How, Now

 In Preventive Medicine Column


Faring Well? How, Now

All the way back in 1993, just as my career was getting launched, Drs. William Foege and J. Michael McGinnis published what I have come to view as the cornerstone of lifestyle medicine: a paper entitled “Actual Causes of Death in the United States.” The revelation in this paper was that the standard entries on a list of “causes” of premature death –heart disease, cancer, stroke, diabetes, and so on- aren’t causes at all. They are effects. The focus of the paper was: effects of what?

That answer was, and remains, a list of ten factors we can modify any time we choose. Some of those factors, like dietary pattern, are modifiable (at least theoretically) by any one of us, while others, like exposure to toxins in the environment or to guns, are only modifiable by all of us working together. Sometimes the best, and sometimes the only robust defense of the human body resides with the body politic.

But that said, the main action was in the area of lifestyle choices any of us can make. While it took a list of ten factors to account for almost all of the premature deaths that occur in our country each year, it took only the first three to account for 80% of those deaths, and those three were: tobacco use, poor diet, and lack of physical activity. All that has changed over the two and a half decades since that paper was published is that the combination of poor diet and lack of activity has overtaken tobacco as the number one cause of premature death in the modern world.

Essentially, what this story means is that we’ve known what it takes to prevent roughly 80% of all premature death, and the chronic diseases that precede it, for well over 20 years. We don’t just know what to do now; we have known what to do for a very long time.

The message that better use of just feet (physical activity), forks (dietary pattern), and fingers (not holding cigarettes) could slash global rates of premature mortality and chronic morbidity is among the more stunningly consistent drumbeats in the peer-reviewed scientific literature. There is a veritable mother lode of relevant citations. But among my favorites is one that came out in 2009, 16 years after the “actual causes” revelation. This one was entitled “Healthy Living is The Best Revenge.”

This paper effectively flipped things 180 degrees, and instead of asking about the causes of chronic disease and premature death, looked at the behaviors that defended against them. The findings were, predictably, the other side of a common currency. The authors found that the combination of not smoking, eating well, being active, and having a healthy weight were associated with an 80% lesser risk of developing any major chronic disease.

We have known what to do to add years to lives and life to years for literal decades. The missing piece of the puzzle isn’t what, it’s how. The focus, accordingly, must be how, now.

There are new opportunities in that area. For instance, I have just joined a start-up company called FareWell as their Chief Medical Officer. FareWell is a digital health company focused on preventing, treating and reversing common chronic diseases through comprehensive diet and lifestyle changes. FareWell, in other words, is an example of how, now; the new ways to get there from here in this digital age.

We have always had two basic options. One is culture change, and it can happen– but it’s not something any one of us can do, and it generally doesn’t happen fast. The second option is changing our skills for dealing with the environment and culture we have. With resources spanning everything from recipes to personalized health coaches, FareWell is an example of how personal skillpower can be changed.

For literal decades, we have known what it takes to add years to lives and life to years. But that prize has beckoned from the far side of troubled waters we have not known how to cross. There are new bridges being built over that span. Opportunity begins by acknowledging we have long known what, and focusing on how, now, to get there from here.

-fin Dr. David L. Katz;; founder, True Health Initiative

Disclosure Statement: Dr. Katz receives compensation as Chief Medical Officer for FareWell.

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