Blog | Thursday, June 22, 2017

Compression of disability should be everyone's health goal


What are you doing to maintain vigor as long as feasible? James F. Fries, MD, wrote a classic article in the New England Journal of Medicine, “Aging, Natural Death and the Compression of Morbidity.”

Dr. Fries argues that chronic disease is our foe; avoiding chronic disease allows us to wait longer until we develop morbidity. The ideal situation is excellent health until 90, then die in your sleep.

How do we do that? Unfortunately, some people develop chronic diseases that we do not know how to prevent. However, any physician will tell you that much chronic disease develops because of lifestyle choices. Here is my list of lifestyle choices that predispose to longer morbidity:
1. Smoking. This one is a “no-brainer”. Smoking has so many negative effects that we need a book to discuss the subject.
2. Excess alcohol. Modest alcohol probably helps, but too much alcohol can cause liver disease, heart failure, chronic pancreatitis and brain damage (and this list is probably incomplete).
3. IV drugs. Every time you inject a drug into your system you put yourself at risk for infection. Obviously you can overdose and die right then.
4. Increased waist circumference. I phrased it this way rather than BMI, because waist circumference is a more accurate measure of being overweight or obese.
5. Lack of movement. Yes, exercise delays much morbidity, thus we maintain vigor. Exercise can help in decreasing the risk of increased waist circumference, but it probably has other very important positive benefits. Some data suggest that exercise has a U-shaped curve; excess exercise may actually cause some problems (read the Haywire Heart)

I would love to have comments on other important lifestyle choices. Obviously driving recklessly, extreme sports and going to bars after midnight are bad ideas.

As a physician I advise these things, but my experience suggests that these choices are personal. Some people seem to not really care about the future. At age 68, still vigorous and exercising, I am very happy that I have made health choices. Perhaps going through medical school and residency showed me the “wrong path”, and thus I have avoided many health pitfalls.

Am I just touting my personal choices? That is possible, but for the younger readers I can assure that being vigorous in ones 60s is a great pleasure. I know too many peers and patients who suffer with prolonged morbidity.

I encourage all my friends and colleagues to exercise and live a healthy lifestyle. I understand that our freedom is based on choice. But those who make bad choices are guilty of indirectly abusing those who make good choices. We have too many people who still smoke, drink excessively, never exercise and make poor food choices. This creates a conundrum for health policy.

For the younger readers, you likely have choices to make over the next many years. Make good choices and you will benefit. Indirectly your peers will also benefit.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.