Two small changes that can improve your health

I'll be taking a few weeks off to travel with my family, and will write infrequently during this time. This is a favorite repost -- in case you missed it. Have a good, safe summer!

Habits tend to cluster.  People who exercise will often also watch their weight, consider the nutrition label, avoid smoking and get enough sleep. On the other end, unhealthy behaviors bunch together, too, and many of us have a long list of practices their doctor would like them to change in order to lower their risk of disease.

But who wants a long shopping list of to-dos and not-to-dos? 

The ideal plan would involve one or two guidelines that could drag with them other positive behavior changes.

Oh, and what if we could also achieve that remotely, with something as simple as a phone app? Wouldn’t that be useful?

Eat your veggies and turn the TV off

A  study, published in the Archives of Internal Medicine studied about 200 people who skimped on fruits and veggies, ate plenty of saturated fats, didn’t exercise much and had a sedentary lifestyle, (sounds like someone you know?) trying out a mobile technology aimed at behavioral change.

The participants each got one dietary behavior to change – either eat more fruits and veggies or lower your saturated fats intake -- and one activity behavior goal – either decrease sedentary leisure (less TV) or increase exercise. That made 4 treatment groups.

The participants got a personal digital assistant, and were asked to report on their diet and activity. The treatment phase lasted 3 weeks, with 20 weeks of follow-up during which the researchers tracked how much of the behavior change persisted.

This was a compliant group – perhaps because participants were rewarded $175 for achieving the 3-week target. All but 1 participant were able to adhere to both the dietary and activity goals within 3 weeks. 

But here’s the interesting part: the group that was instructed to eat the 5-a-day fruits and veggies and reduce screen time achieved not just these goals, but also, without being told, decreased saturated fat intake. 

And those benefits persisted to some degree after the treatment phase was completed, and the participants were no longer paid for adherence or even asked to keep up the positive change. In the 5 months of follow-up this group was still eating more than double the fruits and veggies compared to what they ate before the experiment started, watching an hour and a half less TV, and eating significantly less saturated fat. 

On the other hand, the group that got the more traditional diet regimen of eat less fat and exercise more achieved less healthy change: The participants didn’t eat more fruits and veggies, and lounging in front of the screen was unaltered. 

Healthy chain reaction

As Charles Duhigg discusses in The Power of Habit some habits are keystone ones. Changing one thing, such as starting to exercise, may have a beneficial domino effect, improving diet, stress and productivity unintentionally.

This study suggests that reducing screen time not only offers the advantage of reducing inactive time, but also automatically reduces high-fat intake. There are plenty of studies showing that more TV is linked with higher energy intake and high-fat snacking. I can’t think one good outcome arising from hours in front of the TV.

Mind you, the eat-your-veggies-&-limit-TV advice didn’t get people in this study exercising. Exercise needs its own nudge.

The 5, 2, 1, 0 advice for healthy active families from the American Academy of Pediatrics captures all the important recommendations very simply:

• 5 fruits and vegetables a day,
• 2 hours or less of screen time (TV, computer, video games) per day,
• 1 hour of physical activity a day, and
• 0 limit sugar-sweetened drinks.

These are small changes that can bring about bigger ones!

Dr. Ayala