“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.
“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.
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
Michelangelo’s David:12 month 20 city tour of the US
What we Know• Americans – Eat More – Exercise Less• 2012: – Obesity – Diabetes – Metabolic Syndrome – CV Disease
HealthCare Spending = $2.7 trillion = 17.7% GDP
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
Top 35 leading diagnosis groups at ambulatory care clinics 1: Essential Hypertension 7: Diabetes Mellitus 15/17: Heart Disease
Number and rate of discharges from short stay hospitals 2009 2: Heart Disease 8: Strokes 11: Diabetes Mellitus 17: Essential Hypertension
Admission Diagnosis to Nursing Homes 2009 1: Disease of Circulatory System
“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.
Surgery PharmaceuticalsPhysical ModalitiesLifestyle Medicine
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
“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
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
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).
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
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.
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
Exercise means pink spandex, going to a gym, sweating with a bunch of people I don’t even know or like!
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.
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).
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
Present Recommendations• Flexibility: – 2-3 days/week to improve range of motion• Balance: – 2-3 days/week – Eg: Tai Chi, Yoga
All Kinds• People• Programs• Locations• Products: Pedometers, Accelerometers etc
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
Nutrition DIEt• Up to 50% of Americans are on a Diet Lifestyle
Nutrition• Health Promoting Nutrition: • Majority of Calories derived from Plant-Based Sources • Limited Calories from Refined Foods and Foods of Animal Origins
NutritionThink more about Health and less about Weight Loss
NutritionThink about Calorie Density and less about individual Calories
Toxins• Get em’ out• Get help if you need it• You can do it• You deserve it
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
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
Conclusion• Personal Choices are powerful Medicine• Assess YOUR Health Today• Identify your health goals• Develop a support team• Take charge of your health today!
ConclusionYou are the most powerful influence in your health today, tomorrow and for years to come!