The Greatest Risk Doing almost anything involves some risk. Even doing nothing can involve risk. What makes the important difference in how we manage the risks that we understand and live fulfilling lives despite risks that are beyond our control. Most live productive lives without obsessive fear of being hit by a meteorite except perhaps the one person in history known to have had that misfortune. In contrast, avoiding lightning by not taking cover under a tree is learned risk management. Fortunately, lightning is a risk most learn to manage without having to rely on a personal experience. Each day, in so many ways, we manage risk with learned experiences. Where most fall short in managing risk is when imperceptible short-term effects accumulate over time into debilitating chronic illness or premature death. Indeed, the ability to manage known long-term risks often makes the difference between maintaining our quality of life and becoming tangled in multiple chronic diseases later in life. Today, we have a pandemic of excess weight gain, sleep disorders, stress, and diabetes. Like the story of the frog slowly heated in a pot till cooked, few notice their creeping waistline until it has become an unignorable reality. Contrary to myth, a frog will jump when water gets too hot, unlike people that pack on pounds year after year until chronic illnesses set in. These extra pounds have consequences. In some populations, the prevalence of diabetes is 50%, with half of those affected likely to die prematurely from their diabetes-related complications. Some like to call the current diabetes/weight gain epidemic the black death of the 21st century as a way of calling attention to the magnitude of the health crises. In the 14th century, the problem was creeping unhygienic living conditions. While rats once took the rap, they have since been exonerated. Further analysis has revealed that human fleas and body lice were the most likely cause for the rapid spread of the plague called the black death. Today, creeping waistlines are the most common symptom of a new 21st-century ‘plague’ called diabetes. So, what can we do when over 85% of illness is attributable to the mismanagement of long term risk? For now, the choice is high medical cost for an aging population that is, in turn, driving insurance rates and government budget deficits to record levels or a solution that addresses the root causes. In the long run, changes in national food policy could eventually help by encouraging production of healthier foods and more meaningful education. For now, the best way to avoid the unfolding national pandemic is by self-education that guides lifestyle choices. Most go through life as if small choices have small consequences. When we discover the sum of small consequences adds up, the outcome disappoints us. For example, when there is a cancer diagnosis I expect two questions, “what caused it” and “how can it be cured?” Although the exact cause is usually unknown, the root cause is usually inherited genetics, the environment, the immune system’s ability to respond, or lifestyle. While the answer to ‘why’ can be difficult to pinpoint, most would like to believe it was through no action of their own. As you might guess, the preferred reasons are anything except lifestyle. The rationalization often goes something like this. Both my mother and older sister had this same cancer, so it was just a matter of time. While factors like genetics and environment can increase risk, more often the trigger is the accumulating effects over several decades from living a risky lifestyle. In these moments when life becomes uncertain, an appreciation that lifestyle may have been the root cause can be empowering. Also empowering is an understanding that even with a “miracle cure”, long-term remission from chronic illnesses and cancer will be problematic without a quality of lifestyle upgrade. If the thought of changing lifestyle as a hedge against 85% of the most common diseases seems like a good idea then let me nudge your thinking a little further toward the appealing benefits. As it happens, everyone has cancer. Fortunately, for most cancers, a healthy immune system promptly sweeps up the rogue cells before they become a problem. In contrast, an immune system under stress from a poor diet, poor physical condition, or toxins is less likely to respond. On a positive note, cancer is now far less of a concern due to the technology advances in fast food production which kills most with a heart attack or stroke before cancer can become an issue. So, now that you’ve guessed where this line of thought is going, let me share a few positive thoughts about managing health risk. The greatest risk most face comes from their lifestyle choices. What makes change difficult is a struggle between our present self and our future self. Our present self is relatively powerful. In the blink of an eye, it can pick up another doughnut. Our future self is not nearly so powerful unless we train it to more clearly imagine the future. For example, before reaching for the doughnut, you might picture yourself a decade from now in poor health and struggling to care for yourself and others that depend on you. When our future self is absent from the decision, our present self is in control and ready to trounces our dreams. A strategy for dealing with the dilemma of balancing our present self and our future self is offered compliments of Dan Goldstein in his Ted Talk, “The Battle Between Your Present and Future Self”. For physical fitness, there are three views of our future self that need to be brought into focus: cardiovascular fitness, strength, and flexibility. Often, the key to a successful plan is to identify something social and enjoyable. This could be as simple as meeting a friend at the gym, inviting a friend for a walk or joining a pickleball team. If you enjoy a sport then find a way to be more active in it. Perhaps the solution is looking beyond the usual for an opportunity to participate in soccer, softball, Ultimate Frisbee leagues, or group dancing. Walking with a friend is also a good exercise with social health benefits. For an especially delightful experience, try an early morning walk. For the summer months, an early morning walk offers the advantage of being cool, quiet and near free of flying insects. Perhaps you don’t see yourself as having time in the day for exercise. While that’s a pretty good sounding excuse, it’s not good enough. With 168 hours in a week, it’s unlikely that no time is available. Granted there may not be time to work out at a gym or time to drive across town to a special activity. With a bit of creativity, you will find near unlimited opportunity. With a couple of hand weights and a carpeted floor, you are set for an indoor workout that provides stretching and cardio. On a nice day, short walks or jog can be the answer. Still, the dilemma remains, how to find time when the real problem is that exercise is the last thing you want to do. While this is a timeless topic, covered by many, Laura Vanderkam reminds us that we do have the power to fill our lives with the things that deserve to be there in her TED Talk, “How to gain control of your free time.” A frequent excuse for not exercising is a lack of willpower when your favorite program is running or the urge to settle in for an extended Netflix fix. Whatever diversion is your weakness, you need not despair living a life on repeat if you apply what behavioral scientist Katherine Milkman discovered in an experiment at the Wharton School of Business. Half of the subjects were assigned to a group that got iPods loaded with absorbing audio books that they could only listen to at the exercise destination (gym, walking, etc.). The other half were given an equally valued gift they could use to buy a book. The result was in favor of the audiobook group exercising significantly more than the group that could pick up a gift for remembering to exercise. The point being, if you have an addiction to a particular media feed, then use that force as a pull toward your exercise location. Most programs can be recorded and played back while exercising. Where there is a will, there is a way to exercise and have fun at the same time. If you have trouble imagining yourself as a person in outstanding physical condition then you may have one more obstacle to overcome. Fortunately, this one is easy to deal with and only requires using the power inside you. If you have noticed top athletes pause before approaching their challenge then you already have a clue. Contrary to what some may guess, they are not worrying about the difficult challenge. They are engaged in visualizing success to come. This imagery is a mental rehearsal of what they want to be. While hardly a new idea, countless experiments have confirmed that a person's identity is affected by how they think about themselves. It’s a message past to us through time from great works like Proverbs which remind us, “as a man thinketh in his heart, so will he become.” If you face obstacles, don’t believe they are unmovable. Just close your eyes and vividly envision the future you want. Of course, don’t expect results to magically happen like it seems to when the Olympic high jumper pauses just before an amazing performance. Rarely does it happen that quickly. More likely, it will take many visualizations. Think of it as each visualization sending another reminder to the subconscious that a new plan is needed. In time our amazing minds can find the answer. That’s the mystery and the message of the proverb. Nancy Neighbors, MD Huntsville, Alabama |