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What gets measured gets improved.Peter Drucker—author and management consultant
Mom called it the “Springer gene.” Decades later, when scientists discovered a genetic link to obesity, diabetes, and higher body mass index, they labeled it the “fat mass and obesity-associated” gene.
Whatever you call it, I'm convinced that my chubby German family has it. Practically all of my family members fall somewhere along the continuum between overweight and morbidly obese. Growing up in the rust belt of Northern Ohio in the 1960s, it was very common for people to “have sugar.”
While cancer was spoken of in hushed tones as a “death sentence,” diabetes was accepted as a fact of life, not a big deal; “everybody gets it eventually.” It's something you could “live with.”
Fast forward 50 years and many in my generation now have been diagnosed with diabetes or prediabetes. The few of us who are not obese work diligently at maintaining a healthy weight through careful food choices, exercise, or an active lifestyle.
After 40, It's All Downhill
Although I had never been overweight in my life, menopause, insomnia, stress, and long hours at my desk job translated into steady weight gain during my 40s. By age 50, my body was several dress sizes larger than it had ever been, and regardless of what diets or exercises I tried, I kept gaining weight. I was well on my way to joining the ranks of the family diabetics—until a contest changed my life. As a member of the College of Public Health at the University of Arizona, I won a week in the Life Enhancement Center at Canyon Ranch, a posh spa and wellness center in the Tucson foothills. Mel and Enid Zuckerman, Canyon Ranch founders and major donors to the college, offered scholarships with the goal of strengthening ties between the college and the Ranch. Just a few days after my 50th birthday in 2001, I spent 7 days at Canyon Ranch and learned how to reverse what I had considered to be my family destiny—obesity and type II diabetes.
What did I learn at Canyon Ranch? I learned I was not exercising efficiently or with enough intensity or duration. Post Canyon Ranch, I learned the benefits of mixing it up by adding strength training, yoga, meditation, real cardio (beyond walking the dog), and fun exercises like dancing. I learned I was eating far too many white carbs and not enough protein, fruits, and vegetables. I learned I had metabolic syndrome, and my life was out of balance.
I also learned: What gets measured gets improved.
My stated Canyon Ranch goal was to buck the family fat trend and avoid diabetes. I went all out to achieve that goal. I became an exercise-tracking fanatic. Canyon Ranch trainers advised taking scraps of paper to the gym to write down daily accomplishments and suggested purchasing a heart rate monitor and a pedometer. I devised an elaborate spreadsheet system to track cardio and strength exercises and started going to the gym before and after work for a total of 1.5 hours per day on weekdays, supplemented with swing dancing and fun cardio on the weekends. I religiously tracked everything—from steps to gardening to jogging on the treadmill at the gym. I was on a mission to beat my genetics. I used the Glycemic Index (GI) to avoid high GI foods. I swore off white potatoes, white rice, pasta, and anything with high fructose corn syrup. I switched to carrots, apple slices, and juice popsicles for snacks—instead of chips, peanut butter, cheese, and ice cream. Because I get regular check-ups, I have a stockpile of old printouts showing blood work and my progress toward beating metabolic syndrome.
Fifteen Years Later
Fifteen years later, I am much stronger and 25-30 pounds lighter. I no longer shop for baggy plus-sized clothes because I am mindful of what I eat—every day. I swim laps in the morning year round and supplement that with dancing, cycling, walking the dog, gardening, and playing with my grandchildren. I've been thinner, but I've never been healthier.
Several years ago, I exchanged Excel spreadsheets (Microsoft Corporation, Redmond, WA) and pedometers for Internet-based food and exercise tracking through SparkPeople.com (SparkPeople, Cincinnati, OH), which is still online. SparkPeople was very helpful in collecting rich data, setting goals, creating progress reports, and connecting online with other women for support and locally for workouts, bike rides, and walks.
The camaraderie on SparkPeople was heartwarming, back in 2007 when I was a daily visitor; SparkPeople has the people support of Weight Watchers (New York, NY), without the in-person meetings.
Apps and Wearables
Purchasing my first iPhone (Apple, Cupertino, CA) bumped my food and exercise tracking up to a whole new level. As noted in “Smartphone Applications for Patients' Health and Fitness” by Higgins in this issue of The American Journal of Medicine, smart phone usage and fitness application (app) availability have exploded in recent years. According to Higgins, there are more than 1 million smart phone applications, of which tens of thousands are health and fitness apps.
To help patients maintain healthy lifestyles, Higgins suggests that physicians investigate health and fitness apps for mobile devices. His review includes an extensive list of apps, features, and price ranges; many apps have free versions that people can test drive before purchase.
I wholeheartedly agree with Higgins about smartphone technology and the potential for behavior change. On the iPhone, I have used multiple nutrition/fitness apps. The SparkPeople app has extensive data collection tools with all of the bells and whistles, but I found data entry time-consuming and, as a result, didn't use it regularly. SparkPeople also offers several related apps like recipes, motivational messages, and social media. More recently, I started using the free version of MyFitnessPal app (MyFitnessPal Inc, San Francisco, CA), which is included in Higgins' article. MyFitnessPal has very similar data collection capabilities as SparkPeople, but it is not as robust as SparkPeople. MyFitnessPal's interface is straightforward and includes many easy-to-use, timesaving features like the ability to group foods into meals, store regular workout routines, copy meals from one day to the next, and capture barcode readings from food labels with the camera. These features speed up entering activity and food data into the app. MyFitnessPal also offers encouragement through reminder text messages and predictions about your goals, based upon recent activities.
In addition to apps, there is a world of wearable fitness monitors—like the Fitbit (San Francisco, CA) and the Misfit Shine (Misfit, Burlingame, CA)—that sync with smartphones and apps. A far cry from the pedometers of 15 years ago, my latest fitness tracker is the Misfit Shine; it synchronizes with both the Misfit and MyFitnessPal apps on my iPhone. The Shine directly tracks not only activities but also sleep quality and duration (Figure 1). As a chronic insomniac, the Shine's sleep feature has been extremely helpful in analyzing my sleep quality and how it relates to my evening behaviors (Figure 2). It has allowed me to fine-tune my sleep experience. Misfit Shine is fully waterproof and can be worn while swimming (my primary reason for purchasing it).
All 3 of these apps—SparkPeople, MyFitnessPal, and Misfit—allow users to develop friendships and support groups within the apps and to share milestones on social media platforms like Facebook. Again—the app developers have taken the effective person-to-person support of the Weight Watchers program and digitized it.
Lastly, for the fully digitized patient, personal portals—like the one offered by my primary care physician's group practice—are another great resource for patients who are mindful of their health. I still have my stacks of paper reports from my annual check-ups, but now through the patient portal, I also have 3 years of online data—records of annual check-ups, blood work, mammograms, bone density scans, and office visits plus height, weight, and blood pressure at each visit. The site is not flashy, but it is highly useful.
Whether you use scraps of paper, the length of your favorite workout playlist, a smartphone app, or a wearable device, remember: what gets measured gets improved.
A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity.
Healthcare providers are often looking for ways to objectively monitor and improve their patients' health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient's health and fitness. Specifically, fitness applications or “apps” on smartphones are programs that use data collected from a smartphone's inbuilt tools, such as the Global Positioning System, accelerometer, microphone, speaker, and camera, to measure health and fitness parameters.