A presentation at the Faxton-St Luke’s Campaign for Quality 2012

10/12/12

Stephan Esser MDwww.esserhealth.com

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

Stephan Esser MDInstitute of Lifestyle Medicine

Disclosures

• None

• Your Personal Choices may just be the most powerful influences of your health, today, tomorrow and for years to come

Goals

• Explore the Health of America Today

• Learn why what you do matters

• Develop a plan of health for your life

A Paradigm Shift

“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 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 in the current global epidemics of obesity, diabetes and cardiovascular diseases, among

other non-communicable conditions. Sedentary lifestyles and the use of tobacco are also significant

risk factors. …….. A concerted multi-sectoral approach, involving the use of policy, education and

trade mechanisms, is necessary to address these matters.

Mortality Statistics

Leading Causes of Death in US

Top Ten Causes of Death for Men in the United States

Actual Causes of Death in US

“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 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 in the current global epidemics of obesity, diabetes and cardiovascular diseases, among

other non-communicable conditions. Sedentary lifestyles and the use of tobacco are also significant

risk factors. …….. A concerted multi-sectoral approach, involving the use of policy, education and

trade mechanisms, is necessary to address these matters.

DiabetesDiabetes

High Blood PressureHigh Blood Pressure

High CholesterolHigh Cholesterol

Heart DiseaseHeart Disease

ObesityObesity

2 of 3 2 of 3

Associated Pathology• CVD:

– Hypertension– Congestive Heart Failure– PVD– Impotence– Claudication

• Endocrine:– Diabetes– PCOS – Hypothyroidism– Infertility

• Orthopedics:– Osteoarthritis– AVN

• Hepatic:– #1 cause of liver dz in US

• Obstetrics:– Gestational DM – Macrosomia– Inc. C Section rate– Inc. Perinatal Morbidity– Inc. Pre/Eclampsia

• Cancer:– Prostate– Colon– Breast– Endometrial– Renal Cell– Gallbladder– Esophageal Adeno.

• Other:• Hyperuricemia, Pancreatitis, Gallstones,

Sleep Apnea, Alzheimer’s, Dyslipidemia, Metabolic Syndrome

DIABETES

Overweight risk of DM2 by 3 fold

Obesity risk by 9 fold

The Problem

1:9 adults 1:9 adults

The Problem

• High Blood Pressure:– 1 in 3 adults

1:3 adults1:3 adults

1:6 adults1:6 adults

Waist Circumference > 40” M > 35” W

Triglycerides > 150 HDL < 40 M or < 50 W

BP ≥ 130/85 Fasting Glucose of ≥ 100

> 29% of Americans

> 34% of Americans

How did this Happen?

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% GDPHealthCare Spending = $2.7 trillion = 17.7% GDP

Associated Pathology• CVD:

– Hypertension– Congestive Heart Failure– PVD– Impotence– Claudication

• Endocrine:– Diabetes– PCOS – Hypothyroidism– Infertility

• Orthopedics:– Osteoarthritis– AVN

• Hepatic:– #1 cause of liver dz in US

• Obstetrics:– Gestational DM – Macrosomia– Inc. C Section rate– Inc. Perinatal Morbidity– Inc. Pre/Eclampsia

• Cancer:– Prostate– Colon– Breast– Endometrial– Renal Cell– Gallbladder– Esophageal Adeno.

• Other:• Hyperuricemia, Pancreatitis, Gallstones,

Sleep Apnea, Alzheimer’s, Dyslipidemia, Metabolic Syndrome

1: Essential Hypertension7: Diabetes Mellitus15/17: Heart Disease

1: Essential Hypertension7: Diabetes Mellitus15/17: Heart Disease

Top 35 leading diagnosis groups at ambulatory care clinicsTop 35 leading diagnosis groups at ambulatory care clinics

Number and rate of discharges from short stay hospitals 2009Number and rate of discharges from short stay hospitals 2009

2: Heart Disease8: Strokes11: Diabetes Mellitus17: Essential Hypertension

2: Heart Disease8: Strokes11: Diabetes Mellitus17: Essential Hypertension

Admission Diagnosis to Nursing Homes 2009Admission Diagnosis to Nursing Homes 2009

1: Disease of Circulatory System1: Disease of Circulatory System

Can WE Change this?

Can we Change Health through Lifestyle Or are Genetics the end of the story?

They did not display their parent’s susceptibility to cancer and diabetes….……..the effects of the agouti gene had been virtually erased.

Pima Indians

“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 noncommunicable 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 in the current global epidemics of obesity, diabetes and cardiovascular diseases,

among other noncommunicable conditions. Sedentary lifestyles and the use of tobacco

are also significant risk factors. …….. A concerted multi-sectoral approach, involving the use of policy, education and trade mechanisms,

is necessary to address these matters.

……if…….Lifestyle is the Problem

……if…….Lifestyle is the Problem

What is the answer……..?What is the answer……..?

Lifestyle Medicine

Physical Modalities

Pharmaceuticals

Surgery

What HAS worked?

12 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

50% in all-cause and cause specific

mortality

“Not only do persons with better health habits survive longer, but in such persons, disability is postponed 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

Av. BMI 31

Randomized to standard of care or individualized lifestyle counseling

Av. f/u 3.2 yrs

Risk of Diabetes 58 %

(P<0.001)

N Engl J Med 2001;344:1343-50

“The reduction in the incidence of diabetes was directly associated with changes in lifestyle”

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

infarction, stroke, and cancer• 4 Variables:

– Never smoking– BMI<30– 3.5 h/wk or more of physical activity– healthy dietary principles (high intake of fruits,

vegetables, and whole-grain bread and low meat consumption).

If you had all 4 factors at baseline you had• 78% lower risk of developing a chronic disease

• • 93% lower risk of diabetes

•81% lower risk of myocardial infarction•50% lower risk of stroke, and

•36% lower risk of cancer

If you had all 4 factors at baseline you had• 78% lower risk of developing a chronic disease

• • 93% lower risk of diabetes

•81% lower risk of myocardial infarction•50% lower risk of stroke, and

•36% lower risk of cancer

Sign Me Up!Sign Me Up!

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.

What we Know

Health Comes from Healthy Living

Health Comes from Healthy Living

What can I doto

stay healthy?

FingersFeet

Forksthe

Master Levers of Health Destiny

Feet

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 and Mental Health

• Regular Exercise:– Reduces risk/severity of:

• Depression• Anxiety• ADD/ADHD• Alzheimers Dementia

– Improves:• Mental Clarity, test scores, focus

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

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 sessions

http://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

Maximal Heart Rate:220-Age or 206.9-(0.67x age)

Heart Rate Reserve (HRR):Max. HR- Resting HR = HRR

Target HR=HRR x % intensity + HR @ rest

Maximal Heart Rate:220-Age or 206.9-(0.67x age)

Heart Rate Reserve (HRR):Max. HR- Resting HR = HRR

Target HR=HRR x % intensity + HR @ rest

Talk Test:-Easy: Can Talk and Sing-Moderate: Can Talk but not sing-Intense: Can’t talk or sing

Talk Test:-Easy: Can Talk and Sing-Moderate: Can Talk but not sing-Intense: Can’t talk or sing

Nutrition

• Up to 50% of Americans are on a Diet

DIEtDIEt

LifestyleLifestyle

Nutrition

• Health Promoting Nutrition:• Majority of Calories derived from Plant-

Based Sources• Limited Calories from Refined Foods and

Foods of Animal Origins

Nutrition

Think more about Health and less about Weight Loss

GoodGood

BadBadHealth

PromotingHealth

Promoting

Health CompromisingHealth Compromising

Nutrition

Think 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

Now What?

Stages of Change (Prochaska and DiClemente)

1: Pre-contemplation

2: Contemplation

3: Preparation/planning

4: Action

5: Maintenance

6: Permanent Maintenance (Termination)

GROW

• Goals

• Reality today

• Options

• Will

Setting Goals

• Specific

• Measureable

• Achievable

• Realistic

• Timely

Break Out: 4 minutes

• Set YOURSELF a SMART Goal for 1 Lifestyle Measure and share it with your neighbor!

• Specific• Measureable• Achievable• Realistic• Timely

ExerciseNutritionToxinsSleepEmotional Poise(Stress)

ExerciseNutritionToxinsSleepEmotional Poise(Stress)

Conclusion

• Personal Choices are powerful Medicine

• Assess YOUR Health Today

• Identify your health goals

• Develop a support team

• Take charge of your health today!

Conclusion

You are the most powerful influence in your health today, tomorrow and

for years to come!

Thank You!