Promoting Good Health¶
Chapter 2 | Part 1: The Profession of Medicine · Part 1 – The Profession of Medicine · Chapter 2
Key Clinical Points¶
- Compression of morbidity via prevention strategies is the ultimate goal of health promotion.
- Life's Essential 8™ metrics include diet, physical activity, sleep, nicotine exposure, body mass index (BMI), blood lipids, glycemia, and blood pressure.
- Primordial prevention targets upstream determinants (e.g., socioeconomic factors, dietary habits) to prevent risk factor development.
- Routine health evaluations in asymptomatic adults show limited benefit for total mortality and mixed evidence for specific mortality.
- Sedentary time has adverse health consequences independent of physical activity levels.
- Optimal sleep for adults (≥18 years) is 7–9 hours per night.
- U.S. obesity prevalence has risen from ~10% in 1985 to ~35% in 2026.
- Dietary limits: <10% of calories from added sugars (starting at age 2), <10% from saturated fat (starting at age 2), and <2300 mg/d sodium (less for children <14).
- Exercise goals: At least 150–300 min/week moderate-intensity or 75–150 min/week vigorous-intensity aerobic activity, plus muscle-strengthening ≥2 days/week.
- Motivational interviewing and shared goals are critical for improving adherence to prevention strategies.
1. DEFINITION & OVERVIEW¶
• Health Promotion: Emphasizes positive behavior change (e.g., goal-setting, support) over simple risk enumeration. • Disease Prevention: Focuses on avoiding illness; does not guarantee overall health. • Levels of Prevention: ◦ Tertiary prevention: Rapid intervention to prevent death and preserve organ function in acute illness (e.g., thrombolysis in stroke). ◦ Secondary prevention: Avoiding recurrence of disease in individuals already affected. ◦ Primary prevention: Reducing incident disease risk in individuals with known risk factors. ◦ Primordial prevention: Preventing the development of risk factors by targeting upstream determinants (e.g., socioeconomic factors, diet, physical activity). • Health Concept: A multidimensional construct encompassing biological, psychological, and social domains. • Life's Essential 8™: Metrics used to define cardiovascular health; correlates with longevity, quality of life, and reduced healthcare costs. Includes: diet, physical activity, sleep, nicotine exposure, BMI, blood lipids, glycemia, and blood pressure.
2. EPIDEMIOLOGY¶
• Obesity Prevalence (U.S.): ◦ 1985: ~10% ◦ 2026: ~35% ◦ Impact: Disproportionately affects lower socioeconomic groups and minority populations (Black, Latino, and American Indian). • Sleep Disorder Prevalence: ◦ Obstructive Sleep Apnea (OSA): Affects 9–38% of adults. ◦ Risk Factors: Higher prevalence in males, older adults, and those with higher BMI. ◦ Global Scale: ~1 billion adults affected by OSA.
3. ETIOLOGY & PATHOPHYSIOLOGY¶
• Normative Aging: Characterized by a progressive decline in health; risk factors cause irreversible damage (e.g., left ventricular hypertrophy from hypertension). • Compression of Morbidity: The goal of prevention is to 'square the curve' (Figure 2-1), where morbidity is compressed into a short period just before death. • Impact of Prevention: ◦ Primordial prevention (maintaining optimal BP, diet, activity) can abolish cardiovascular disease risk and extend healthy lifespan. ◦ Treated hypertension reduces but does not eliminate risk compared to those who maintained optimal BP without medication.
4. CLINICAL FEATURES¶
• Sleep Disorders: ◦ Symptoms: Persistent poor sleep quality, excessive daytime somnolence, and witnessed apneic episodes. • Exercise-Related Risks: ◦ Sudden cardiac death risk correlates with exercise duration but is mitigated by training. ◦ Clinical consideration: Balance patient health, injury risk, and training capacity before endurance events.
5. DIFFERENTIAL DIAGNOSIS¶
• Screening vs. Prevention: ◦ Screening: Identifies preclinical disease markers (e.g., dyslipidemia, hyperglycemia) to enable early intervention. ◦ Prevention: Reduces the actual incidence of disease.
6. INVESTIGATIONS & DIAGNOSIS¶
• Routine Evaluation: ◦ Asymptomatic adults: Periodic evaluations have low yield for total mortality; focus on evidence-based screening and counseling. • Sleep Assessment: ◦ Tools: Sleep logs (to identify insomnia types) and clinical tools like the STOP-Bang questionnaire (to screen for sleep apnea). • Dietary Guidelines (Table 2-1): ◦ Infants <6 months: Exclusive human milk or iron-fortified formula. ◦ 6–12 months: Introduce variety of nutrient-dense foods. ◦ General: Focus on vegetables, fruits, whole grains, dairy, and protein foods (lean meats, poultry, eggs, seafood, beans, peas, lentils, nuts, seeds, soy). ◦ Limits: Added sugars (<10% calories starting at age 2), saturated fat (<10% calories starting at age 2), sodium (<2300 mg/d; less for children <14). • Physical Activity Guidelines (Table 2-2): ◦ 3–5 years: Active throughout the day. ◦ 6–17 years: 60+ min/day moderate-to-vigorous activity; include aerobic, muscle-strengthening, and bone-strengthening 3+ days/week. ◦ 18–64 years: 150–300 min/week moderate-intensity or 75–150 min/week vigorous-intensity aerobic activity; muscle-strengthening ≥2 days/week. ◦ ≥65 years: 150 min/week moderate-intensity aerobic activity; include balance training and muscle-strengthening.
7. MANAGEMENT & TREATMENT¶
• Dietary Management: ◦ Focus: Nutrient-dense foods, whole foods (vegetables, fruits, whole grains, lean proteins), and healthier oils (canola, olive). ◦ Limits: Added sugars (<10% of calories), saturated fat (<10%), sodium (<2300 mg/d). ◦ Alcohol: ≤2 drinks/day for men, ≤1 drink/day for women. • Physical Activity Management: ◦ Goal: 150–300 min/week moderate-intensity or 75–150 min/week vigorous-intensity aerobic activity. ◦ Strength: Muscle-strengthening activities ≥2 days/week. ◦ Sedentary behavior: Reduce sedentary time through standing and stretching. • Sleep Management: ◦ Behavior: Regular schedules, avoid pre-sleep alcohol. ◦ Medication: Limit sedatives due to dependence risks. • Weight Management: ◦ Strategy: Sustainable behavior change via motivational interviewing. ◦ Referral: Early referral to dietitians for personalized plans.
8. PROGNOSIS & COMPLICATIONS¶
• Cardiovascular Health: Higher scores correlate with longevity; primordial prevention prevents irreversible damage. • Sleep Deprivation: Increases cardiovascular risk and daytime dysfunction; untreated OSA contributes to hypertension and arrhythmias.
9. SPECIAL CONSIDERATIONS¶
• Age-Specific Recommendations: ◦ Children (3–17 years): 60+ min/day of varied activity including bone-strengthening. ◦ Older adults (≥65 years): Multicomponent exercise (aerobic, strength, balance). • Alcohol Considerations: ◦ Limit to ≤2 drinks/day for men, ≤1 drink/day for women. ◦ Contraindications: Pregnancy and specific medical conditions.
10. KEY PEARLS & HIGH-YIELD POINTS¶
• Primordial prevention is more effective than tertiary interventions for long-term health. • Overemphasis on screening may lead to overtesting and patient anxiety. • Sedentary time harms health independently of physical activity levels. • Motivational strategies are essential for improving adherence to lifestyle changes.
Reference Tables¶
TABLE 2-1 Guidelines and Key Recommendations from the Dietary Guidelines for Americans , 2020–2025 GUIDELINES 1. Follow…¶
Harrison's 22e, p.10
| GUIDELINES | KEY RECOMMENDATIONS |
|---|---|
| 1. Follow a healthy dietary pattern at every life stage. For the first 6 months of life, infants should exclusively be fed human milk, or iron-fortified formula if human milk is unavailable. From 6 to 12 months, infants should be introduced to a variety of complementary nutrient-dense foods. From 12 months to older adulthood, the dietary pattern should meet nutrient needs, help achieve a healthy body weight, and reduce the risk of chronic disease. 2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. The Dietary Guidelines provide a framework of several dietary patterns intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the United States. 3. Focus on meeting food group needs with nutrient- dense foods and beverages and stay within calorie limits. Nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits. 4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages. At every life stage, meeting food group recommendations, even with nutrient-dense choices, fulfills most of a person’s daily calorie needs and sodium limits, with little room for extra added sugars, saturated fat, or sodium, or for alcoholic beverages. |
The Dietary Guidelines’ Key Recommendations for healthy eating patterns should be applied in their entirety, given the interconnected relationship that each dietary component can have with others. They are also intended as a framework to accommodate personal preferences, cultural traditions, and budgetary considerations. Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits to achieve a healthy weight and reduce the risk of chronic disease. The core elements that make up a healthy dietary pattern include: • Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables • Fruits, especially whole fruit • Grains, at least half of which are whole grain • Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives • Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products • Oils, including vegetable oils and oils in food, such as seafood and nuts A healthy eating pattern limits: • Added sugars—Less than 10% of calories per day starting at age 2. Avoid foods and beverages with added sugars for those younger than age 2. • Saturated fat—Less than 10% of calories per day starting at age 2. • Sodium—Less than 2300 mg/d—and even less for children younger than age 14. • Alcoholic beverages—Adults of legal drinking age can choose not to drink or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant. Meet the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans In tandem with the recommendations above, Americans of all ages—children, adolescents, adults, and older adults—should meet the Physical Activity Guidelines for Americans to help promote health and reduce the risk of chronic disease. Americans should aim to achieve and maintain a healthy body weight. The relationship between diet and physical activity contributes to calorie balance and managing body weight. |
TABLE 2-2 Recommendations from Physical Activity Guidelines for Americans, 2nd Edition (2018) AGE 3–5 years 6–17 years¶
Harrison's 22e, p.12
| AGE | RECOMMENDATIONS |
|---|---|
| 3–5 years | • Preschool-aged children (ages 3 through 5 years) should be physically active throughout the day to enhance growth and development. • Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types. |
| 18–64 years | • Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits. • For substantial health benefits, adults should do at least 150 min (2 h and 30 min) to 300 min (5 h) a week of moderate-intensity or 75 min (1 h and 15 min) to 150 min (2 h and 30 min) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous- intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. • Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 min (5 h) of moderate-intensity physical activity a week. • Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits. |