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Common sense isn’t common

Common sense isn’t common, at least with healthy behaviours. The vast majority of us know that we should eat sensibly, be a reasonable weight, exercise regularly, not abuse alcohol, and avoid smoking. Do you know what percentage of people actually follow all this obvious advice? A survey (Reeves and Rafferty 2005) of over 153,000 US adults in 2000 found that only 3% ticked all four boxes when asked if they didn’t smoke, were a healthy weight (body mass index, calculated as weight in kilograms divided by square of height in meters, 18.5 to 25.0), consumed 5 or more portions of fruit and vegetables daily, and exercised in leisure time for at least 30 minutes, 5 or more times per week (this includes brisk walking).

In a similar kind of survey, over 84,000 US nurses were asked if they currently smoked, had a body mass index of less than 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, (on average), and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fibre, marine n-3 fatty acids, folate, and healthy fat intake (Stampfer, Hu et al. 2000).

These were health professionals, yet still only 3% ticked all the boxes – following this well known lifestyle advice on smoking, alcohol, exercise, weight and diet. During 14 years of follow-up, this healthiest 3% of the nurses had only about a sixth of the chance of suffering a major coronary event (death from heart disease or nonfatal heart attack) compared with the less healthy 97%. Overall the researchers estimated that 82% of all coronary events suffered by the 84,129 nurses were preventable if sensible lifestyle advice had been followed. What might one conclude from these findings?

One can argue that taking longer or more intense exercise three or four times weekly may be as helpful as walking five times weekly.  One can also argue that a body mass index of between 25 and 30 is not too bad for one’s health if other lifestyle factors are OK – see the Journal of the American Medical Association report (Flegal, Graubard et al. 2007). Despite these queries, it’s highly likely that only a very small proportion of adults across the developed world rigorously follow healthy lifestyle advice. Extensive knowledge – as in the nurses’ study – isn’t enough to lead to lifestyle change. It’s changing our actions that’s crucial. All the findings from positive psychology, cognitive therapy, healthy relationships and other fields is of very limited benefit if one is already dead from a cause that one could potentially have avoided!

Flegal, K. M., B. I. Graubard, et al. (2007). "Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity." JAMA 298(17): 2028-2037. [Abstract]
Reeves, M. J. and A. P. Rafferty (2005). "Healthy lifestyle characteristics among adults in the United States, 2000." Arch Intern Med 165(8): 854-7. [Free Full Text]
Stampfer, M. J., F. B. Hu, et al. (2000). "Primary prevention of coronary heart disease in women through diet and lifestyle." N Engl J Med 343(1): 16-22. [Free Full Text]