Book: “A Roadmap to Better Health”

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A new book by Arizona State University and Mayo Clinic health experts outlines focuses on behavior to improve the health of citizens of this country. The authors of “A Roadmap to Better Health” say that chronic conditions such as heart disease and type-2 diabetes result mostly from behaviors and lifestyle choices in diet and exercise. Dr. Denis Cortese, director of ASU’s Healthcare Delivery and Policy Program, and Robert Smoldt, CEO Emeritus of the Mayo Clinic, will tell us more about their book.

TED SIMONS: A new book by ASU and Mayo Clinic Health experts focuses on behavior to help fight type 2 diabetes, heart disease, and other chronic conditions. The book is titled, "A Roadmap To Better Health," and it emphasizes lifestyle choices, diet and exercise. Dr. Denis Cortese, director of ASU's Healthcare Delivery and Policy Program and Robert Smoldt, CEO Emeritus of the Mayo Clinic, are among the book's co-authors. Thanks for joining us. Road map to better health. What are we talking about here?

DENIS CORTESE: Well, this road map is to help people focus on one or two things that they can do to improve their health themselves. And the reason we undertook this book is that from the standpoint of health, we have to recognize that the healthcare delivery system has very little to do with health. It has very little to do with health. Health has much more to do with personal behaviors, genetic factors, social circumstances as well as their financial situation, too, and their education level.

TED SIMONS: Before we get too far down the road, define health.

ROBERT SMOLDT: What we're talking about is your wellbeing over your lifetime. And I got interested in this about 10 years ago. So here I am with Mayo clinic on the panel. And somebody on the panel, we're talking about improving healthcare delivery, somebody on the panel says which of these would do the most to improve our health over our lifetime, the president of the United States, Congress of the United States, CEO of your insurance company, CEO of the hospital or all of us individually? And his answer was all of us individually. The personal decisions we make and we all know what they are, it's eating healthy, good exercise, moderation in many things is the secret.

TED SIMONS: And I know that in your report, low physical activity, high calorie world, that's the challenge, isn't it?

DENIS CORTESE: It is and when you look at the key, if we look at behaviors as having a major impact on overall health that a person can control, it's a 40% to 50% impact on health, when you look at the key elements within that behavioral environment, it's tobacco, it's weight, obesity, and physical activity. And of that group the thing you can do the most control is physical activity and it turns out, which is really good news is that any degree of physical activity improves your overall health regardless of your other problems.

TED SIMONS: I was going to say, exercise -- exercise is becoming increasingly thought of as a bit of a panacea, isn't it? It really works wonders.

ROBERT SMOLDT: I don't think it's a panacea but it definite helps and if there was one thing that we would recommend, where would we concentrate on? And we went with physical activity, which again to me is different than necessarily exercise.

TED SIMONS: Explain.

ROBERT SMOLDT: It's walking, going out, doing a variety of things. And it's amazing how many people get practically none anymore. Some people used to get more in your work but now, we've got office jobs and so the key is how can we build in nudges so that people will actually get more physical activity? And just to give you an example of one. Dr. Cortes at his desk is basically a treadmill. It goes very slowly because he doesn't like to run too fast.

But you actually get physical activity and it helps. Has standup meetings every half-hour, stand up, move around, and it's amazing what it will do for us.

TED SIMONS: And we also hear that some of this high-interval training exercise even for those of us who aren't as young as we used to be, this makes a difference, too.

DENIS CORTESE: The high-intensity does? Oh, yes. High-intensity would do it but the message we're trying to get across is that if everyone just focused on increasing activity, that's how we built down to this, and then also what can we do to help people focus on increasing their activity? And you can do that when you think about environmental nudges that we can, we think about economic nudges that we can do to get people rewarded for doing some things and at the educational level, exercise back in schools, absolutely needed. But we have employers, such as ASU and I heard just last week that the public libraries in Phoenix are going to be installing standup desks, just standing up and reading gives you a little more activity.

TED SIMONS: We've got exercise recovered and in the report, physical activity absolves other sins, it may not be a panacea but that's pretty close. Let's get to diet. I don't think I'm alone in thinking there's so much conflicting information about diet, what's good for you, what's not good for you, what we're eat, what you should eschew, what do we make of this?

ROBERT SMOLDT: I think you're absolutely right. As we have stated in the book, moderation is a big part of the key in this, especially with diet. The other thing is we found that it doesn't make any difference so much which diet you're going to follow, but that you stick with the diet. And so being able to not just do it for a week or so or a month but to stick with it.

TED SIMONS: Does that make sense to you? What if I'm on the so and so diet and the such and such diet would be much better for me. Should I stick with the so and so diet?

DENIS CORTESE: Yes, and actually there is no one diet that is better for any particular person, unless you have diabetes or a condition that you have to watch what you eat. The real key is the physical activity and sticking with the diet and the physical activity is the most important thing because for people who have a BMI over 25, a body-mass index, over 25 is when you're getting into the overweight category, over 30 is in the obese category. Even those groups of people when they are exercising and they've demonstrated just walking, 30 minutes a day on a continuous basis, their health improves. So even without losing the weight or changing anything else, just being active every day, treadmill desk, getting up and walking around, employers are learning and in schools it's very clear, kids learn better when they're active.

TED SIMONS: As far as diet, what kind of nudge to action are you looking at as far as diet is concerned?

ROBERT SMOLDT: We've got some financial ones that have actually worked, and I think we're better than education, I'll give you my own personal view.

TED SIMONS: Which ones do you think work better?

ROBERT SMOLDT: Here's one that Safeway has used in the past. So if you are overweight by a certain body mass index, you're going to pay more for your healthcare premium from Safeway. Then at the end of the year, if you have your weight back in normal limits, they rebate to you that amount that you paid extra. And guess what? I don't remember the percentage we actually have it in the book, there's a reduction, and so it's a bigger reduction in the people who are overweight and they did this for other conditions, the percentage of people who are smoking and smoking and weight were the toughest but with blood pressure and cholesterol, that's where they had the biggest reductions in people who were at risk from a financial incentive. So there are not just educational incentives, there are financial and other nonfinancial ones that can occur, too.

TED SIMONS: And that sounds like the carrot. Let's get to the stick here, things like sin taxes make sense to you?

DENIS CORTESE: You can make a strong argument for it. The sin taxes have been discussed in the past. When it comes to sugary drinks, when you look at sugary drinks that you can buy in the store. Every one of those has 11 grams of sugar in them per ounce. The difference is the size of the drinks have changed. They used to be quite small and they're bigger. It's the moderation part. It's not that you have to cut it out totally. But just being moderate in what you do so people have suggested sin taxes and there's no question that negative incentives do work also.

TED SIMONS: Yes, but people are still smoking, they've cut it down but there's still a sizable number of folks who smoke.

ROBERT SMOLDT: But have you looked at the reduction? We have made progress. We aren't where we need to be and my guess is we never will be exactly where we want to be but there has been significant progress and the data shows that to the intent that you increase that sin tax, you do get a further reduction in smoking.

TED SIMONS: I guess there's a tipping point to that isn't there for the sin tax? You can only go to a certain extent.

ROBERT SMOLDT: Exactly.

TED SIMONS: Last question before we let you out of here, what do you want this to accomplish? What do you want the book to accomplish, the report, the study?

DENIS CORTESE: To let people know it's in their control much more than anybody else realizes. This has got to be the people being motivated to do it and two that the rest of the community should build a milieu that allows people to be more successful in moderation and in physical activity.

TED SIMONS: All right. Gentlemen -- please go ahead.

ROBERT SMOLDT: I was going to say we're big on nudges and we think that employers, cities, they all have unique cultures and they should come up with innovative ways to get nudges that will work in their community or in their place of employment.

TED SIMONS: Interesting stuff, good to have you both here.

Dr. Denis Cortese:Director of ASU's Healthcare Delivery and Policy Program,Robert Smoldt:CEO Emeritus of the Mayo Clinic

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