In 1993, a revolutionary study titled, “Actual Causes of Death in the United States,” co-authored by doctors JM McGinnis and WH Foege, caught people’s attention.
Whereas a typical “cause of death” might be listed as cardiac arrest, heart disease, cancer and the like, they pointed out that it wasn’t really disease that was bringing individuals to their demise, it was their behaviors.
Their data showed that the most prominent contributors to mortality in the United States in 1990 were tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles accidents, and illicit use of drugs.
All of these are modifiable behaviors. Whereas the order has now changed (poor diet and lifestyle kills more people than tobacco now), the mere awareness that early mortality is largely something we can control certainly raised some eyebrows.
This study was a catalyst for much more research. As time has gone by, we now know with great certainty that we have a greater ability to increase the odds of preventing 90% of heart disease, half of cancers, the vast majority of Type 2 diabetes cases, and most cases of Alzheimer’s and other kinds of dementia. In the end, it’s the poor lifestyle habits bringing their ravage that are to blame.
Changing our habits
Changing habits can certainly be tough stuff – ask any smoker who went through the process of quitting. With some exceptions, it can be a miserable experience. Think about this: Almost everyone who smokes knows that doing so will probably bring one or more of a variety of illnesses and shorten their lives – the data says smokers live 10 years less than they would have.
On the other hand, if you quit, especially before age 40, you reverse that statistic. Even though smokers know all this, they continue to smoke. On the surface, that seems strange. However, whether it’s cigarettes, alcohol, ultra-processed foods or drugs, knowing the potential damage doesn’t at all assure abstention. It goes further – there are oncologists who smoke and dieticians who are obese. Habits are really hard to break, so what can we do?
There really isn’t a one size fits all approach to get someone to change behaviors. Here in The Wellness Clinic, I use a combination of two tried and tested techniques that work well: Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT). But as circumstances dictate, I sometimes have to think out of the box and rely on my “6th sense.”
Habits have a structure, or what we call a habit loop. That loop always starts with a cue: a trigger that initiates the habit. It can be a time of day, a location, a feeling, or an action by another person. Learning how to identify these triggers makes a big difference.
For our purposes, think about it – what happens when you have unhealthy choices in your home? Or, even with all the willpower in the world, what happens when I go out with friends for some fast food?
In the CBT world, we call this “setting up your environment for success.” For instance, having an abundance of healthy food choices or keeping your exercise clothes accessible, while at the same time avoiding the traps that will trigger poor behavior – these are all part of creating a successful environment.
Atomic habits
One of the best books for habit improvement is the best seller by James Clear called Atomic Habits. As the author’s last name may imply, he does a terrific job in his book of clarifying behavioral change, making it understandable and relatively easy to accomplish. I think his most important point is to take things one step at a time – even half a step at a time. Clear has four rules of behavior change to implement and they can all be applied to your health habits.
- Make it obvious – increase the visibility of what you want to accomplish and decrease the visibility of those things you want to do less of or eliminate. For instance, keep fruits and vegetables available on the kitchen counter but don’t even buy the candy, cakes and sugary, oily foods.
- Make it attractive – pick an exercise you like to do and put on headphones and use that time to listen to your favorite music or lecture or watch a video that you like. That makes the exercise more attractive to do. Pick the healthy foods you like to eat – there are certainly many choices. If cooking is complicated for you, find foods that don’t require time consuming or complicated preparation.
- Make it easy – start with a 2-3 minute walk. Eventually you’ll get up to 30-35 minutes, but to change from being sedentary to active, start very small. If you need to eat five servings of fruits and vegetables a day and you currently eat only one or two, start by adding one fruit or one vegetable. You’ll get there.
- Make it rewarding – your clothes will fit better, your blood test will come out better, your blood pressure will decrease, or you will feel much more energy – and your mood will improve! These are noticeable benefits and very rewarding.
The idea is to start very small and just keep building up. Focus on each small reward, but remember that the bottom-line, larger rewards are going to ultimately translate into a longer and much healthier life.
Healthy behaviors are critical
We saw from the 1993 study just how crucial healthy behaviors are. Since that study, this point has been proven over and over again.
Just a few weeks ago Dr. JoAnn Manson, a professor of medicine at Harvard Medical School, wrote a commentary on a recent report in the Canadian Journal of Cardiology about lifestyle modification in terms of preventing cardiac arrest.
Dr. Manson points out that in this study, researchers looked at half a million participants with an average age of 56. Over 14 years, there were about 3,100 instances of sudden cardiac arrest. They examined 125 heart risk factors and found 56 of those were related to cardiac arrest.
The eight life-factors that the American Heart Association lists as risk factors were all related to sudden cardiac arrest. They include a sedentary lifestyle, less than 7 hours of sleep per night, large waist circumference (overweight), and smoking. In addition, psychosocial factors like depression, and not enough vegetables and fruits were also linked.
The conclusion was that 40% to 63% of cases of sudden cardiac arrest are preventable just by eliminating these risk factors. It all comes down to our behaviors. We desperately need our physicians to deem our lifestyle behaviors to be as important as the pills they prescribe daily. As soon as patients hear this coming from their doctor, we will see more people complying.
So start the habit changing process so that you can “add hours to your days, days to your years, and years to your lives.”
The writer is a wellness coach and personal trainer with more than 25 years of professional experience. He is a member of the International Council of the True Health Initiative, on the board of Kosher Plant Based, and director of The Wellness Clinic. alan@alanfitness.com