Blog | Thursday, December 5, 2019

What health is for


All too readily in my world, health can masquerade as a moral imperative—the admonishment attached to a wagging finger and reproaching scowl. While there may be responsibilities wound up with health, for ourselves and one another, the main reason to pursue it is far more enticing. Other things being equal, healthy people have more fun. Health is for pleasure. This is perhaps especially noteworthy as the holiday season, with its inevitable blend of temptation, indulgence, and guilt closes in on us.

Health is for pleasure. The only real problem with that otherwise quite valid assertion is the potential for profligacy and excess. All pleasure must respect the limits of propriety and autonomy. So, for instance, perhaps it pleases me to swing a stick. My right to do so ends where your nose begins. All respectable pleasure honors such boundaries.

Perhaps, then, we might apply a related term, less prone to slippage on a slope toward decadence: quality of life. Health is for maximizing the quality of life.

This term offers many advantages, while preserving the main theorem. The quality of your life is informed by many factors, including pleasure, but perhaps others even more importantly: fulfillment, gratification, satisfaction, pride. These all borrow from pleasure and contribute to it as well, but are all distinct. Quality of life also passes the filter of medical legitimacy, having evolved into a term of that trade and a valid measure of outcome. More often than not, quality and time are commingled into “quality adjusted life years.” My routine user-friendly reworking of this is: years in life, and life in years; vitality conjoined to longevity. Health fosters both, by these or any other words.

This is more important than it seems, and directly relevant as you look for some balance between doing what you want to do, and doing what you think you should do. Should you eat, or resist, that dessert? Have, or decline, that mulled wine? Take, or decline, that hors d’oeuvre making the rounds?

When health is relegated to the abrasive realm of moral imperatives, these and many other holiday temptations (and, for that matter, temptations year round) are choices between what's right, and what's fun. But if within reason, maximizing “fun” is what doing what's right is for, it changes the equation.

More and more evidence favors the powerful, health-promoting effects of fairly modest, but consistent commitments. The evidence that sitting is harmful points toward a simple, potent, and for most of us quite easy remedy: stand, stretch, and walk around briefly throughout your standard day.

Recent evidence shows that running in even very modest doses is a potent defense against premature death. Don't despair if disinclined to run. Evidence suggests that just walking, exercise readily accessible to most of us, confers powerful health benefits.

As for eating, the weight of evidence, regarding weight, and every other outcome of importance, is comparably encouraging. Despite an obscuring fog of boisterous bickering, there is no one diet you must adopt to profit your well-being. There are many variants, albeit on a common theme, that empower us all to love the foods that love us back. Shop your options with that goal in mind.

There is no magical combination of foods you must maintain to maintain your weight; the latest and best evidence on that topic indicates, clearly and emphatically, that calories count above all. Don't count them, that's very tedious, but acknowledge their imperium by doing what you can to favor wholesome and simple foods, free of willful manipulation, while avoiding ultra-processed foods. Among the many virtues of the former, they fill us up on many fewer calories than the latter.

While the pop culture narrative about intermittent fasting is, inevitably, hyperbolic, implying some metabolic magic the research fails to reveal, there is a happy take-away from this tale nonetheless. Fasting periodically works as well for weight control as daily restraint, and thus provides an alternative tactic. The tactics that work best for you are … those that work best for you. So, options are a very good thing.

Blended, these and related tidbits of evidence and ingredients of argument come together in a rather lovely recipe. Almost all exercise is good exercise, and you will support your health just by making some movement part of your routine. The more the better for health, generally, but maybe not for net pleasure and quality of life. Some of us love exercise (I do), but some don't. Across the spectrum from love it to hate it, the optimal dose, intensity, and frequency that lead to the greatest net pleasure and quality of life vary. Only you can choose your sweet spot. You're the boss.

So, too, for food. An inveterate foodie is perhaps apt to be happier, truly happier, with culinary latitude and a somewhat larger waist to show for it. Conversely, a health and fitness fanatic would almost certainly favor more dietary asceticism in the service of stronger, faster, fitter, leaner. If the formula that maximizes quality of life varies with our dispositions and character, it is no health professional's place to impose a one-size-fits-all decree.

My whole career is about optimizing health, so of course I think it is important. But I recognize that health, per se, is not the prize. The prize is having the best possible life, and health matters so much because of the contributions it makes to that measure. But the pursuit of health can at times compete with other sources of pleasure, fulfillment, and fun, and at those times, there is a balance to be struck.

The holidays are, quintessentially, such a time. My advice is guilt-free holiday pleasure and a year-round commitment to health by the means that work best for you as one among your priorities. Not because someone says you should. Just because, other things being equal, healthy people really do have more fun.

David L. Katz, MD, FACP, MPH is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his Linked In page.