I don’t know that there are any studies that show what the health care savings or costs are over the lifespan of people who live healthier lifestyles. A study like that seems overwhelming to me – imagine all the variables.

My point is that when we start confusing expensive medical screening tests with “prevention” we end up concluding that prevention is too expensive and somehow this quickly gets translated into the umbrella conclusion “there is no cost savings in coaching patients to live healthier lifestyles – why bother.”

Dr. Mathew Reeves of Michigan state university told me in an interview that there is no more powerful tool for preventing chronic diseases than getting people to adhere to the four simple lifestyle habits of eating a diet based on fruits and vegetables, exercising daily, not smoking, and maintaining a BMI < 25. Dr. Reeves published his study in the Archives of Internal Medicine in 2005 showing that only 3% of our population has such a lifestyle. You can read his article abstract at this link: http://archinte.ama-assn.org/cgi/content/abstract/165/8/854?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=healthy+lifestyle+characteristics&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

You can also listen to my recorded interview with Dr. Reeves in Fitness Rocks podcast 103 at this link: http://www.fitnessrocks.org/?s=mathew+reeves

There are two studies on compression of morbidity that are worth looking at. The first is entitled “Aging, Health Risks, and Cumulative Disability” it is in the NEJM and the article abstract is at this link: http://content.nejm.org/cgi/content/abstract/338/15/1035

The second article on compression of morbidity is in the Archives of Internal Medicine called “Reduced Disability and Mortality Among Aging Runners.” The article abstract is at this link: http://archinte.ama-assn.org/cgi/content/abstract/168/15/1638

I did an interview with the lead author of the Reduced Disability in Runners article in Fitness Rocks Podcast 108 and you can listen to that interview at this link: http://www.fitnessrocks.org/?s=reduced+disability+in+aging+runners

I don’t see how we will ever get clear data that healthy lifestyles save money – you would need to follow an enormous group of people for decades and somehow verify that they were really living a healthy lifestyle the whole time.

But, we have irrefutable data that healthy lifestyles prevent chronic diseases more effectively than anything else we have. Chronic Diseases have been estimated to account for 75% of healthcare spending. Given the low cost of walking around your neighborhood, eating apples instead of donuts, not buying cigarettes at $7.00 or more per pack, and not being obese – I think it’s a good investment.

By the way, I should mention that Dr. Steven Blair, who I interviewed in Fitness Rocks Podcast 097, states that his decades of research on exercise have shown that remarkably little exercise is needed to get significant benefits with regard to lowering morbidity and mortality from chronic diseases. The link to that interview is http://www.fitnessrocks.org/2008/05/11/fitness-and-risk-of-cancer-an-interview-with-dr-steven-blair/

I have spent the past three years reviewing the medical research on lifestyle and health. I have interviewed dozens of medical researchers about their work. All of this is available to the public for free at http://www.fitnessrocks.org. Fitness Rocks is my retirement hobby. I have no financial incentive for doing it. The website has links to article abstracts of hundreds of excellent articles on the subject.

Monte Ladner, M.D.

These are only important screening measures when recommended appropriately. When overused, they are a waste of money. But try telling a 40-year-old female with no risk factors that cholesterol screening is nearly useless… never mind explaining that mammograms in her age group with no family history of breast cancer are of questionable screening utility.

People believe the marketing.

Dr. Rappange,

Are you familiar with the concept of “compression of morbidity?” I don’t have online access to your full article, so I could only read the abstract.

The point you bring up about aging populations costing more is true when we look at people who are kept alive by medical interventions. But, researchers from Stanford Medical school have repeatedly demonstrated that healthy lifestyles not only prolong life, they also reduce medical disabilities at all ages and delay the onset of medical disabilities by around seven years. Compression of morbidity refutes the argument that healthy lifestyles will result in more old people with lots of medical disabilities to care for.

The metaphor for the phenomenon of compression of morbidity is a light bulb burning brightly until the very end, and then going out quickly.

Monte Ladner, M.D.

The world Health Organization, based on several peer-reviewed studies, has stated that 90% of all cases of type 2 diabetes can be prevented by a healthy lifestyle. Likewise, 80% of all cases of coronary heart disease and about a third of all cancers can be prevented by the same healthy lifestyle habits.

The healthy lifestyle habits are: 1. not smoking 2. eating five or more fruits and vegetables per day 3. exercising every day 4. maintaining a BMI less than 25.

How expensive is a healthy lifestyle as described?

Another important concept is “compression of morbidity.” Researchers at Stanford Medical School have been writing since 1980 about their studies showing that people who adhere to a healthy lifestyle as outlined above not only live longer on average, but they have fewer medical disabilities at every age, and develop disabilities around 7 years later in life compared to people who don’t have healthy lifestyles.

We doctors have got to get past the idea that getting people to eat right and exercise is something less than real medicine. I’ve interviewed researchers from around the country working on the issue of lifestyle and chronic disease. They all make the same comment: “Nothing in modern medicine is as powerful as the four basic habits of a healthy lifestyle for preventing chronic diseases.”

So, with such a powerful role to play one would think that lots of people would take the simple steps toward living a healthy lifestyle. However, the numbers on this are appalling: a 2005 article in the Archives of Internal Medicine revealed that only 3% of Americans have a lifestyle that incorporates all four healthy habits. Additional studies by separate research groups have confirmed this dismal number.

Measuring blood glucose and cholesterol every year or so, performing colonoscopies and mamograms are important screening measures – and cost money. But, these medical tests do nothing to prevent the diseases they may detect. I am constantly confronted with patients and physicians who believe that since their last cholesterol test was “normal” they have nothing to fear and no need to watch their diet or exercise – as if coronary heart disease were something that develops acutely instead of chronically over several years or decades.

Before we discount the role of prevention as too expensive to pursue, let’s make sure we define what prevention really means. It’s something people do for themselves – not something the medical system does for them.

Monte Ladner, M.D.

even if that’s the case, preventative health care is still worth society paying for it. during the prolonged, healthier, and more productive lifespans of its citizens, society will generate more economic output as a result of higher levels of investment in health.