Don’t Let Health Behavior Change Become Another COVID Casualty

Health Behaviors are Just as Important as Masks

The 2020 Simulation

If Neil DeGrasse Tyson is right and we’re living in a massive computer simulation I suspect, given the COVID pandemic, our program is running on the alien equivalent of a cheesy slot machine at a tired Atlantic City casino.

Except, instead of BAR, Bells, and Cherries, we pull the handle only to have the wheels stop on increasingly worse COVID statistics pulled straight from the Hopkins COVID Dashboard. Wake up. Pull the handle. Wheels spin. Wheels stop. COVID cases get worse. Where’s the payout?

It’s going to get worse before it gets better. Dr. Anthony Fauci’s comments that we’re experiencing a “surge upon a surge” is right on point. Hospitals are full, clinicians are burned out, cities are going back into lockdown. As of this writing, 26 states states still have optional mask rules.

Big Guns

In healthcare doctors refer to “serious” treatments like chemo, steroids, and broad spectrum antibiotics as “big guns”. On initial review it seems our pandemic Maginot line is well armed. Lockdowns, social distancing, masks, dexamethasone, ventilators, and vaccines have earned their respective position. The fanfare around vaccines, (coming to a high risk population near you), is well deserved. History will look upon their rapid development as a tour de force of science and teamwork (basically the opposite of South Dakota’s COVID response).

Missing In Action

So, it’s incredibly frustrating to realize that one of the biggest guns we have has been left off the line. I’m referring specifically to our health behaviors-behaviors we engage within 3 distinct areas. Sleep, nutrition, and exercise. The simple truth: actions we take within these categories of behavior influence the course of our general health beyond any other factor. If you don’t believe me just consider that they are the root cause of the diseases that kill us. Heart disease (still the number one killer), stroke, diabetes, high blood pressure, cholesterol, cancer, lung disease, and obesity are largely diseases of lifestyle.

And don’t think this is a rarified segment of the population. 60% of of people in the US are affected by one or more of these conditions-conditions that are eminently preventable. These chronic conditions are also pandemics — they’ve become so ubiquitous that their familiarity has made it difficult to muster the same level of concern. Dying from obesity is a “slow burn” compared to dying from COVID respiratory failure. Pandemic “fatigue” is real whether the pandemic is metabolic or viral.

Medications alone won’t save you. Taking Lipitor to lower your cholesterol while still eating like crap most of the week is like pushing on the “metabolic” gas and the brake at the same time.

Underlying Conditions and COVID

COVID is straining people’s ability to deal with their health behaviors. Recent data suggests that mental health, sleep, nutrition, and exercise have significantly suffered during the pandemic and associated lock down. We’re more anxious, exercising less, sleeping poorly, and eating more junk food. The effect on obesity in particular may be disproportionately high. Snacking behaviors and eating related to stress and anxiety that were worse in people who were already overweight. Worsening health behaviors invariably leads to worsening chronic disease.

All of this matters because COVID thrives in those with pre-existing conditions. If you are obese and diabetic you’re more likely to have serious complications like severe symptoms, hospitalization, and respiratory failure, not to mention long term effects after viral resolution.

Poor sleep, exercise, and diet directly stunt your immune system. Diseases like obesity are intrinsically inflammatory states. Expecting your immune system to fight COVID while it’s already annoyed by underlying chronic disease is a big ask.

Absent Messaging

It’s disappointing that loud and clear messaging on the protective effects of health behaviors is largely absent from public discourse. I reviewed a number of examples of material aimed at the public — though they correctly share the mantra of masks, social distancing, assertive guidelines on sleep, nutrition, and exercise aren't given nearly the same amount of stage time. Only WHO guidelines clearly stress health behaviors. The CDC’s recommendations focus on maintaining your supply of medications. Important but insufficient.

It shouldn’t fall to the shoulders of stand up comedians like Joe Rogan and Bill Maher to spearhead this message. On his podcast Rogan surfaced the point of health behaviors in his conversation with Yale physician-scientist Nicholas Christakis who promised to pass the message up the COVID chain of influence. Personally, I’m running out of patience with the medical community’s long standing habit of replacing conversations of health behavior change with prescription pads. Public health officials need to be extremely clear in their messaging about the important role of health behaviors in preventing COVID complications. Doctors who have a platform need to echo the message of health lifestyle choices in the same sentence as masks and vaccines.

Take Action

Changing behaviors is hard but doable.Small changes matter and there is no better time to start taking the necessary steps.

Virtual care and telehealth are now mainstream. Home fitness, wellness, and coaching platforms are available and affordable over your smartphone. Sign up for one. Your nutrition is the most important “drug” you take everyday. Combine fruits, vegetables, high protein, and low calorie diets with consistent physical activity and exercise and you create an environment that trains your immune system to special forces standards. Prioritize physical activity between zoom calls. Buy and use a set of resistance bands for low inpact training. They’re cheap and they work. Just 30 minutes of exercise a day, even just walking, can make a difference. Sleep 6–9 hours per night. Set a sleep time and stick to it. Throw away everything you own that has high fructose corn syrup. Rid the pantry of junk and replace it with vegetables, fruit, and protein. Cut the portion sizes and drop the donuts.

We live in a digital health world. We have wrist worn health trackers and access to virtual health coaching at our fingertips via smartphones. There are free resources everywhere online. Pinterest has poster after poster of healthy snack options and recipes along with instructions on how to exercise.

Take Control

Over 900 health workers and 1.48 million people have already died from COVID-19. Don’t let one of the most important tools we have, healthy behaviors, become another COVID casualty. This isn’t a simulation. And COVID isn’t a slot machine, although it may feel like it. The odds of transmission and complications are well known as are the personal actions that can alter those odds in our favor.

Protect yourself. Boost your immune system and treat your chronic conditions effectively by pursuing healthy behaviors DAILY. You are not a helpless statistic. Use this pandemic as an opportunity to explore and build your health self efficacy. And, help others. Setup zoom workouts with your friends for support if you have to. Do whatever it takes. You have the time. Masks, social distancing, vaccines, and health behaviors are the fundamental weapons we can use to survive this.

Physician, Digital Health Entrepreneur, Troublemaker

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store