbox1/exercise/supports/Exercise_METS.gif
  • -- http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.usatoday.com/news/health/2008-02-10-salt-dangers_N.htm -- Intersalt Cooperative Research Group (1988). Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ . 297 : 319–328. --The contradictory nature of these findings accords with the unreliability of the methods used in NHANES III and IV (ie, 24-h dietary recall). Twenty-four-hour urinary sodium from complete urine samples is the only accurate way to estimate dietary salt intake, and this was not measured in NHANES III and IV. The large international study—INTERSALT, 2 which had 24-h urinary sodium and BP measured, showed that salt intake is directly associated with BP and the increase in BP with age in more than 10,000 individuals including both hypertensives and normotensives. -- -- http://www.nhlbi.nih.gov/new/press/nov30a99.htm -- Healthy adults living in a temperate climate can maintain a normal sodium balance with as little as 115 mg of dietary sodium per day. In consideration of the wide variation in Americans’ physical activity and climatic exposure, a safe minimum of 500 mg of sodium per day has been recommended.
  • -- http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.usatoday.com/news/health/2008-02-10-salt-dangers_N.htm -- Intersalt Cooperative Research Group (1988). Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ . 297 : 319–328. --The contradictory nature of these findings accords with the unreliability of the methods used in NHANES III and IV (ie, 24-h dietary recall). Twenty-four-hour urinary sodium from complete urine samples is the only accurate way to estimate dietary salt intake, and this was not measured in NHANES III and IV. The large international study—INTERSALT, 2 which had 24-h urinary sodium and BP measured, showed that salt intake is directly associated with BP and the increase in BP with age in more than 10,000 individuals including both hypertensives and normotensives. -- -- http://www.nhlbi.nih.gov/new/press/nov30a99.htm -- Healthy adults living in a temperate climate can maintain a normal sodium balance with as little as 115 mg of dietary sodium per day. In consideration of the wide variation in Americans’ physical activity and climatic exposure, a safe minimum of 500 mg of sodium per day has been recommended.
  • -- http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.usatoday.com/news/health/2008-02-10-salt-dangers_N.htm -- Intersalt Cooperative Research Group (1988). Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ . 297 : 319–328. --The contradictory nature of these findings accords with the unreliability of the methods used in NHANES III and IV (ie, 24-h dietary recall). Twenty-four-hour urinary sodium from complete urine samples is the only accurate way to estimate dietary salt intake, and this was not measured in NHANES III and IV. The large international study—INTERSALT, 2 which had 24-h urinary sodium and BP measured, showed that salt intake is directly associated with BP and the increase in BP with age in more than 10,000 individuals including both hypertensives and normotensives. -- -- http://www.nhlbi.nih.gov/new/press/nov30a99.htm -- Healthy adults living in a temperate climate can maintain a normal sodium balance with as little as 115 mg of dietary sodium per day. In consideration of the wide variation in Americans’ physical activity and climatic exposure, a safe minimum of 500 mg of sodium per day has been recommended.
  • -- http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.usatoday.com/news/health/2008-02-10-salt-dangers_N.htm -- Intersalt Cooperative Research Group (1988). Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ . 297 : 319–328. --The contradictory nature of these findings accords with the unreliability of the methods used in NHANES III and IV (ie, 24-h dietary recall). Twenty-four-hour urinary sodium from complete urine samples is the only accurate way to estimate dietary salt intake, and this was not measured in NHANES III and IV. The large international study—INTERSALT, 2 which had 24-h urinary sodium and BP measured, showed that salt intake is directly associated with BP and the increase in BP with age in more than 10,000 individuals including both hypertensives and normotensives. -- -- http://www.nhlbi.nih.gov/new/press/nov30a99.htm -- Healthy adults living in a temperate climate can maintain a normal sodium balance with as little as 115 mg of dietary sodium per day. In consideration of the wide variation in Americans’ physical activity and climatic exposure, a safe minimum of 500 mg of sodium per day has been recommended.
  • SpecificWell definedClear to anyone that has a basic knowledge of the project MeasurableKnow if the goal is obtainable and how far away completion is Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be RealisticWithin the availability of resources, knowledge and time Time BasedEnough time to achieve the goalNot too much time, which can affect project performance

Transcript

  • 1. A presentation at the Faxton-StLuke’s Campaign for Quality 2012 10/12/12 Stephan Esser MD www.esserhealth.com
  • 2. The Power of Personal Choices:Harnessing Fingers, Feet and Forks Stephan Esser MD Institute of Lifestyle Medicine
  • 3. Disclosures• None
  • 4. • Your Personal Choices may just be the most powerful influences of your health, today, tomorrow and for years to come
  • 5. Goals• Explore the Health of America Today• Learn why what you do matters• Develop a plan of health for your life
  • 6. A Paradigm Shift
  • 7. “A global response to aglobal problem: the epidemic of overnutrition.” WHO It is estimated that by 2020 2/3rds of the globalburden of disease will be attributable to chronic non-communicable diseases, most of them strongly associated with diet. The nutrition transition towards refined foods, foods of animal origin, and increased fats plays a major role inthe current global epidemics of obesity, diabetes and cardiovascular diseases, among other non-communicable conditions. Sedentary lifestyles and theuse of tobacco are also significant risk factors. …….. Aconcerted multi-sectoral approach, involving the use ofpolicy, education and trade mechanisms, is necessary to address these matters.
  • 8. Mortality Statistics
  • 9. Leading Causes of Death in US
  • 10. Top Ten Causes of Death for Men in the United States
  • 11. Actual Causes of Death in US
  • 12. “A global response to aglobal problem: the epidemic of overnutrition.” WHO It is estimated that by 2020 2/3rds of the global Diabetes Heart Diseaseburden of disease will be attributable to chronic non-communicable diseases, most of them strongly associated with diet. The nutrition transition towards refined foods, foods of animalObesity High Blood Pressure origin, and increased fats plays a major role inthe current global epidemics of obesity, diabetes and cardiovascular diseases, among other non-communicable conditions. Sedentary lifestyles and the High Cholesteroluse of tobacco are also significant risk factors. …….. Aconcerted multi-sectoral approach, involving the use ofpolicy, education and trade mechanisms, is necessary to address these matters.
  • 13. 2 of 3
  • 14. Associated Pathology• CVD: • Obstetrics: – Hypertension – Gestational DM – Congestive Heart Failure – Macrosomia – PVD – Inc. C Section rate – Impotence – Inc. Perinatal Morbidity – Inc. Pre/Eclampsia – Claudication • Cancer:• Endocrine: – Prostate – Diabetes – Colon DIABETES – PCOS – Breast – Hypothyroidism – Endometrial – Infertility – Renal Cell – Gallbladder• Orthopedics: – Esophageal Adeno. – Osteoarthritis • Other: – AVN • Hyperuricemia, Pancreatitis,• Hepatic: Gallstones, Sleep Apnea, Alzheimer’s, – #1 cause of liver dz in US Dyslipidemia, Metabolic Syndrome
  • 15. Overweight ↑ risk of DM2 by 3 foldObesity ↑ risk by 9 fold
  • 16. The Problem1:9 adults
  • 17. The Problem• High Blood Pressure: – 1 in 3 adults1:3 adults
  • 18. 1:6 adults
  • 19. Waist Circumference > 40” M > 35” W > 29% 34%Triglycerides > 150 HDL < 40 M or < 50 W of Americans BP ≥ 130/85 Fasting Glucose of ≥ 100
  • 20. How did this Happen?
  • 21. Perspective• We eat more – Sugar, Salt, Fat, Meat, Dairy – 1970-2006: • ↑ 24.5 % C/day ≈ 617K/day• We get less then ideal Physical Activity – 18.8% of adults achieved CDC reccs on Exercise – 10% of adults >65 y/o
  • 22. Michelangelo’s David:12 month 20 city tour of the US
  • 23. What we Know• Americans – Eat More – Exercise Less• 2012: – Obesity – Diabetes – Metabolic Syndrome – CV Disease
  • 24. HealthCare Spending = $2.7 trillion = 17.7% GDP
  • 25. Associated Pathology• CVD: • Obstetrics: – Hypertension – Gestational DM – Congestive Heart Failure – Macrosomia – PVD – Inc. C Section rate – Impotence – Inc. Perinatal Morbidity – Inc. Pre/Eclampsia – Claudication • Cancer:• Endocrine: – Prostate – Diabetes – Colon – PCOS – Breast – Hypothyroidism – Endometrial – Infertility – Renal Cell – Gallbladder• Orthopedics: – Esophageal Adeno. – Osteoarthritis • Other: – AVN • Hyperuricemia, Pancreatitis,• Hepatic: Gallstones, Sleep Apnea, Alzheimer’s, – #1 cause of liver dz in US Dyslipidemia, Metabolic Syndrome
  • 26. Top 35 leading diagnosis groups at ambulatory care clinics 1: Essential Hypertension 7: Diabetes Mellitus 15/17: Heart Disease
  • 27. Number and rate of discharges from short stay hospitals 2009 2: Heart Disease 8: Strokes 11: Diabetes Mellitus 17: Essential Hypertension
  • 28. Admission Diagnosis to Nursing Homes 2009 1: Disease of Circulatory System
  • 29. Can WE Change this?
  • 30. Can we Change Health through Lifestyle Or are Genetics the end of the story?
  • 31. They did not display their parent’s susceptibility to cancer and diabetes….……..the effects of the agouti gene had been virtually erased.
  • 32. Pima Indians
  • 33. “A global response to a global problem: the epidemic of overnutrition.” WHO It is estimated that by 2020 2/3rds of the global burden of disease will be attributable to chronic ……if…….Lifestyle is the noncommunicable diseases, most of them strongly Problem associated with diet. The nutrition transition towardsrefined foods, foods of animal origin, and increased fats plays a major role in the current global epidemics of obesity, diabetes and cardiovascular diseases, among other noncommunicable conditions. Sedentary What of tobacco are also significantlifestyles and the use is the answer……..?risk factors. …….. A concerted multi-sectoral approach, involving the use of policy, education and trade mechanisms, is necessary to address these matters.
  • 34. Surgery PharmaceuticalsPhysical ModalitiesLifestyle Medicine
  • 35. What HAS worked?
  • 36. 50% ↓ in all-cause and cause specific mortality12 year Cohort Study1507 men 832 WomenAges 70-90 yearsOutcomes: 10 yr all cause mortality4 Factors: Med. diet, Moderate EtOH, physical exerciseand non-smoking were ass. w ↓ in ACM
  • 37. “Not only do persons with better health habitssurvive longer, but in such persons, disability ispostponed and compressed into fewer yearsat the end of life.”Vita, AJ et al. NEJM 1998; 338:1035-1041
  • 38. Finnish Diabetes Prevention Trial Total 522: 172M 350W Av. age 55 Risk of Av. BMI 31 Randomized to standard of care or individualized lifestyle counseling Diabetes ↓ 58 % Av. f/u 3.2 yrs (P<0.001)“The reduction in the incidence of diabetes wasdirectly associated with changesN in lifestyle” Engl J Med 2001;344:1343-50
  • 39. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study 2009• 23,153 participants (35 to 65yr) for about 8 years• Rates of type 2 diabetes mellitus, myocardial Sign Me Up! infarction,all 4 factors at baseline you had If you had stroke, and cancer• • 4 Variables: of developing a chronic disease 78% lower risk – Never smoking • – BMI<30 lower risk of diabetes • 93% – •3.5 h/wk orrisk of myocardial infarction 81% lower more of physical activity •50% lower risk of stroke, and – healthy dietary principles (high intake of fruits, •36% lower risk of cancer vegetables, and whole-grain bread and low meat consumption).
  • 40. Motorola• Cost ≈ $6 mil/yr on wellness and work/life programs• Offerings: Health Screenings, Education, gym access etc• Cost-effectiveness: – $1 invested in wellness benefits, $3.93 saved – 2.4% increase in annual health care costs for participating employees vs 18% increase for non- participants – $6.5 million annual savings in medical expenses for lifestyle-related diagnoses (e.g., obesity, hypertension, stress) compared with non-participants
  • 41. Northeast Utilities• 17% healthcare costs = LR• WellAware program: financial incentives for participation, employees and spouses eligible, a health risk assessment, secondary coronary artery disease management program, phone contact and Internet site allows access at work and home, and a toll free hotline for materials and questions.• 1st 2 years: 1.6 return on investment, including a $1,400,000 reduction in lifestyle and behavioral claims and flat per capita costs for health care.• Participants demonstrated: 31% decrease in smoking, a 29% decrease in lack of exercise, a 16% decrease in mental health risk, a 11% decrease in cholesterol risk, an 10% improvement in eating habits, and a 5% decrease in stress.
  • 42. What we KnowHealth Comes from Healthy Living
  • 43. What can I do tostay healthy?
  • 44. Fingers Feet Forks theMaster Levers of Health Destiny
  • 45. Feet
  • 46. Exercise and Physical Health• Reduces risk of – Heart Disease ≈ 40% – Obesity: ≈ 30-100% – Stroke ≈ 50% – Type 2 Diabetes ≈ 50% – Hypertension ≈ 50% – Disability delayed ≈15 years – Colon Cancer ≈ 25-40% – Breast Cancer ≈ 20%-44% – Osteoporosis ≈ 20+%• As many as 250,000 deaths per year in the United States are attributable to a lack of regular physical activity
  • 47. Exercise and Mental Health• Regular Exercise: – Reduces risk/severity of: • Depression • Anxiety • ADD/ADHD • Alzheimers Dementia – Improves: • Mental Clarity, test scores, focus
  • 48. Exercise and Emotional Health• Regular Exercise: – Increases Self Confidence – Teaches skills to manage adversity – Enhances Self Esteem – Develops Discipline – Encourages Goal setting and self awareness
  • 49. Exercise means pink spandex, going to a gym, sweating with a bunch of people I don’t even know or like!
  • 50. Categories• Leisure time Exercise: organized sports, running, gym activities, rehabilitation etc.• Lifestyle Exercise: activity incorporated into our daily pattern of life – eg: parking in the distant portion of the parking lot rather then the first bumper, taking the stairs instead of the elevator etc.
  • 51. Present Recommendations• Cardiovascular: – 150 minutes of moderate-intensity exercise per week. – 30-60 minutes of moderate-intensity exercise (five days per week) or 20-60 minutes of vigorous- intensity exercise (three days per week).
  • 52. Present Recommendations • Resistance Training: – 2-3 days per week – All major muscle groups – 2-4 sets of each exercise – 48 hours in between sessionshttp://www.acsm.org/about-acsm/media-room/news-releases/2011/08/01/acsm-issues-new-recommendations-on-quantity-and-quality-of-exercise
  • 53. Present Recommendations• Flexibility: – 2-3 days/week to improve range of motion• Balance: – 2-3 days/week – Eg: Tai Chi, Yoga
  • 54. All Kinds• People• Programs• Locations• Products: Pedometers, Accelerometers etc
  • 55. Intensity of Exercise Talk Test: -Easy: Can Talk and Sing -Moderate: Can Talk but not sing Maximal Heart Rate: -Intense: Can’t age) or sing 220-Age or 206.9-(0.67x talk Heart Rate Reserve (HRR): Max. HR- Resting HR = HRRTarget HR=HRR x % intensity + HR @ rest
  • 56. Nutrition DIEt• Up to 50% of Americans are on a Diet Lifestyle
  • 57. Nutrition• Health Promoting Nutrition: • Majority of Calories derived from Plant-Based Sources • Limited Calories from Refined Foods and Foods of Animal Origins
  • 58. NutritionThink more about Health and less about Weight Loss
  • 59. Good Health Promoting Bad Health Compromising
  • 60. NutritionThink about Calorie Density and less about individual Calories
  • 61. Toxins• Get em’ out• Get help if you need it• You can do it• You deserve it
  • 62. Basics• Physical Activity: – Achieve 150 min of aerobic exercise and 2 sessions of strength training per week• Nutrition: – Eat a high nutrient density program – Limit/moderate lean meats, limit refined foods, fat, sodium and cholesterol• Eliminate Smoking and Limit Alcohol Consumption
  • 63. Now What?
  • 64. Stages of Change (Prochaska and DiClemente)1: Pre-contemplation2: Contemplation3: Preparation/planning4: Action5: Maintenance6: Permanent Maintenance (Termination)
  • 65. GROW• Goals• Reality today• Options• Will
  • 66. Setting Goals• Specific• Measureable• Achievable• Realistic• Timely
  • 67. Break Out: 4 minutes• Set YOURSELF a SMART Goal for 1 Lifestyle Measure and share it with your neighbor!• Specific Exercise• Measureable Nutrition Toxins• Achievable Sleep• Realistic Emotional Poise(Stress)• Timely
  • 68. Conclusion• Personal Choices are powerful Medicine• Assess YOUR Health Today• Identify your health goals• Develop a support team• Take charge of your health today!
  • 69. ConclusionYou are the most powerful influence in your health today, tomorrow and for years to come!
  • 70. Thank You!