As we continue the brave work of controlling the COVID-19 pandemic, we also have to face our long-standing epidemic of obesity-related chronic diseases. About 133 million people in the United States are affected by these chronic conditions, and the usual suspects are: heart disease, stroke, diabetes, chronic kidney disease, mental health disorders, fatty liver disease, asthma, obstructive lung disease, and dementia. Today, most people in the US are either affected by or are vulnerable to one or more chronic conditions.
Although COVID-19 has caused us to focus – as never before – on personal health and the safety of our families, when life returns to a “new normal,” we are at risk of returning to our past practices, including not acknowledging another epidemic in our midst that is caused by obesity. Chronic disease affects all ages and even reaches into the lives of our youth and infants. The good news is that right now, health and healthy behaviors have our undivided attention. If we can leverage that momentum to improve our individual health, huge change is possible.
Families and individuals can start today by making changes to their daily lifestyle habits. These changes have immediate benefit, improving health and outcomes within weeks and even days.
The most important behaviors related to chronic disease prevention are diet and physical activity. While the human body certainly hasn’t changed much over the past 50 years, our food culture and cultural routines definitely have changed. Today, we are surrounded by unhealthy, highly processed foods and sugar-sweetened drinks not found in nature, and we sit a lot, even as our brains have never been so stimulated and overloaded. The typical American adult is sedentary for 60 percent of their waking hours, including sitting for an average of six hours per day.
“While the human body certainly hasn’t changed much over the past 50 years, our food culture and cultural routines definitely have changed.”
We know that the human body is not designed to handle highly processed foods in huge quantities or sitting in chairs all day. Research shows that our bodies have been trying to warn us for decades about these hazards through high blood pressure readings; wildly fluctuating blood sugars; livers that are enlarged and don’t work well when embedded with fat; inflammation markers in blood and tissues; rising immune system and stress markers; blocked and hardening arteries to the point where they shut down; unhealthy bacteria profiles and inflammation in the gut; hunger and satiety systems that have gone haywire; and disrupted mood and energy levels.
So, why haven’t people stopped eating highly processed foods and sugar drinks and become more physically active? To begin, our farming and food corporations have built very successful businesses selling these highly processed, “food-like” products, and our jobs and social/entertainment routines encourage sitting. Foods and drinks have been carefully designed and heavily marketed to increase popular demand for them. After decades of exposure, these “foods” are so familiar that there is no longer a cultural memory of anything different. We don’t remember a time when junk foods weren’t present, when physical activity was a part of daily life, or when chronic diseases were rare.
Fortunately, even today there are always healthy alternatives and ways to adjust our environments to avoid sedentary situations. We must raise awareness about our modern culture and help people make choices that improve their lives. Individually, it is never too late for someone to educate themselves, start making healthier choices, and reap the benefits.
“Individually, it is never too late for someone to educate themselves, start making healthier choices, and reap the benefits.”
What has been proven to improve health outcomes?
We know from solid scientific evidence and international consensus that when people switch from the Modern American Diet (MAD) of highly processed foods and sugar-sweetened drinks to a diet mainly consisting of minimally processed plants, including vegetables, fruits, whole grains, nuts, seeds, mushrooms, and beans, with small amounts of added fish, meat and dairy (as accents to meals and not the centerpiece), they avoid, slow down the progression of, or reverse lifestyle-related chronic diseases. Type 2 diabetes, for example, can be reversed with lifestyle changes – a profound alternative to taking drugs and needing lifelong medical visits and procedures. However, we must dramatically change the culture of healthcare delivery to reflect the fact that chronic diseases are preventable and that patients must be helped to better navigate difficult environments and food options.
What practical lifestyle actions can help me avoid or reduce the impact of chronic diseases?
By far the simplest and most effective step you can take to improve your health is to sharply cut back or eliminate your consumption of fast foods and the highly processed foods found in supermarkets, gas stations, corner stores, and cafes. The central ingredients that cause problems in the body when eating these foods are: white flour (no nutrients, no fiber, quickly turn to sugar in the body), added sugars (these unnaturally spike blood sugars and insulin levels), added salt, trans fats, and added chemicals and additives (there are 1,000s and they are poorly regulated). This is all possible because the Federal Drug Administration allows self-regulation and offers loopholes to the food industry.
When you replace highly processed foods with enjoyable meals and snacks made mainly from vegetables, fruits, whole grains, nuts, seeds, and legumes, your body begins to heal immediately from the negative effects of processed foods, effects which contribute to chronic diseases.There are many social websites that help individuals plan and get support to make this change. And there are many trustworthy clinical organizations driving this change as part of the broader movement toward lifestyle medicine, which is critical to the future of healthcare.
When the switch to more natural foods is made, it is typical for people with diabetes, heart disease, hypertension, and similar conditions see their worrisome lab and clinical exam results improve rapidly. Improvement can be seen within days or weeks, especially if weight loss is achieved at the same time. A good place to start is by experimenting for a few weeks on your own, or even better, working with a doctor or other qualified clinician to help track the changes in your body. The results can be dramatic and provide you with motivation to continue.
Many people find it helpful when making the change to real foods/drinks to use a structured meal plan. Several are aligned with the American Diabetes Association guidelines and the new Lifestyle Medicine movement, including the Mediterranean, DASH, low carb, low fat, low glycemic load, and Keto diets. Essentially, these diets all do the same thing: replace highly processed foods/sugar drinks with healthy, minimally processed food/drink options. The differences between the diets and their varied emphasis on fats, carbs, and protein intake are much less important.
What are the essential skills needed to effectively maintain healthy dietary behaviors and improve outcomes?
Preventing and/or effectively managing chronic disease requires a combination of knowledge, skills, and motivation. I’ll discuss Silver Fern’s model of behavior change more in future posts, but below I focus on the key skills that individuals can develop that will help them maintain healthy dietary behaviors in the long term.
- Learn to read the Food Label and ingredient lists, both of which are printed on the side of packaged goods. Use this skill when shopping at supermarkets, gas stations, pharmacies, and corner stores. This has become a modern survival skill due to the abundance of obesity-causing foods in our environments. Here is a useful video on reading food labels.
- Find delicious, healthy recipes and meal options that work with your personal lifestyle, habits, and preferences. Here are some apps to explore.
- Cook at home more (and eat out less). Focus on high-quality, fresh food, with added herbs and spices for flavor. If healthy food and drinks are the only options that you allow to come into your home, it makes healthy choices easier.
- Pay attention to your daily eating habits. Pause and be mindful of what food and drinks you choose. Enjoy food as a social occasion, and slow down to enjoy it. Decouple activities such as watching television from eating and drinking to improve portion control. Here are some apps to explore.
- Make more mindful choices when eating out to avoid low quality and high quantity foods/drinks.
- Drink water, coffee, flavored seltzers, or teas to keep the body hydrated.
- Cut back or eliminate sugar-sweetened drinks such as soda, fruit drinks, and fruit juices that heavily tax the body. Reading labels for added sugars is critical. Those eager to dive deep into this topic can read Robert Lustig’s research on the damage that sodas made from high fructose corn syrup do to the liver and how they cause insulin resistance and promote diabetes.
- Focus on reducing portion sizes, not counting calories. The large portion sizes of today would shock people from the 1950s. Here is a great CDC infographic on portion size and some CDC tips.
- Don’t focus your attention on supplements, as the evidence for them is weak unless medically prescribed for a deficiency.
Up next, I will explore a question that clinical teams and healthcare organizations often face: What if people or communities at risk of getting chronic conditions or who already have them don’t want to make healthy choices or are resistant to make changes to their comfortable daily habits? We’ll dig into this challenge, and I’ll provide a fresh perspective.
Garry Welch, PhD is an expert in the area of behavior medicine for chronic disease care. He has extensive experience leading clinical research on behavior change strategies for people with diabetes and other chronic diseases. Dr. Welch’s 30+ years of clinical research led to co-founding Silver Fern Healthcare. He leads research and development at Silver Fern.