Holistic Statistics
Weekly series discussing various health topics & how they relate to our overall well-being.
Holistic Statistic #1: Life expectancy
10/03/21
▻ For several reasons, health coaches are more in demand now than ever.
◆ For one thing, the American population is aging; the average American is a decade older then just 50 years ago (38.2 vs. 28.1 years old).
▻ Unfortunately, for the first time in history, life expectancy has plateaued in the United States.
◆ Despite advancements in healthcare, (without significant lifestyle changes) the average American is expected not to live as long as his or her baby-boomer parents.
Resources
1. Statista (2020). Median Age of the United States from 1960-2018.
https://www.statista.com/statistics/241494/median-age-of-the-us-population/
2. Centers for Disease Control and Prevention (2016). Mortality in the United States, 2015.
https://www.cdc.gov.nchs/products/databriefs/db267.htm
3. American Council on Exercise (2019). The Professional’s Guide to Health and Wellness Coaching, pg. 465
https://www.acefitness.org
4. Original photo, Ludwigia sedioides
Holistic Statistic #2: Sleep
17/03/21
▻ Sleep deficits worsen many cognitive functions, including memory, reasoning, and decision making. Many accidents result from fatigue associated with lack of sleep. Deeply concerning are research findings suggesting an association between lack of sleep and dementia.
◆ Approximately 50-70 million adults in the United States have a sleep disorder.
▻ In general, studies have found that people over the age of 45 who sleep fewer than six hours per night have twice the rates of heart attack and stroke compared to people who sleep six to eight hours.
Resources
1.. Xie, L. et al. (2013). Sleep drives metabolite clearance from the adult brain. Science, 342, 6156.
DOI: 10.1126/science.1241224
2. Centers for Disease Control and Prevention (2015). Insufficient Sleep is a Public Health Problem.
www.cdc.gov/features/dssleep/index.html
3. National Sleep Foundation (2018). Exercise and Sleep.
https://sleepfoundation.org/sleep-polls-data/sleep-in-america-poll/2013-exercise-and-sleep
4. Original photo, Kula sunset
Holistic Statistic #3: Stress
24/03/21
▻ An individual’s evaluation of the balance between perceived demands and perceived resources to cope with the stressor is believed to be the basis for one’s stress response.
◆ Stress can also be viewed from a cumulative perspective in terms of lifetime stress exposure. This is defined as the total sum of acute life events & chronic difficulties a person has experienced over the course of his or her life.
▻ Interestingly, just as chronic stress can result in changes in the expression of genes, studies have shown the elicitation of the relaxation response can lead to genomic changes that are positive in both the short- and long-term.
◆ Health coaching has been shown to play a positive role in increasing resilience and improving goal attainment.
Resources
1. Crum, A.J. et al (2017). The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, Stress & Coping, 30, 4, 379-395
2. Shields, G.S., Moons, W.G., & Slavich, G.M. (2017). Inflammation, self-regulation and health: An immunologic model of self-regulatory failure. Perspectives on Psychological Science, 12, 588-612.
3. Bhasin, M.K., et al. (2013). Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One, 8, 5, e62817.
4. Grant, A.M., Curtayne, L., & Burton, G. (2009). Executive coaching enhanced goal attainment, resilience and workplace well-being: A randomized controlled study. The Journal of Positive Psychology, 4, 5, 396-407.
5. Original photo, Miltoniopsis
Holistic Statistic #4: History of Nutrition Label
31/03/21
▻ It was not until the early 1970’s, when consumers faced a boom in production of processed foods, that nutrition labels were included on packaged foods.
◆ The FDA proposed regulations in 1972 to require food labels on packaged foods that added nutrients or made nutrition claims. The labels would be voluntary for foods without claims. The first nutrition labels contained basic information, including calories, protein, carbohydrate, and fat, as well as the RDA for protein & several vitamins & minerals. Inclusion of sodium, saturated fatty acids, and polyunsaturated fatty acids was optional.
▻ In 1984, the National Cancer Institute and Kellogg’s launched a food-labeling campaign on a high-fiber cereal box linking the high-fiber intake to a possible reduction in some cancers. In the absence of regulatory action, other food manufacturers followed suit, leading to a frenzy of nutrition and health claims on food labels.
◆ In 1990, congress passed the Nutrition Labeling and Education Act (NLEA), which gave the FDA the authority to require nutrition labeling on most food packages and specified the information and nutrients that must be included on the label.
▻ The Nutrition Facts Panel with which most of today’s consumers are familiar with was mandated in 1993. Though trans fats were not initially included on the nutrition label, their inclusion was required by 2003 if the product contained more then 0.5 grams of trans fat per serving. This regulation drastically decreased the amount of trans fats used in food production.
◆ In 2016, the FDA introduced a new Nutrition Facts label. The compliance date in which all product labels on the market will include these changes is January 1, 2020.
Resources
1. Food and Nutrition Board (2010). Examination of Front-of-Package Nutrition Rating Symbols and Systems: Phase 1 Report. Washington, D.C.: National Academies Press
2. Photo of example nutrition label, highlighting many nutrients lacking in the Standard American Diet (SAD) & pointing out less ingredients is better then more ingredients, on any package.
Holistic Statistic #5: Health Coaches
07/04/21
▻ The National Board for Health & Wellness Coaching (NBHWC) defines health & wellness coaches as individuals who “partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and thereby enhancing well-being.”
◆ It is believed that these new strategies in the U.S. of moving away from the fee-for-service model, focusing on primary prevention, and reducing healthcare consumption are driving forces propelling the health coaching industry forward.
▻ Of note, as the high rates of provider burnout and the negative effects provider burnout has on patients has been increasingly recognized, some have advocated that the triple aim* actually be a quadruple aim, which also takes into account provider well-being.
Resources
1. National Board for Health & Wellness Coaching (2017). NBHWC Code of Ethics.
https://nbhwc.org/wp-content/uploads/2019/04/FINAL-Code-of-Ethics-4_15_19.pdf
2. May, C.S. & Russell, C.S. (2013). Health coaching: adding value in healthcare reform.
Global Advances in Health and Medicine, 2, 3, 92-94. DOI: 10.7453/gahmj.2013.032
3. Bodenheimer, T. & Sinksy, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12, 6, 573-576
4. ” Triple-aim” of healthcare: A 3D approach to optimize health-system performance which seeks to improve:
- patient experience
- health of populations
- per capita cost of healthcare
5. Original photo, Lilikoi flower
Holistic Statistic #6: Obesity
14/4/21
▻ There has been a rapid increase in the prevalence of overweight & obesity in the United States over the past 60 years. The magnitude of the change in prevalence has been too sudden to be caused solely by genetic factors & is more likely to be caused by behavioral & environmental factors.
◆ Estimates from twin, family & adoption studies show that the rate of heritability of body mass index (BMI) ranges from 40 to 70%. Nevertheless, specific genes associated with BMI & body fat account for less than 5% of the total variation.
▻ There are some genetic disorders that affect appetite, metabolism, energy balance & fat distribution. Thus, genetic factors can be important for a few, but it is likely that lifestyle is more important for the majority of people.
◆ The genetic predisposition to obesity can be reduced by about 40% by being physically active (PA).
▻ There appears to be a curvilinear relationship between PA & health, such that those individuals who are sedentary or get minimal PA benefit significantly from relatively modest increases in PA and physical fitness in terms of improvements in health status.
Resources
1. American Council on Exercise. (2019). The Professionals Guide to Health and Wellness Coaching, 286.
2. Bray, M.S. et al. NIH working group report-using genomic inflammation to guide weight management: From universal to precision treatment. Obesity (Silver Spring), 24, 14-22.
3. Pigeyre, M. et al. (2016). Recent progress in genetics, epigenetics & metagenomics unveils the pathophysiology of human obesity. Clinical Science (London), 130, 943-986.
4. Karam, J.G. & McFarlane, S.I. (2007). Secondary causes of obesity. Therapy, 4, 5, 641-656.
5. Li, S. et al, (2010). PA attenuates the genetic predisposition to obesity in 20,000 men & women from EPIC-Norfolk prospective population study. PLoS Medicine, 7,8, e1000332.
6. American College of Sports Medicine (2018). ACSM’s Guidelines for Exercise Testing & Rx (10th ed.). Philadelphia: Wolters Kluwer.
7. Original photo, flower from Lewis Ginter Botanical Garden, Richmond, Va
Holistic Statistic #7: Hypertension
21/04/21
▻ In 2017, the American College of Cardiology (ACC) & the American Heart Association (AHA) released new guidelines for managing hypertension.
◆ In these guidelines, they changed the definition of hypertension from a blood pressure (BP) of:
≥140/90 mmHg to ≥130/80 mmHg.
▻ It is important to note that the majority of these new patients can be treated with lifestyle changes instead of medications, with the biggest impacts coming from changes in diet & exercise.
◆ There is sufficient evidence showing that psychological stress is a primary risk factor for hypertension.
▻ As a result of this evidence, national hypertension guidelines recommend psychosocial intervention as a means to prevent or delay the onset of hypertension.
Resources
1. Whelton, P.K. et al. (2017). 2017. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaltuation, and management for high BP in adults: A report of the ACC/AHA Task Force on Clinical Practice Guidelines. Journal of the ACC, Nov 7. Pii: S0735-1097 (17) 41519-1.
2. Ioannidis, J.P. (2018). Diagnosis & treatment of hypertension in the 2017 ACC/AHA guidelines in the real world. Journal of the American Medical Association, 319, 115-116.
3. Ushakov, A.V., Ivanchenko, V.S., Gagarina, A.A. (2016). Psychological stress in the pathogenesis of essential hypertension. Current Hypertension Reviews, 12, 3, 203-214.
4. Chobanian, A.V. et al. (2003). Joint Nat’l Committee on Prevention, Detection, Evaluation, & Treatment of High BP. Nat’l Heart, Lung & Blood Institute, Nat’l High BP Education Program Coordinating Committee. 7th report of the Joint Nat’l Committee on Prevention, Detection, Evaluation, & Treatment of High BP. Hypertension, 42, 6, 1206-1252.
5. Original photo, walking through Honolua Bay forest, Maui
Holistic Statistic #8: Sedentary Lifestyle
28/04/21
▻ Traditionally, the term sedentary has been defined as the absence of physical activity (PA).
◆ However, sedentary behavior has evolved to include prolonged sitting. Many adults in Western & developed countries are in occupations that require prolonged sitting. Evidence suggests that these working adults spend half of the workday sitting down.
▻ The high incidence of prolonged occupational sitting among full-time workers has prompted investigations into the association between prolonged sitting & health status, even in individuals who exercise regularly.
◆ Healy & colleagues (2011) found that prolonged periods of sedentary time, even in people who also performed moderate-to vigorous-intensity exercise, were associated with indicators of declining cardiometabolic function & increased systemic inflammation.
▻ The researchers also found that, even in people who sat for prolonged periods, the more breaks workers took during this time, the smaller their waists & the lower their levels of C-reactive protein *.
◆ Further, Keeling, Buchanan & Dalleck (2017) found that low-intensity movement interruptions (i.e., 5 mins. of 2 MET* movements) each hour was enough to drive important health improvements in sedentary workers.
Resources
1. Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure & sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56, 2655-2667.
2. Jans, M.P., Proper, K.I., Hildebrandt, V.H. (2007). Sedentary behavior in Dutch workers: Differences between occupations & business sectors. American Journal of Preventive Medicine, 33, 450-454.
3. Healy, G.N. et al. (2011). Sedentary time & cardiometabolic markers in U.S. adults: NHANES 2003-06. European Heart Journal, 32, 590-597
4. Keeling, S.M., Buchanan, C.A., & Dalleck, L.C. (2018). What is the optimal FIT of sedentary interruption bouts to improve cardiometabolic health? Journal of Exercise Physiology, 21, 2, 1-18.
5. Original photo, Rafting on the Colorado River
*C-reactive protein: an important marker of inflammation
*MET, Metabolic Equivalent: Simplified system for classifying PA, 1 MET = resting O2 consumption,
2 MET ≈ Walking slowly around office, standing while performing light work
Holistic Statistic #9: Socioecological Model
05/05/21
▻ While maintaining a healthy lifestyle through behavior modification & increasing access to healthcare by reforming the healthcare delivery system are necessary to improve health at an individual level, research shows that improving health at a population level & achieving health equity can happen only if the social, economic, & environmental factors that influence health are properly addressed.
◆ Health starts in homes, schools, workplaces, neighborhoods, & communities. In other words, place matters. In fact, some have argued that a person’s zip code is the most influential determinant of health.
▻ An ecological perspective* has been adopted to understand the multiple influencers on an individual’s health status, including social determinants of health as well as an individual’s knowledge, attitude, cultural beliefs, & values.
◆ Addressing social determinants of health* is necessary for achieving health equity. Research has consistently identified that differences in health outcomes are associated with variations in populations regarding race, ethnicity & income.
▻ According to the U.S. Department of Health & Human Services, health disparities are “differences in health outcomes that are closely linked with social, economic, & environmental disadvantage.
Resources
1. Heiman, H.J., & Artiga, S. (2015). Beyond Healthcare: The Role of Social Determinants in Promoting Health & Health Equity. www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
2. Larson, N.I., Story, M.T., & Nelson, M.C. (2009). Neighborhood environments: Disparities in access to healthy foods in the US. American Journal of Preventive Medicine, 36, 1, 74-81.
3. USDHHS. (2016). Health Information Privacy. www.hhs.gov/hipaa/index.html
4. Glanz, K., et al. (2008). Health Behavior & Health Education: Theory, Research & Practice. San Francisco: John Wiley & Sons.
*Social Determinants of Health: the structural determinants & conditions in which people are born, grow, work, live & age
*Ecological Perspective: a perspective on health/health behaviors that examines interpersonal & environmental influences/factors along with the dynamic interplay among them
Holistic Statistic #10: Depression
12/05/21
▻ Positive reinforcement feels good to everyone, but depression & chronic stress often develop when opportunities for positive reinforcement have become sparse.
◆ Goal setting in the context of depression, anxiety, or chronic stress can be particularly effective when it involves selecting goals that are connected to the client’s values.
▻ One study found that a Facebook group that helped increase physical activity in cancer survivors resulted in increase in both physical activity & social support.
Resources
1. Lejuez, C.W. et al. (2011). Ten year revision of the Brief Behavioral Activation Treatment for Depression (BATD): Revised treatment manuel (BATD-R). Behavior Modification, 35, 111-161.
2. Valle, C.G. et al. (2015). Exploring mediators of physical activity in young adult cancer survivors: Evidence from a randomized trial of a Facebook-based physical activity intervention. Journal of Adolescent and Young Adult Oncology, 4, 26-33.
Holistic Statistic #11: Diabetes
19/05/21
▻ About 5 to 10% of people have Type 1 Diabetes, which equates to around 1.25 million American children & adults.
◆ More than 90% of people who have diabetes, have Type 2 Diabetes, which is largely related to lifestyle habits that promote insulin resistance & inflammation that lead to hyperglycemia, such as sedentary lifestyle, excess caloric intake, & nutritional deficiencies.
▻ While many women go into pregnancies with pre-existing diabetes, women without diabetes can develop Gestational Diabetes during pregnancy if their blood glucose levels rise above normal during the 2nd or 3rd trimester.
◆ If a woman has given birth to a baby weighing 9 lbs. (4 kg) or more, then she likely experienced Gestational Diabetes during her pregnancy, whether she was aware of it or not.
▻ Estimates suggest that 38% of American adults have Prediabetes.
◆ With over 84 million Americans with Prediabetes at risk for developing Type 2 Diabetes, there is a great need for intervention to prevent more cases of diabetes from occurring.
Resources
1. American Diabetes Association (ADA) (2017c). Children & Adolescents. Diabetes Care, 40, S105-S113.
2. ADA (2017b). Classification & diagnosis of diabetes. Diabetes Care, 40, S11-S24.
3. American Council on Exercise (2019). Gestational diabetes mellitus. The Professional’s Guide to Health & Wellness Coaching, 369.
4. Menke, A. et al. (2015). Prevalence of & trends in diabetes among adults in the U.S., 1988-2012. Journal of the American Medical Association, 314, 1021-1029.
5. CDC (2017). Nat’l diabetes statistics report: Estimates of diabetes & its burden on the U.S., 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
6. Original photo, Honolua Bay flower
Holistic Statistic #12: Cancer
27/05/21
▻ The Greek carcinos/carcinoma & Latin, cancer, are all words used to describe “crab.”
◆ From a medical perspective, the origin of the term cancer is rooted in the observations by Greek physicians Hippocrates (460-370 BC) & Galen (130-200 AD), among others, that certain tumors with swollen veins looked similar to crabs.
▻ Cancer is one of the leading causes of morbidity*/mortality worldwide & was responsible for 8.8 million deaths in 2015, with a global death toll of nearly 1 in 6.
◆ The cause of cancer is complex & linked to many factors, such as environmental exposures, lifestyle practices, medical interventions, viral infections, genetic traits, gender & aging. It is estimated that around 30% of deaths from cancer are due to the 5 leading behavioral & dietary risks:
· High body mass index (BMI)
· Low consumption of fruits & veggies
· Physical inactivity
· Tobacco use
· Alcohol intake
▻ Traditionally, cancer was thought of as a disease associated with weight loss because patients undergoing treatment were often among those with late-stage cancer. The treatments tended to leave them with significant untreated nausea & vomiting, which led to decreased weight.
◆ In contrast, patients with cancer now are being diagnosed at earlier stages when the treatments are more effective & larger numbers of people have overweight or obesity at the time of diagnosis.
Resources
1. American Cancer Society (2017a). Early History of Cancer. https://www.cancer.org/cancer/cancer-basics/history-of-cancer/what-is-cancer.html
2. World Health Organization (2017). Cancer Fact Sheet, February 2017. http://www.who.int/mediacentre/factsheets/fs297/en/
3. Pekmezi, D.W. & Denmark-Wahnefried, W. (2011). Updated evidence in support of diet & exercise interventions in cancer survivors. Acta Oncology, 50, 167-178.
*Morbidity: the disease rate, ratio of sick to well persons in a community
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