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.

Nutrition – Part 1: What to eat

Ahh, nutrition – probably one of the most debated areas on the Wheel of Health. There is so much that can be written about eating a “healthy diet” but given that the recommendations seem to change daily, where does one start? Eggs are bad for you. Whoops, now they’re good for you! Eat low fat foods. Nope, now you need healthy fats. No wonder so many people are confused and frustrated – and therefore, reach for the quickest, most convenient thing they can eat regardless of its nutritional value. Who has time to figure it out, right?

Let me start by stating that I do not have a degree in nutrition and I am not a registered or licensed dietician so I will not be dispensing any specific dietary advice. My goal with this post is to help weed through much of the conflicting information out there and present some basic guidelines that most of the experts do agree on when it comes to the food we put in our bodies. I am of the firm belief that everybody – and every BODY – is unique and thus, what works for one person will not work for someone else. The bottom line is choosing foods that nourish and strengthen your body and mind.

What the experts say

It’s probably no surprise that even the experts can’t agree on what specific diet is best for us. However, in a review of the health benefits of many popular diets (think low fat, low carb, vegan, Mediterranean, paleo and so on), there were a few general patterns that rose to the top. In a nutshell, they include:

  • Eat minimally processed foods direct from nature
  • Eat mostly plants
  • If eating animal foods, choose ones that were raised on plant foods

(Of note, the authors point out that these dietary guidelines are beneficial not just to humans, but other species as well as the environment around us. A win-win-win if you are equally concerned about animal welfare as well as the impact of farming on the earth.) The well-known author/journalist Michael Pollan wasn’t too far off when he summed it up in seven words: “Eat food, not too much, mostly plants.” And to clarify, he meant eat real food like vegetables, fruits, whole grains, fish and lean meat. Or as he so simply states it: Don’t eat anything your great-grandmother wouldn’t recognize as food.

Some small steps to get started

I know what you’re probably thinking – easier said than done, especially if you work full-time, have a family to take care of and don’t want to (or can’t) spend hours focused on planning and preparing healthy meals! The good news is that it does not have to be hard. There is a plethora of resources available for anyone who is looking for a little help in this arena. I have listed a few of my personal favorites near the bottom of this post, but here are a few simple guidelines to help you get started:

  • Reduce the amount of processed foods you eat, which is pretty much anything that comes in a box or package with a food label on it. And if that food label has more than 5 ingredients or a bunch of ingredients you can’t pronounce, put it back on the shelf.

 

  • One way to help reduce the amount of processed foods you eat is to avoid the middle aisles at the grocery store as that is where most processed foods are found. You may already be familiar with the advice to shop the perimeter of the store, where most of the fresh foods are located (e.g., produce, fresh meats). Good advice and a great place to start.

 

  • Many of us could benefit from increasing our fruit and vegetable intake. Both the USDA MyPlate and the Harvard Healthy Eating Plate recommend that half your plate at meals consist of healthy fruits and vegetables (unfortunately, potatoes and French fries don’t count). There are so many choices when it comes to produce – experiment and find what works best for you, whether it is munching on raw veggies as a snack, drinking a fruit smoothie for breakfast, or adding a salad of leafy dark greens as a mainstay of your lunch and dinner. Even the pickiest of eaters can find a few fruits and veggies that they like.

Resources to help you take a deeper dive

As someone who is responsible for the bulk of meal planning and grocery shopping for my family, I understand that it may feel daunting to figure out how to put these recommendations into action. Thus, I have compiled a few resources that have really helped me in this arena. As I mentioned earlier, everyone is different so these may or may not work for you, but I pass them along as food for thought (pun intended).

There are many books and websites out there related to the “real food” movement, but one of my favorites is 100 Days of Real Food by Lisa Leake (the website and the related cookbooks). The reason it resonates with me is because it is a real family that made a pledge to reduce – or actually, eliminate – the amount of processed foods they ate and they were successful, even with two young children. My family has not yet taken the plunge to completely eliminate processed foods, but we have been inspired to reduce the processed foods in our diet and cook and eat more real, whole foods. I have one of Lisa’s cookbooks, which has many simple, healthy recipes (a key for me as I am not all that confident in the kitchen). Her website is also chock full of healthy recipes and meal plans for those who need a little extra help in the kitchen.

Given that my family’s quest to eat a truly healthy diet is still a work in progress, and we stumble from time to time with less than optimal choices, I have found comfort in the “good-better-best” approach when it comes to decisions about what to eat. I am not sure who gets credit for this principle, but I found a neat infographic on the Weed ‘Em and Reap website. In essence, this approach is about “doing the best you can with what you have” – which is all we can really ask, right? Maybe you’ll never live in the “best” column, but if you can make some small changes that bump you from bad to good or good to better in a couple of the food areas, that is reason to celebrate. Every little bit helps.

Finally, if you feel overwhelmed by the time and effort you think it might take to implement changes in your diet and seek a supportive community to help you on this journey, you may want to look into The New School Kitchen, or NSK as we members like to call it. The New School Kitchen is an interactive, video-based monthly membership program designed to help you “rock your cooking and eating without hating your family or life” as owner/creator Ryanna Battiste describes it. I have been a member since NSK was launched in August 2016 and it has been a huge help with meal planning and meal preparation centered around eating tasty, healthy real food. Members have access to everything from meal planning tips to healthy recipes to cooking demonstration videos. There is also a private Facebook group where members can ask questions, share resources and support one another along this real food journey. Most recently, the NSK has added the option of working with a health coach either individually or as a group. The beauty of the NSK is that it is self-paced – you determine when and how to engage and work at whatever pace suits your needs. Membership is only $21/month and you can cancel your subscription at any time.

(Note: In the spirit of full disclosure, Ryanna is a fellow Certified Integrative Health Coach – we did our training together at Duke Integrative Medicine. However, I am not getting compensated to promote NSK – in fact, she doesn’t even know that I am mentioning her business in this blog post. I hired Ryanna as my coach a couple of years ago when I decided to work on reducing dairy in my diet after years of suspecting that I had an intolerance. I can personally vouch for her integrity, wisdom and professionalism as a health coach. She is an amazing woman and to me, has created one of the most innovative approaches to healthy eating with The New School Kitchen. She is also just a ton of fun to watch in her videos as she’s not afraid to be real and share the ups and downs of her own real food journey.)

Whew, that was a lot to cover! Next time, we’ll move beyond what to eat and focus on how to eat – mindful eating, one of my favorite subjects!