A Do a Day Keeps the Doctor Away
Just a new and simple behaviour may have marked health benefits…
Posted Jan 06, 2014
In December 2013 a couple of new research studies were published which provide compelling medical evidence for the benefits of making very small changes in behaviour.
On December 17th a team led by Peter Scarborough from Oxford University published research in the BMJ that asked if the 150 year old adage “An apple a day keeps the doctor away” had any relevance in today’s high tech medical world. They measured vascular mortality rates for such things as cerebrovascular and ischaemic heart disease, heart failure and aortic aneurisms. They compared the health benefits of eating an extra apple a day with having a daily dose of statins (a commonly used drug for reducing cholesterol). Statins are effective drugs that reduce vascular mortality by about 12%. They concluded that the annual number of vascular deaths that would be averted or delayed by eating one additional piece of fruit would be of the same magnitude as having statin pills, and without any of the side effects of statins (e.g. myopathy, diabetes diagnoses).
So, eating an extra piece of fruit each day—whether or not statins are also taken—would be an effective and non-medicalised intervention. It would not require a big change in ‘lifestyle’ either. The question remains as to whether people would do it. Other research suggests not, but I will come back to this issue later.
Another longitudinal study, spanning 30 years, by Peter Elwood and his team from the UK was also published in December 2013. It compared the health benefits of five simple behaviours on men’s health: not smoking, moderate alcohol intake, eating fruit & vegetables in the diet, taking regular exercise and keeping trim (a body mass index of 18-25).
Perhaps the most astounding result was the very low rates of these healthy behaviours in the population studied. Fewer than 1% of the men adopted all 5 behaviours, and fewer than 5% had at least 4. The researchers had to reduce the criterion for healthy fruit and veg intake from 5 to only 3 portions/day because only 15 of the 2,235 men ate 5 or more.
The results showed a clear pattern. The simple lifestyle behaviours contributed enormously to health. The more of the healthy behaviours that were followed the better the outcome for all illness, other than cancer (which did show the expected association with smoking). For example, for vascular disease, the delay in vascular events from engaging in these healthy behaviours was up to 12 years. There was also a 50% reduction in diabetes, and a 60% reduction in all-cause mortality. This study was the first of its kind to include cognitive decline and dementia rates, as well as the more usual chromic diseases. The study showed that the simple lifestyle behaviours contributed to a 60% reduction in cognitive impairment and dementia (see my previous blog about the potential of Do Something Different for staying younger for longer)
The importance of simple changes in lifestyle is also shown by other large US and European studies, as pointed out by the authors, including a 61% reduction in diabetes from lowered body mass alone, and an 85-87% reduction in heart disease and coronary events in those who adopt all 4-5 healthy behaviours. This can equate to many years living—in the European study it was about 14 years extra.
So it seems that the adoption of even one simple new behaviour may improve well-being and mortality risk. All very interesting you might say, but ‘so what’? People don’t change, do they? You might remind me about my own ‘Fletcher’s Law’ (in my book Flex: Using the Other 9/10ths of Your Personality) which states that 90% of people will not make small changes to their lifestyle, even when the health stakes are very high. You are right. Very few of the men in the study by Elwood, for example, adopted the healthy behaviours despite 30 years or more of expensive health education campaigns by government.
In a 2014 paper in the journal Perspectives in Public Health, Karen Pine and I have discussed this problem. The government attempts to change health behaviour range from providing information, incentives and overt persuasion, to regulatory measures. We argue that it is not information deficit that usually prevents people adopting new simple healthy behaviours. Generally speaking the majority of people do not lack knowledge about how to live a healthy life. They do not need educating about health. Moreover, once educated, they do not act in their own best interests. Willpower does not really exist as a useful resource for change for most people in most situations, despite the apparent attractiveness of the concept.
Instead of trying to fill some ‘information deficit’ we believe, lifestyle and behavioural change needs to focus on the ‘doing’ channel, instead of the thinking channel. This is what Do Something Different does. The Do Something Different behaviour change technique disrupts the habit chains that exist in daily living and gives the individual the chance to do what they want and need instead of what the automatically do. Only then can actions and knowledge become properly integrated and life take on a coherence that may otherwise be lacking.
Elwood, P., Galante, J., Pickering, J et al (2013) Healthy lifestyles reduce the incidence of chronic diseases and dementia: Evidence from the Caerphilly Cohort Study. PLOS One, 8, 12, e81877
Briggs, A., Mizdrak, A. & Scarborough, P. (2013) A statin a day keeps the doctor away: A comparative proverb assessment modelling study. BMJ, 2013 BMJ 2013;347:f7267
Pine, K. & Fletcher, B. (C) (2014) Time to shift brain channels to bring about effective changes in health behaviour, Perspective in Public Health, in press