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Table of Contents
Better Leadership Through Better Physical Health
By James W. Long, Jr., M.D.
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Sidebars:
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Imagine being in the prime of your life, admired as a leader, responsible for a thriving, dynamic ministry, and gifted with an incredible family. Truly, you have been blessed.
Suddenly, out of nowhere, the "big one" hits, and you begin experiencing a life-threatening heart attack with excruciating chest pain, extreme shortness of breath, profuse sweating, and overwhelming nausea. As your body reactions intensify, your emotions are assaulted. The initial waves of fear are replaced by panic as a hundred questions race through your mind about your own future as well as the futures of those who need you so much—your family and church. And then, somewhere in the course of events dawns the realization that you had not done all you should have to prevent this. Out of those thoughts arise guilt and depression, coupled with a sense of failure for those you have let down.
Impossible, you say. Don’t count on it. Or, maybe I should have said, "Don’t bet your life on it."
Let me share with you my perspective as a heart surgeon. My work includes combating death and disability due to heart disease with the most advanced therapies and technologies available. It also includes fundamental approaches to preventing heart disease by providing my patients with knowledge, inspiration, and motivation to change their lifestyles. (The latter process should sound quite familiar to spiritual leaders.)
Heart disease is no respecter of age. Too many of my patients are still in the prime of their lives. And too many suffer big enough heart attacks to induce disability if not death.
Let me illustrate. George was only 46 when he had his heart attack. Shortly after it started, he began slipping into life-threatening heart failure. Angioplasty to open up his coronary arteries was not enough to reverse the heart attack. Soon, even large amounts of heart stimulating medications were not adequate to sustain the failing heart and prevent shock.
I rushed George into the operating room to implant an artificial heart assist pump. He recovered, but his heart did not. While artificial heart pumps are fast becoming the standard of care to give people quality of life, heart transplantation is still the leading therapy for irrecoverable heart failure. George underwent surgery again 6 months later to receive a heart transplant. For nearly a year surrounding these experiences, George’s life was on hold until he could put the pieces back together, allowing him to become productive again.
To put this into perspective, George is one of the fortunate among those who experience abrupt heart attacks at a young age. (Lest you think George is an exception, the average age of people receiving artificial hearts from me is 50.
What can you do now, before it is too late, before your dynamic, productive life is compromised?
Be Aware of the Threats To Your Health
Cardiovascular disease, America’s No. 1 killer, is amenable to prevention. To capitalize on that opportunity, we need to understand the factors that contribute to coronary artery atherosclerosis, the most prevalent and most preventable form of heart disease.
Following is a compilation of the important risk factors for developing cardiovascular disease. While these factors clearly contribute to cardiovascular disease, they are not exclusive to cardiovascular disease; they also underlie other important conditions adversely affecting overall health.
Being overweight
Obesity is an immense problem, a nationwide threat. At least 60 percent of people are well over their ideal body weight. Obesity is a rapidly growing threat to health. Over the last several decades, the problem of being overweight has worsened by 20 to 25 percent with no end in sight. Children are affected as well as adults, and childhood risks often carry into adulthood.
While physiologic and genetic factors influence the process, being overweight is most often the result of improper diet, improper eating habits—including overeating—and inadequate physical activity.
Prior to the era of modern science, obesity was considered primarily an inconvenience of configuration and size. This is illustrated in an unusual, descriptive way in the narrative about Eli, the leader of Israel for 40 years. When troubled by bad news, Eli "fell backward from his seat . . . broke his neck and died . . . for he was . . . very fat" (emphasis mine, 1 Samuel 4:18*).
Today, we know that being overweight is a major risk for poor health, and not just because of physical limitations. Being overweight raises the risk of developing heart disease by two to fourfold. Other conditions made worse by obesity include high blood pressure, diabetes, stroke, cholesterol abnormalities, gall bladder disease, arthritis, respiratory problems, sleep disorders, and several types of cancer. Medical procedures, such as surgery, are made more challenging, and often more risky by obesity. Superimposed on the medical issues is the myriad of social consequences of obesity.
Added to the risks of excessive weight alone is the presence of an abdomen protuberant with fat. Men who have waists greater than 40 inches, and women with waists larger than 35 inches, are at even greater risk than predicted simply by weight.
There is a tendency to discount the importance of being overweight relative to other factors that adversely impact health, such as smoking. A recent study by the RAND institute, however, concluded that "obese adults have more chronic health problems than smokers or heavy drinkers." This finding should be eye-opening in environments where the use of tobacco and alcohol are condemned, but obesity abounds.
Sedentary lifestyle
Exercising has become a high -profile activity in our society. Flashy jogging outfits, personal trainers, and health club memberships have become familiar icons of the devoted.
Despite the exuberant, if not sometimes excessive commitment of some, it is estimated that 35 to 55 percent of adults of various age ranges, social classes, and sex are sedentary with essentially no leisure physical activity.
Physical inactivity is associated with a 1.5 to 2.4 times increased risk of developing heart disease. That risk is comparable to that observed for high cholesterol, high blood pressure, or cigarette smoking. Inactive people have a 1.3 to 1.5 times greater chance of developing high blood pressure.
Studies have demonstrated that even moderate intensity exercise, such as walking, is associated with a reduction in heart disease and stroke.
High or abnormal cholesterol and lipids
High levels of cholesterol represent a clear risk for cardiovascular diseases. Several types of cholesterol have been recognized. Low levels of "good cholesterol"—HDL-cholesterol—and high levels of "bad cholesterol"—LDL-cholesterol—add to the risk, as does another category of circulating fatty lipids—triglycerides.
Being overweight and having inappropriate diets that contain too many fat calories and/or particularly worrisome types of fat, including cholesterol and saturated fats, are the usual causes of high cholesterol. Occasionally, genetic predisposition can be an important factor.
High blood pressure
High blood pressure is often described as a silent killer because it insidiously promotes the development of heart and vascular disease, increasing risk for heart attacks, strokes, and failure of the circulation. While most cases of high blood pressure have no single cause, being overweight, inactivity, and dietary indiscretion certainly contribute.
Diabetes
Diabetes is the sixth leading cause of death by disease in the U.S. Seventy-five percent of diabetes-related deaths are attributable to cardiovascular disease. In fact, those with diabetes are two to four times more likely to have heart disease than people without diabetes. In addition, having Type 2 diabetes increases heart attack risk as much as heart disease does for a person without diabetes. People with diabetes tend to experience several metabolic abnormalities that contribute to an increased risk of heart disease including obesity, high blood pressure, increased blood clotting, increased levels of proteins associated with atherosclerosis (hardening of the arteries), and insulin resistance. (See the sidebar, "Testing for Diabetes.")
Genetic predisposition
Family history of premature coronary artery disease is a factor in cardiovascular disease. Of concern are people with a family history of heart attack or death due to heart disease in fathers or male first-degree relatives at 55 years of age or younger, or similar episodes in mothers or female siblings age 65 or younger.
Manage Your Risk Well And Be Rewarded
There is no time like the present to take control of your health. The rewards of successful management are immense while the consequences of failing are staggering.
Given what is at stake, why do people fail to manage their risks? There are three reasons: (1) inadequate knowledge on which to base change, (2) insufficient motivation for self-control, or (3) ineffective approaches and execution.
Knowledge
Today, inadequate knowledge about health risks may be a reality for those who don’t read, don’t watch TV, don’t listen to the news, don’t talk to friends and family, don’t see doctors, or don’t use the Internet. But for everyone else, information and tools are widely available. The American Heart Association and the National Heart, Lung, and Blood Institutes have assembled scientific and educational materials and launched full-scale public education campaigns. (See "Health Related Resources" sidebar.) Tools for determining and managing risk are available on the Internet and for handheld PDAs. Doctors and other medical professionals are better prepared to help. Educators and advisors are becoming widely available. In this era, one almost has to deliberately avoid exposure or access to information.
Motivation
I can expect a high rate of success with lifestyle modification from those who feel threatened by an unexpected diagnosis of heart disease, those who have just been through open-heart surgery, or those who have narrowly escaped death. But the price for waiting until such motivators of behavioral modification occur is often unacceptably high. I witness a lot of damage that results in disability or early death that occurred needlessly because people mismanaged their health by failing to proactively control their risk. As much as I would like to believe that emphasizing the benefits would be sufficient motivation, fear of harm is often more influential. I say, "Whatever it takes." Fortunately, for those who need to sense fear in order to become motivated, there is plenty to fear if risk is not properly managed.
Approach and methods
After being armed with sufficient knowledge and motivation to change, next comes implementation. Finding the most efficient, least stressful, and most effective approaches is not always easy. But with adequate motivation and resources, those who are driven succeed. Here are a few tips.
Control your weight
To determine whether your weight is a risk factor, look at the table in the sidebar "Risk of Developing Heart Disease, Diabetes, or High Blood Pressure Based on Weight for a Given Height." If your weight falls above one of the cutoffs listed, you bear a degree of risk proportional to the magnitude of your weight within one of four risk categories.
Weight control begins by setting a goal to reduce your weight to first lower and then eliminate your risk of developing heart disease. To looe weight, one needs a diet that is individually planned to reduce one’s usual caloric intake by 500 to 1,000 kcal/day. This should be an integral part of any program aimed at achieving a weight loss of 1-to-2 pounds per week. The use of a moderate reduction in caloric intake is designed to achieve a slow, but progressive weight loss.
Most weight loss occurs because of decreased caloric intake. Sustained physical activity is also helpful in the prevention of weight regain.
Exercise
You don’t have to become an athlete or fanatic to benefit from exercise. In fact, too much of a good thing may be harmful, especially for those who exercise sporadically and with inconsistent intensity. Sophisticated monitoring and exercise algorithms exist to guide the driven. For most, pushing to the point of comfortable fatigue, with some sweating and hard breathing over 20-to-30 minutes of exercise 3 to 5 times per week is just fine.
Besides the direct benefits for health and conditioning, exercise, at least to a moderate level, is often an important part of weight control. Staying fit is important for everyone. Exercise is also a way to reduce stress.
Cholesterol and abnormal lipid control
Abnormal cholesterol and similar fatty compounds can be detected with blood work. (See sidebar "Understanding Cholesterol Levels.") Such testing should be performed during periodic physical exams, especially once midlife is reached. Those with a family history of severe lipid abnormalities should be evaluated early in life.
In the absence of any known coronary artery disease, weight control and diet modification to reduce fat and cholesterol intake may be all that is required. Failing that, medications may be necessary. For those with known coronary artery disease, the newer cholesterol-lowering medications (statins) offer proven benefit, even after cholesterol becomes normal.
High blood pressure control
The most effective management of high blood pressure begins with its diagnosis. Therapy is almost always effective, starting with reducing salt intake and evolving to medications as needed. Close monitoring, sometimes with home equipment, facilitates long-term control.
Diabetes control
For the majority of those with diabetes—in particular those with the most common Type 2, also referred to as adult onset—factors such as being overweight and dietary indiscretion are initial targets for effective control. If that is not adequate, medications, oral agents and/or insulin are necessary. Careful monitoring and medical supervision are essential.
Family history
Rebirth to acquire a new set of genes is obviously not possible, and genetic engineering solutions are not yet available. The best way to neutralize a strong family history of health problems is to undergo early medical screening and work diligently to control all other risk factors.
Be An Effective Leader And Example
The importance of health management for one’s own well-being is obvious. For those who are in position to exercise spiritual leadership, this process takes on new meaning. Motivation moves beyond just a personal desire to avoid early death or disability. Motivation begins to stem from:
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a sense of spiritual and moral responsibility.
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a desire to avoid an adverse impact of one’s own ill-health on people for whom that person feels responsible. What would your family and church do if you were severely disabled or died from a heart attack?
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a desire to be productive, optimized for efficiency and effectiveness.
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the joy of being consistent with balanced attention to all those factors important to an abundant life.
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a desire to inspire others to be the best they can be, complete and balanced whole beings.
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an interest in making your own life qualified to be a living example of the benefits of self-control and personal discipline.
- The well-informed of the world consider health essential to a full, abundant life and want to be inspired. Those less informed are in need of instruction.
The world is waiting to be taught and inspired by exemplary leaders who are made better because they practice better health.
The apostle Paul said it well: "So I run straight to the goal with purpose in every step. I am not like a boxer who misses his punches. I discipline my body like an athlete, training it to do what it should. Otherwise, I fear that after preaching to others I myself might be disqualified" (1 Corinthians 9:26,27).
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James W. Long, Jr., M.D., Ph.D., is a heart surgeon who lives in Salt Lake City Utah. He is director of the Utah Artificial Heart Program in Salt Lake City and leads a team that is developing a revolutionary magnetically suspended, artificial heart pump. |
*Scripture references are from the New Living Translation.
References
American Heart Association
www.americanheart.org
National Heart, Lung, and Blood Institute
www.nhlbi.nih.gov
RAND Corporation Study of Obesity
www.rand.org/hot/press/obesity.060601.html
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