23
Dec
2021

Improving Health and Wellness in 2022

David Shaywitz

As we start to think about 2022 and improving our health and wellness in the New Year, we make ambitious resolutions and urgently try to identify the optimal diet and best exercise program to achieve our health goals.

Stop Searching For The One

As intuitive as this approach sounds, it’s almost certainly the wrong mindset.

What behavior change experts, including Brad Stulberg and Steve Magness (best known for their books and for “The Growth Equation” website and podcast) as well as John Berardi (author of Changemakers, discussed here) and others all emphasize is that there generally isn’t a magic diet or exercise routine that’s intrinsically better than others. There is no fitness program that rules them all. 

While healthy eating (essentially, avoiding highly processed foods) and regular movement (get off the couch) are clearly good for you, the best routine is one you are most likely to stick with over time.

As tempting as it might be to pick some elaborate, ambitious exercise program, say, you need to ask yourself what are you truly likely to stick with; otherwise, you are just setting yourself up for the inevitable disappointment once life intervenes.

As Magness says (podcast quote edited slightly for clarity), “If you look at the research, and you look at the data on successful diets especially, there isn’t any that shows that one specific diet works better than anything else over the long haul.  When it comes to diet, what you can consistently adopt over a very long time works best.” 

Magness cautions against wasting your time seeking the “one answer” — the “magic bean” — and says if you do, “you’re just setting yourself up for failure.”

The same advice holds for exercise, Magness says. “Are there specific types of movement activity that might be slightly better or slightly worse?” he asks. “Sure. But in general, if you move sometimes long, sometimes hard, sometimes strong, you’re going to be good.”

What’s critical, Magness adds, is not to “get caught in the details, like ‘Oh, is this workout with 15 second intervals better than this one with 60 second intervals. It doesn’t freaking matter.”

Tech: Use With Caution

Can tech tools – like wearables – help us become healthier over the long term?

Well, maybe. To the extent a tracker can serve as prompt to remind you to exercise, and a community on Strava, say, can motivate your participation – great. 

But, as we’re increasingly recognizing, trackers also bring a series of challenges.  One concern is the tendency to rely on the wearable and begin to lose touch with your own body, reducing your confidence in your ability to understand the feedback your body is giving you.

Brad Stulberg, author of “The Practice of Groundedness” and “Peak Performance”

Another problem: the quality of the output of these devices depends on the quality of the input (see we discussed this summer); so if a PPG device, say, struggles to detect and measure heart rate accurate especially during physical activity, then measures derived from these measurements – independent of the intention and quality of the algorithm applied – will be suspect.

A third problem, described eloquently by Stulberg, is when “tracking becomes a religion,” an “ideology.”  He adds,

“You get all these secondary effects. Much like someone that is an evangelical devout Christian or an Orthodox Jew, you get someone that becomes an Orthodox Tracker, where their community becomes other trackers, and their whole life is dictated by eating during certain windows, breathing in certain ways, only eating certain foods, uploading everything to a computer, and pretty soon, you have no time and energy for anything else.”

He points out that while “these extreme communities” may “represent themselves publicly like the healthiest people in the world,” the reality is “unless they show me that they are living longer with higher function, they simply look like adherents to a very fervent religion to me.”

Choose (And Pursue) Goals Wisely

Other advice from experts relates to the nature of goals. While we’re tempted to focus on performance goals (an 8-minute mile, say, or 8 hours of sleep a night), experts like Stulberg, Magness, and Berardi all advise focusing instead on behavior goals, specific actions you can do, with the long-term mindset of achieving “mastery.”

Also important: pick goals and select actions that are small, realistic, and which you believe you are highly likely to consistently do; you can build on these. Also important: being kind to yourself, celebrating the progress you make and not beating yourself up when life inevitably happens.

To support yourself in pursuing the actions you plan to take, remember that your best chance of success happens when you don’t rely on will power (almost universally now believed to be inadequate to the task), but instead, modify your environment, where possible, to help you out. If you don’t want to eat candy bars, don’t keep them around the house. If you want to get to the gym in the morning, leave your stuff out and ready to go the night before.

The Value Of Community

Community can play an important role in promoting your health and well-being, at a number of levels.  For one, we’re happier when we’re part of communities and engaging with others – one of the reason the pandemic has been especially devastating. Seeking out opportunities to engage in communities, to connect in person with other people authentically, can enhance your wellbeing – and theirs.

For all the discussion of sensors and AI, I suspect the most significant contribution from digital fitness platforms – as I’ve repeated discussed in the context of Peloton – is the potential to create and nourish a sense of community. 

The huge opportunity I see here is for a wellness platform to perhaps initially attract users through sexy technology like a connected bike, rower, strength machine, or wearable, but then to view the platform as far more than a supportive environment for already fit cyclists, rowers, lifters, or gadget hounds. 

Instead, the real win (and it seems that at least Peloton may be pursuing this) is to create and nourish a far broader and more inclusive community, one that attracts and sustains individuals with a diverse range of fitness abilities, and interests, providing a range of attractive on-ramps to a range of offerings that collectively support an expansive conception of wellness.

Avoid Quick Fixes

On the other hand, there are things I’d urge you not to do in the new year, and they generally boil down to avoiding quick fixes, even (I’m tempted to say especially) if pitched as “natural.” 

I tend to be skeptical about supplementation in general, and exceptionally skeptical about the increasingly-popular idea of “precision supplementation,” which strikes me as bullshit squared. 

I’m also wary of pseudo-medical “hyperwellness” products – although a company offering a range of highly dubious offerings (including a range of “IV drip therapies”) just raised $140M from a top PE firm.  As Quizzify CEO and wellness guru Al Lewis observed, “I don’t know which of these is scariest and what went wrong with evolution that we need IV drips and intramuscular shots in order to thrive,” adding “how is half this stuff even legal?”

Recognize And Treat Obesity As A Chronic Disease

Transitioning from the overutilization of pseudo-medical treatments to underutilization of actual medical treatments, let’s spend a few minutes taking (another) hard look at the problem of severe obesity, once again benefiting from the insight of MGH physician and obesity scholar Fatima Cody Stanford.

What I’ve taken away from a long conversation with Stanford, as well as from many of her lectures, talks, and podcast appearances, is that while we’re collectively obsessed with weight loss, we really haven’t yet come to terms with obesity as a medical condition, preferring to consider it a regrettable life-style choice, rather a chronic disease such as hypertension or diabetes.

As a result, patients who suffer from severe obesity, or who are progressing in that direction, rarely receive the medical care they require, and often getting little more than vague and tepid “diet and exercise” advice, offered half-heartedly.  While doctors tend to be quick to treat the hundreds (UpToDate, as I discussed, lists over 230) of conditions associated with obesity, obesity itself tends to languish.

This is especially unfortunate, Stanford argues, because in addition to emphasizing the foundational role of diet and exercise, there are increasingly well-described roles, she says, for pharmacological treatments — which she’d like to see deployed comfortably and routinely by primary care doctors — as well as surgery (as I discussed in Forbes in 2012).

As Stanford sees it, we don’t use a teaspoon to clean up after a Boston blizzard – we use a snowplow, a tool suited to the demands of the job. Similarly, she argues patients suffering from severe obesity deserve access to appropriate tools and modalities.

Dr. Fatima Cody Stanford, obesity medicine expert, MGH

The issues around medication were captured in a very thoughtful exchange with an audience member at a talk Stanford gave in 2018 at the Radcliffe Institute (video here). 

The questioner noted that years ago, when she studied nutrition in college, “nobody gave drugs. Never.” Even more recently, she continued, “it was like a no-no. It’s like, ‘Well, why would you take amphetamines? You know, it’s really an artificial thing.’”

But Stanford’s perspective, the questioner observed, seemed strikingly different, viewing medication as a way to manage a “physical problem the person has with absorption or energy expenditure or whatever. So that’s a whole new thing.” 

Finally, she asked, when patients start medicines, “do they have to take them for life or and how much weight do you lose? And then do they plateau out? How does it really work over a long period of time?”

On the use of medicines, Stanford explained,

“I see these medications as complementary to someone that has improved already their diet quality and physical activity. These are the patients that come in and they’re doing everything right. I love what they’re doing and I’m like, ‘there’s not anything else I can do. But we do need to modify how your brain sees its weight set point.’”

In Stanford’s view, medicines for obesity, a chronic condition, need to be viewed the same way as medicines for other chronic conditions – when necessary and appropriate, they can make a difference, but typically need to be maintained for life, otherwise the condition they are treating reverts.  In a sense, it’s like you’re keeping the obesity in remission, rather than “curing” it.

I’m sorry,” Stanford explained.  “It’s the reality for patients, you know, and that’s what I tell patients before we commit to it. Because if the medicine works, then I’m going to keep you on.”

In addition to emphasizing the need for primary care doctors to become more comfortable offering medical therapies for obesity, Stanford also highlights the value of comprehensive obesity care centers like the one she’s in at MGH – and which has a waiting list of nearly 2,000 patients.

Stanford stresses the need to democratize comprehensive obesity care, and serves on the advisory board of what seems like a promising startup, Calibrate, with this medical mission; the company raised a $100M series B in late August.

Healthier Workplaces

As we find ourselves still dealing with the challenges of the pandemic, the need for a healthy workplace – as I’ve recently discussed – has only become more urgent.

Many employers have sought to address these challenges by increasing the buffet of wellness offerings; yet useful as these may be to some individuals, these offerings, although abundant, may not really address the core issue.

More promising, I suspect, is an evidence-driven approach, distilled into a toolkit, that has been developed by the Work and Well-Being Initiative, a “joint research-for-action” effort from the Harvard School of Public Health and MIT’s Sloan School of Business. 

The basic thesis goes as follows:

“Many employers, increasingly concerned about rising health care costs, have implemented corporate wellness programs that use workplaces as venues for promoting individual health behaviors (such as healthy eating and increased exercise). However, recent research demonstrates that these programs are not very effective and have only limited positive influence on employee health outcomes, medical costs, and productivity.

In contrast to wellness programs, the approach we offer in this toolkit emphasizes the importance of targeting and changing work conditions—that is, how workplace practices and relationships are designed and organized. Ample research has demonstrated that these are often the real root causes of employee ill health and stress.”

The initiative contends that “three work dynamics—job control, job demands, and social relationships at work— are root drivers of many forms of worker health,” and emphasizes that by addressing these issues organizationally, with employee/management partnership (which should be in the enlightened self-interest of both), and by also focusing on the emerging principles of promoting positive health (vs avoiding negative health; see my discussion here), healthier workplaces are possible.

What a hopeful vision for the upcoming year.

Best wishes for a healthier, happier, and more positive 2022.

Note to readers: reflecting the evolving focus of both my work and writing, the column will now be called “KindWellHealth.” It will concentrate on health, wellness, flourishing, and entrepreneurship.  The core principles and priorities are unchanged: I remain firmly grounded in science, cautiously optimistic about technology, and centered, as always, on people. Column-related inquires can now be sent to me here: Writing@KindWellHealth.com.

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