The Lucky Years: How to Thrive in the Brave New World of Health (21 page)

About 67 percent of Americans are overweight or obese, a statistic that you’ve no doubt heard over and over again. But only 36 percent of these individuals admit to being overweight. And the others don’t admit it because
they don’t know it
. In other words, they may not be in denial; they might be so out of touch with their own reality that they cannot recognize and accept the fact that they are overweight.

Indeed, this finding is counterintuitive: we assume that everyone is aware of obesity, including those who are overweight. The fact that someone could be overweight or obese and not know it seems unbelievable, as if you grew an extra limb and didn’t notice. But this phenomenon is not news to health professionals. I routinely treat patients who don’t recognize how overweight they are or who minimize their weight as just “a few extra pounds.”

A 2010 study published in the journal
Obstetrics & Gynecology
turned
conventional wisdom on its head when it reported that nearly 40 percent of overweight women and a little more than 10 percent of obese women believed themselves to be of normal weight or underweight.
³
The general media has us thinking that most women perceive themselves as fat, but the same study showed that only 16 percent of normal-weight women in the study saw themselves as overweight. One of the study’s authors makes a good point: when the world around you is obese, you begin to identify overweight as normal, and this thinking is not based on the scale but on how you simply perceive yourself in your context.
⁴

And it’s not just excess fat that people are oblivious to: nearly two-thirds of parents underestimate their children’s weight. According to a study published in 2014 in the journal
Pediatrics,
half of parents don’t even see that their children are overweight or obese.
⁵
What’s more, about 30 percent of kids and teens ages eight to fifteen misperceive their own weight status. Among children and teens who were deemed overweight by medical standards (between the 85th and 95th percentiles on the CDC’s growth chart), 76 percent thought they were “about right”; approximately 23 percent said they were overweight. Among obese kids and teens (those in the 95th percentile and higher on the chart), about 42 percent thought they were okay weight-wise, while 57 percent believed they were in the “overweight” category. Younger kids, boys, and children from poorer families were more likely to misperceive their weight.
⁶

Our reluctance to acknowledge our weight problems affects our health tremendously. For example, breast cancer is the most common cancer among women, and postmenopausal obese women are nearly 60 percent more likely to develop this cancer compared to their healthy-weight counterparts. Ignorance may be bliss in some circumstances, but in many areas of health, ignorance can be deadly.

The idea that we tend to disregard or underestimate our own risk factors for health conditions extends far beyond matters of weight. How many of us, for instance, miscalculate how much processed sugar we consume, how much exercise we get, and how much stress we are under? We’re
terrible at self-evaluating these important metrics and keeping them in check. A recent landmark study shows a huge gap between how much sugar people think they consume and the reality. And the reality is more dramatically skewed the more overweight a person gets. Put another way, obese individuals are more likely than people of normal weight to underestimate their sugar consumption significantly.

In this particular study, a team of scientists from the universities of Reading and Cambridge, in the United Kingdom, and Arizona State University compared sugar intake in 1,700 people.
⁷
They used two methods: self-reported sugar consumption and sugar levels in urine samples, the latter of which was the more accurate and objective measure. After three years, those taking part in the study had their body mass index (BMI) measured. The researchers found that the people who ate the most sugar, as determined using the urine test, were 54 percent more likely to be overweight than those who ate less sugar. And obese participants tended to misrepresent how much sugar they were consuming. The people who claimed to be eating the most sugar were actually 44 percent less likely to be obese than those who said they were consuming the lowest amounts.

Granted, this study had its limitations, and many other variables were likely involved to arrive at these results. We cannot, for example, conclude that sugar causes obesity from this one investigation. But we can entertain the fact that we each have an underlying psychology at play when it comes to accepting our behaviors. Such a psychology can work for or against us. Which brings me to the two-week challenge. It’s time to get real. It’s time to take an honest look at where—and who—you are in matters of health.

Two weeks. I’m going to ask you to work through this chapter over the course of fourteen days. You may even gain benefits that you feel physically toward the end of these two weeks. The whole point here is
to help you identify your own personal context and then optimize that context going forward with the information in the coming chapters. And this exercise won’t require a doctor’s appointment, although I will give you some tips to maximize the benefit of your next doctor’s visit. Here’s what you will need:

• Pen and paper (or computer file; basically, a way to keep track of what you’re doing over these next fourteen days)

• A way to measure your blood pressure (you can buy these devices at local pharmacies or online)

To remind you of the analogy I used before: If I asked you to tell me how long it takes to drive from New York to Los Angeles, some of the questions you will ask are which roads are taken, which type of car is driven, even who is driving. You can take the car apart and examine all of the pieces individually but still can’t tell how long it will take to get to the destination. There are just too many variables—and the same is true of the complex human body. No one can tell you how long it’ll go on cruise control before hitting a roadblock or meeting its endpoint. But there are big factors that play mightily into health that should be considered. This is akin to telling you that the drive in a modern car from A to B will cover 2,500 miles on major highways under excellent driving and weather conditions. With that kind of contextual information, you have more data to predict the experience. I want you to have that kind of data in terms of your health, so you can have the best experience down your own road in life. Below are the top ten factors—your car parts—that can help you achieve just that.

The decade you are in today automatically provides a lot of context. A person in her thirties, for example, will have a different set of health issues and concerns than someone in her sixties. Time goes by fast for most of us, and we can easily lose sight of what we should be considering health-wise, just based on our age alone. We may feel thirty when we’re
sixty, but that doesn’t mean our bones and metabolism are behaving as such.

Obviously, the risk of developing age-related chronic disease increases as you get older. One of the invisible lines seems to be around the age of forty, after which the body begins to go through more dramatic shifts as it moves out of the fertile years, and it becomes more important to stay on top of certain screenings. This is also the time when taking more aggressive preventive measures such as a baby aspirin a day and/or a statin should be considered. The importance of establishing healthy habits in your twenties and thirties cannot be overstated. Chronic disease doesn’t happen spontaneously when you’re older. It’s the accumulation of insults to the body over time, coupled with underlying genes, that often result in illness later in life. The problem is that it’s very difficult to think about the health challenges of aging when you’re young or enjoying great health. But planning for optimal health is just as important as planning for future financial needs.

Whatever decade of life you’re in, I encourage you to check your blood pressure twice daily over the next two weeks. See if you can find a pattern to it. Does it go up after lunch and down after exercise? Check it at different times throughout the fourteen days, and note what’s going on during those times (“just woke up” or “just had an argument with my teenage son”). This experiment will help you identify your blood pressure range, so months or even years from now you can tell if that range has shifted—for better or worse.

Do you know what killed your great-grandparents on both sides of the family? Or what kind of cancer your uncle Elroy had when he was forty? Family history is one of the most underused but extremely powerful tools to understanding your health. And it may be the best tool to predict genetic cancer risks. Good family health trees are rare; less than a third of us have one, and my bet is your doctor hasn’t pushed you to complete your family tree (despite those questions you tried to fill out during your first visit).

The US Surgeon General operates a free website—https://familyhistory.hhs.gov—that will help you to create a family health history, learn about your risk for conditions that can run in families, and share it electronically with relatives and your doctor. Be sure to include as much information from both sides of the family as possible, and record any environmental or lifestyle factors that could have contributed to a family member’s untimely death. Who smoked? Who was overweight? Who was hospitalized or treated for mental illness? The answers to these questions can be enlightening on many levels and can lead to better personal care. Once you exhaust the limits of this kind of rough detective work, you may want to consider taking it to the next level and undergo genetic screening. But remember that DNA tests aren’t as much of an oracle into your future risks and health as you might think, and they are not for everyone.

A popular children’s book,
Eat, Sleep, Poop
, has more to say about life and health than you might think. Babies are born with an inherent programming to know what they require to survive. They have distinct patterns to their needs, which are dictated primarily by the urge to eat, sleep, and poop and pee. We as adults often don’t listen to and follow our bodies’ physiological cues and needs for the very same fundamental activities. We can let distractions and responsibilities rule our lives, as well as wield the power of the mind over matter.

One of the most important things to know about your body is that it loves rhythms, patterns, and predictability. There is a reason we tend to get tired at the same time each day, to wake up within the same fifteen minutes each morning, to crave coffee at the same time, and to feel hunger for dinner at about the same time every day. Maintaining such routines reduces stress on the body and keeps its preferred, balanced state of being—a state in medicine we call homeostasis. Another way of understanding homeostasis is to consider the human body’s average temperature of 98.6 degrees F. When it shoots up, it’s a sign that something is wrong or out of balance inside, perhaps set off by an infection.
The body then goes to work on remedying the problem to bring down the temperature back to normal. It does this all day long based on what you encounter and how you treat your body to either support its natural balance or challenge it.

To get a sense of how powerful timing can be for the body, look no further than a study done in 2015 and published in the prestigious journal
Science
.
⁸
Researchers at San Diego State University and the Salk Institute for Biological Studies discovered that by limiting the period during which fruit flies could eat, they could prevent heart problems related to diet and aging. They also found that genes responsible for circadian rhythm—the body’s internal clock that’s aligned with the twenty-four-hour solar day—are integral to this process.

As with mice, fruit flies have long been used as model organisms to study the genetic basis of human disease, including cardiovascular disease. The average life span of a fruit fly is about thirty days, thereby making experiments on aging and disease even easier. Fruit flies share with us a number of genes that control development of a complex, symmetrical body plan. Thomas Hunt Morgan and his students at Columbia University identified the first fruit fly mutations in the early 1900s. Ever since, scientists have amassed an extensive library of genetic mutants for study. It’s easy to play with fruit fly genes, disrupting them or introducing foreign ones. This is what makes the fruit fly such a versatile and excellent model organism for studying animal development, including behavior, learning, and memory.

From previous research, we already knew that late-night eaters are more prone to developing heart disease than those who stop eating earlier. But this study adds a lot more to the notion that timing can mean everything. More specifically, here’s what these clever researchers did. In their experiments, one group of young fruit flies was fed freely a standard diet of cornmeal (the flies could eat to their hearts’ content all day long). Another group had only a twelve-hour daily window during which they could access the food.

Over the next several weeks, the scientists recorded the food consumption among the flies. They also checked a slew of health parameters
related to their sleep, body weight, and heart physiology. At the three-week mark, the results were in: flies limited to eating within the twelve-hour time frame slept better, didn’t pack on as much weight, and had far healthier hearts than their “eat anytime” peers. This was true even though both groups consumed similar amounts of food. After five weeks, the researchers documented the same results. In fact, the difference between the hearts of the twelve-hour eaters versus those eating all twenty-four were so striking that the researchers thought for a moment that they had mistaken some young three-week-old flies for the older group. They repeated the experiments several times to convince themselves that, indeed, the improvement was related to the time-limited feeding. Moreover, another set of experiments showed that the young flies weren’t the only ones benefiting from a time-restricted diet. The older flies’ hearts became healthier when they were forced to eat only during a twelve-hour period daily. So even if you limit the feeding starting very late in the life cycle, there are still some benefits, and they can persist. In these experiments, even the flies that went back to eating whenever they wanted still enjoyed some degree of heart protection.