Some observations on health overseas

My family and I just returned from a short vacation over in London. I was struck by a number of health- and wellness-related observations I made while abroad, so I thought I would share them while still fresh on my mind (fortunately, the jet lag hasn’t been too bad). As promised back when I started this blog, I’m stating up front that these are just my anecdotal observations. Not evidence-based but interesting nonetheless – or at least I hope you think so!

So many steps

I think I broke my Fitbit record for steps this past week – yahoo! Here in the US, I typically struggle to get 10,000 steps before I go to bed at night – and that’s with my 30-60-minute workout each day. In London, I was easily at 10,000 steps before midday tea every day except our travel days. Even with hopping the “tube” around town to visit various sites, there was still a ton of walking to be done. Most of the Underground stations had several flights of stairs or escalators to get to street level. In one older station, the elevators (or “lifts” as they like to call them) were out of order so we had to take the stairs – 193 in total, equivalent to 15 stories (or so said the lovely British woman on the PA system as she broke the news to travelers). I felt the burn that day!

The amount of walking we did in London got me thinking about our life – and lifestyle – here in Raleigh. While sight-seeing in London, we didn’t bat an eye at walking a mile to the next tourist attraction. It just seemed natural and most of the time, quicker than trying to catch the nearest tube. Yet, I realized the movie theater we frequent here in town is about a mile from our house…and we rarely walk to it, even in beautiful weather when we have plenty of time. There’s really no excuse – there are sidewalks almost the whole way and crosswalks at the “busiest” intersections, which really aren’t busy at all when I put it into perspective. We’re just so used to the convenience of our cars. I understand the argument that US suburbs are nothing like high density cities such as London, but bottom line: a mile is a mile. If we can walk it over there, we can walk it over here. I’m going to nudge my family in that direction next time we have plans to catch a flick.

Size matters

Another thing I noticed, particularly as we were riding the subway, was the noticeable lack of overweight and obese individuals. Sadly, the ones we did see often had American accents. I’m guessing that all of that walking around helps the natives manage their weight, as I also noticed the scarcity of gyms and fitness centers around the city. There were some scattered here and there, and I definitely saw women dressed in athletic wear, often carrying yoga mats. But nothing like here where you’ll often find two or three gyms within a mile radius.

Something else my husband pointed out when we were getting coffee near our flat was the distinct lack of choice when it came to cup sizes. In many shops and restaurants where we dined, there was one size and I would say it was on the smaller side compared to back home. I think the coffee cup at our favorite shop was about 12 ounces – not too big, not too small. The business decision behind the cup size was probably more cost-related than health-related, but I imagine it helps keep calorie counts down as well. At most of the nicer restaurants where we ate, the beverage glasses were definitely smaller than those at restaurants here in the states. Prices seemed lower too, even with the British pound to American dollar conversion. Smaller sizes, lower prices – a win-win in my book.

Up in smoke

Lest you think I believe London has a leg up on all health- and wellness-related matters, let me say that they seem to be lagging behind the US in their tobacco cessation efforts.  Although most restaurants and shops were smoke-free inside, smoking was allowed when dining outside, much like it is here in the US. I also saw people smoking regular and e-cigarettes quite frequently while we were sight-seeing. It was rather frustrating to be walking along the Thames River on a beautiful day when suddenly you find yourself trapped in a cloud of vapor emanating from the person in front of you. I did see the usual no smoking signs in public places, but I did not see many anti-smoking messages like we have here in the states.

Media fast

One thing that struck me once we were getting ready to come home was how happy I had been for the four days when I was essentially on a “media fast,” with limited access to news. Here at home, I usually read the Raleigh newspaper every morning and I have two news apps (one local and one national) that I check regularly throughout the day. I didn’t pick up a newspaper once while we were gone. We had a TV in the flat we rented but flipped it on only a few times when we were still adjusting to the time change and needed to just chill out before going to bed. We had chosen to do the “pay as you go” travel plan for our cell phones and thus, limited ourselves to one “activated” phone per day. Even on the days when it was my turn to have cellular turned on – and despite having access to free WiFi almost everywhere we went – I did not have the urge to check on the news like I do back home.

Maybe it was a matter of trying to be truly disconnected from the world, so I could enjoy my vacation, but it made me realize that I can survive (and thrive, really) without the constant need to know what’s happening around me. I pride myself to some extent with being an informed citizen who stays abreast of current events, but to be honest, I’m more often overwhelmed by the sense of information overload I experience when trying to take it all in. I think this vacation demonstrated that being tuned out now and then is not the end of the world and leads to more peace of mind than being in the know every minute of the day. I’m hoping I can continue my limited media exposure as I ease back into my normal schedule, now that I realize it’s better for my mental health.

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Know your numbers – but which ones?

It’s that time of year when many employers are strongly encouraging their employees to complete their biometric screening, typically as part of an employee wellness incentive program. According to the CDC, a biometric health screening is defined as “the measurement of physical characteristics such as height, weight, body mass index, blood pressure, blood cholesterol, [and] blood glucose…that can be taken at the work site and used as part of a workplace health assessment to benchmark and evaluate changes in employee health status over time.” Many organizations use this screening as a way to increase benefit offerings, improve employee health, and decrease health plan costs at the same time. Given the amount and variety of measurements involved in such screenings, making sense of the numbers can be challenging for many people.

I recently came across an article in the Washington Post written by a registered dietitian, who surveyed 20 experts in her field for their suggestions of which numbers are the most important when it comes to monitoring health. Interestingly, many of the numbers they believed to be most important are not even part of the usual biometric screening. For example, the first two recommendations focused on daily fruit, vegetable and fiber intake:

  • When it comes to a healthy diet, a simple method to use is the plate model, with appropriate proportions of fruits, vegetables, proteins, and grains. The rule of thumb is to fill half your plate with mostly vegetables and some fruit, which may be easier than trying to track how many servings of each you’ve eaten. Using this plate method can also help you get the recommended daily amount of fiber, which is 25-35 grams. Fiber is important for regularity, managing cholesterol and blood sugar levels, and prevention of certain cancers including colorectal cancer. It is also helpful in weight management as it keeps you feeling full for longer. Fiber-rich foods include most vegetables (the darker the color, the better), fruits, beans, nuts/seeds and whole grains.

The article did reference two of the typical biometric tests as being important for health management: fasting blood glucose (sugar) level and blood pressure:

  • The fasting blood glucose test is used to check for Type 2 diabetes and the goal is for it to be less than 100 mg/dL. These days, it seems more and more people are diagnosed with “pre-diabetes,” which corresponds to a blood sugar level of 100-125 mg/dL. The good news is that you can often reverse the effects of Type 2 diabetes (and pre-diabetes) through eating a healthy diet and exercising regularly. Therefore, it’s important to conduct this test at least annually to monitor your blood sugar level so you’ll be able to make necessary lifestyle changes to prevent or reverse a diagnosis of diabetes.

 

  • High blood pressure is commonly referred to as the silent killer because it often has no clear symptoms. However, if untreated, high blood pressure can lead to a heart attack or stroke. Therefore, it’s important to monitor your blood pressure regularly so you can seek treatment if necessary. This measurement is more important than ever as new guidelines from the American Heart Association lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. Previously, a measurement of 140/90 or greater was considered high. Now, the threshold has been lowered to 130-139/80-89 and even 121-129/<80 is considered “elevated” and an early warning that blood pressure should be lowered through non-medication approaches (primarily diet modification and exercise).

 

The author also addressed some measurements that she and her colleagues believe don’t matter as much when it comes to monitoring health. I agreed with all of them, but the one I want to address is body mass index or BMI, as there has been lively debate for some time now as to whether it is an accurate measure of health, particularly of obesity. As the author notes, BMI is a tool used to classify people into categories of normal weight, overweight or obese depending on height and weight. Individuals with BMI results in the latter two categories are often encouraged to lose weight by their healthcare provider and many are incentivized to do so through workplace wellness programs. However, BMI does not consider factors such as age, gender and bone structure, nor can it distinguish between muscle and fat. Thus, you can have a healthy, athletic person who exercises regularly but has a high BMI due to muscle mass. Or conversely, you can have a person with a normal BMI who does not eat well or exercise at all and is generally unhealthy. Going by BMI only, the athlete would be considered the obese or unhealthy one.

Scientists have recognized that what really matters is not body weight but body fat, and thus given the limitations of BMI, they now recommend a different measure for body fat/obesity: waist circumference. Measuring your waist to learn if you have abdominal obesity and excess visceral fat (fat surrounding your internal organs) is important as excessive fat inside the abdomen is a major contributor to cardiovascular disease. You have a higher risk of developing obesity-related conditions if you are:

  • A man whose waist circumference is more than 40 inches
  • A non-pregnant woman whose waist circumference is more than 35 inches

The one drawback to waist measurement is that it is more prone to errors than measuring height and weight. Click here to learn the proper way to measure waist circumference. It may also help to have a family member or a healthcare professional measure it for you, to be as accurate as possible.

There are numerous ways to measure and monitor your health and wellbeing. It’s important to look at a variety of screening test results to understand the complete picture of your health, but it’s also important not to get hung up on measurements that may not be all that accurate. I encourage you to discuss the options with your healthcare provider at your next physical or checkup so that together you can determine the best measures of your health.

On the Fourth, Put Safety First

Many of us are looking forward to July 4th, a day off to celebrate our nation’s independence and frolic in the summer sun. Whatever activities you have planned, please consider the following safety tips (courtesy of the American Red Cross) so you and your family can enjoy the holiday and remain safe while doing so.

Highway safety

Millions of people will travel by vehicle over the Fourth of July holiday. Follow these four rules to stay safe while driving:

  • Adults should wear seat belts and children should be in appropriate car seats at all times.
  • Observe speed limits and use extra caution in work zones or congested areas.
  • Do not drink and drive or operate a vehicle under the influence of other drugs.
  • Pay full attention to the road – pull over if you need to make a call or send a text.

Water safety

Many of you may be planning to swim and/or engage in other water-related activities. Here are a few ways to make water safety a priority whether at the pool, the beach, or your favorite watering hole:

  • Always swim with a buddy; do not allow anyone to swim alone.
  • Have young children and inexperienced swimmers wear a life jacket.
  • Obey all instructions and orders from lifeguards.
  • Always check weather conditions before going in the water, especially at the beach.
  • Be aware of the danger of rip currents. If caught in one, swim parallel to the shore until out of the current. When free, turn and swim toward shore. If unable to swim to the shore, call out for help, float or tread water until free of the rip current and then head toward shore.

Grilling safety

One of the best parts of the holiday is the yummy eats that are served up at backyard parties. Stick with these steps to safely cook up treats on a charcoal or gas grill:

  • Always supervise a grill when in use.
  • Never grill indoors – not in the house, camper, tent, or any enclosed area.
  • Make sure young children and pets stay away from the grill.
  • Keep the grill out in the open, away from the house, the deck, tree branches, or anything that could catch fire.

Fireworks safety

Perhaps the most exciting tradition on the Fourth: the bright, loud colorful displays that light up the night sky. The safest way to enjoy fireworks is to attend a public show put on by professionals. If fireworks are set off at home, please adhere to these safety steps to avoid serious injury:

  • Always follow the instructions on the packaging.
  • Keep a supply of water close by as a precaution.
  • Make sure the person lighting fireworks wears eye protection.
  • Never throw or point fireworks toward people, animals, vehicles, structures or flammable materials.

Don’t forget about sun protection

If we’re lucky, Mother Nature will cooperate and provide lots of sunshine this week, so we can enjoy the beautiful outdoors. However, the hot sun and high temperatures can also bring potential health hazards such as heat stroke. Watch for warning signs including hot, red skin; changes in consciousness; rapid, weak pulse; and rapid, shallow breathing. If you suspect someone is suffering from heat stroke, do the follow:

  • Call 9-1-1 and move the person to a cooler place.
  • Quickly cool the body by applying cool, wet cloths or towels to the skin (or misting it with water) and fanning the person.
  • Watch for signs of breathing problems and make sure the airway is clear. Keep the person lying down.

Check out my earlier post for additional tips on staying safe in the summer sun. After all, no one wants to have the fun cut short due to a nasty, painful sunburn, right?

I wish you all a safe, happy and relaxing Fourth of July!

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