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

1. A presentation at the Faxton-St
Luke’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

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

6. Goals
• Explore the Health of America Today
• Learn why what you do matters
• Develop a plan of health for your life

7. A Paradigm Shift

8. “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.

9. Mortality Statistics

10. Leading Causes of Death in US

11. Top Ten Causes of Death for Men in the United States

12. Actual Causes of Death in US

13. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3rds of the global
Diabetes Heart Disease
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
Obesity High Blood Pressure
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
High Cholesterol
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.

14. 2 of 3

15. 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

16. Overweight ↑ risk of DM2 by 3 fold
Obesity ↑ risk by 9 fold

20. The Problem
1:9 adults

21. The Problem
• High Blood Pressure:
– 1 in 3 adults
1:3 adults

22. 1:6 adults

23. 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

25. How did this Happen?

29. 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

30. Michelangelo’s David:
12 month 20 city tour of the US

31. What we Know
• Americans
– Eat More
– Exercise Less
• 2012:
– Obesity
– Diabetes
– Metabolic Syndrome
– CV Disease

32. HealthCare Spending = $2.7 trillion = 17.7% GDP

34. 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

36. Top 35 leading diagnosis groups at ambulatory care clinics
1: Essential Hypertension
7: Diabetes Mellitus
15/17: Heart Disease

37. Number and rate of discharges from short stay hospitals 2009
2: Heart Disease
8: Strokes
11: Diabetes Mellitus
17: Essential Hypertension

38. Admission Diagnosis to Nursing Homes 2009
1: Disease of Circulatory System

39. Can WE Change this?

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

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

42. Pima Indians

44. “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 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
What of tobacco are also significant
lifestyles 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.

45. Surgery
Pharmaceuticals
Physical Modalities
Lifestyle Medicine

46. What HAS worked?

48. 50% ↓ in all-cause
and cause specific
mortality
12 year Cohort Study
1507 men 832 Women
Ages 70-90 years
Outcomes: 10 yr all cause mortality
4 Factors: Med. diet, Moderate EtOH, physical exercise
and non-smoking were ass. w ↓ in ACM

49. “Not only do persons with better health habits
survive longer, but in such persons, disability is
postponed and compressed into fewer years
at the end of life.”
Vita, AJ et al. NEJM 1998; 338:1035-1041

50. 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 was
directly associated with changesN in lifestyle”
Engl J Med 2001;344:1343-50

51. 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).

52. 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

53. 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.

54. What we Know
Health Comes from
Healthy Living

55. What can I do
to
stay healthy?

56. Fingers
Feet
Forks
the
Master Levers of Health Destiny

57. Feet

58. 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

59. Exercise and Mental Health
• Regular Exercise:
– Reduces risk/severity of:
• Depression
• Anxiety
• ADD/ADHD
• Alzheimers Dementia
– Improves:
• Mental Clarity, test scores, focus

60. 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

61. Exercise means pink spandex, going to a
gym, sweating with a bunch of people I
don’t even know or like!

63. 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.

64. 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).

65. 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

66. Present Recommendations
• Flexibility:
– 2-3 days/week to improve range of motion
• Balance:
– 2-3 days/week
– Eg: Tai Chi, Yoga

67. All Kinds
• People
• Programs
• Locations
• Products: Pedometers, Accelerometers etc

68. 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 = HRR
Target HR=HRR x % intensity + HR @ rest

69. Nutrition
DIEt
• Up to 50% of Americans are on a Diet
Lifestyle

70. Nutrition
• Health Promoting Nutrition:
• Majority of Calories derived from Plant-Based
Sources
• Limited Calories from Refined Foods and
Foods of Animal Origins

71. Nutrition
Think more about Health and
less about Weight Loss

72. Good
Health
Promoting
Bad
Health Compromising

73. Nutrition
Think about Calorie Density
and less about individual
Calories

74. Toxins
• Get em’ out
• Get help if you need it
• You can do it
• You deserve it

75. 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

76. Now What?

77. Stages of Change
(Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance (Termination)

78. GROW
• Goals
• Reality today
• Options
• Will

79. Setting Goals
• Specific
• Measureable
• Achievable
• Realistic
• Timely

80. 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

81. Conclusion
• Personal Choices are powerful Medicine
• Assess YOUR Health Today
• Identify your health goals
• Develop a support team
• Take charge of your health today!

82. Conclusion
You are the most powerful influence
in your health today, tomorrow and
for years to come!

83. Thank You!