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October 2015

Call to arms (and legs); Soul and Seoul; Be well


I just returned from Seoul, South Korea, my first trip there. It was fascinating and I’ll tell you more in SOUL from Seoul. The main reason I traveled there was to participate in an International Lifestyle Medicine and Addiction symposium hosted by Sahmyook University. They were celebrating the official opening of their brand new Lifestyle Medicine and Health Promotion Institute.

One of the invited keynote speakers was Edward M. Phillips, M.D., Founder and Director, Institute of Lifestyle Medicine, Joslin Diabetes Center, Boston, Massachusetts; and Assistant Professor of Physical Medicine and Rehabilitation, Harvard Medical School. Like addiction treatment, lifestyle medicine is a neglected, yet so important body of knowledge too little taught in medical school and across all the helping professions. Dr. Phillips highlighted some facts and figures which will convince you too it is time to pay more attention to lifestyle medicine and wellness.


Review these keynote points and see if you can ignore the need to embrace lifestyle changes in your life and the nation’s.

Dr. Phillips opened by a “Call to Arms (and Legs)”. He said:

  • “We know why the majority of the population will die prematurely.
  • We know the root cause of two-thirds of all disease.
  • We know where most of our health care dollars could be saved.
  • Yet: we don’t teach this to doctors and our health care system continues to practicesickness-based care.”

Here are more facts and figures:

  • 70% of cardiovascular disease can be prevented or delayed with dietary choices and lifestyle modifications (Forman D, Bulwer BE, Curr Treat Options Cardiovasc Med. 2006;8:47-57)
  • The World Health Organization states that by 2020, two-thirds of all global disease will be lifestyle-related (Chopra M et al.Bull WHO. 2002;80:953-958)
  • 78% of health care expenditures are consumed by the management of chronic disease (Anderson G, Horvath J.Public Health Report. 2004;119:263-270)
  • The combined effect of lifestyle factors such as physical inactivity, obesity, poor diet, cigarette smoking, and excess alcohol consumption have a significant impact on morbidity and mortality from the resulting chronic disease (Hu FB et al. N Engl J Med. 2001;345:790-797) and leads to the following increases:

* Increases 55% all causes of mortality (van Dam RM et al. BMJ. 2008;337:a1440)

* Increases 44% cancer mortality (van Dam RM et al. BMJ. 2008;337:a1440)

* Increases 72% cardiovascular mortality (van Dam RM et al. BMJ. 2008;337:a1440)

I know it’s easy for your eyes to glaze over with all those big picture statistics and wonder what is the impact at the ground level of your daily life. We’ll get to what you can do soon. But first a few more big picture statistics which will inspire you to make even a small change in lifestyle.


Take note of the Wellness Dividend for just a 2% change in lifestyle.

  • Annual health care costs in 2019 estimated to be $4.48 trillion 

(Centers for Medicare and Medicaid Services. National Health Expenditure Data

  • WHO estimates 66% of health care costs result from lifestyle = $3 trillion annually by 2010 Bull WHO. 2002;80:953-958)

If we made a small change of 2% in weight, activity, smoking, etc. e.g., walking an additional 500 steps a day or giving up the last cookie, the result: 

  • Wellness Dividend of annual $60 billion in cost savings.


So let’s bring this all closer to home- from the big statistical picture to ‘where the rubber meets the road’ in your running shoes or with the fork at your meal table. Dr. Phillips had the audience assess their own health habits.


Get with a group of friends or acquaintances and see who is the last person standing.

Here are the instructions:
Everybody stands up and if you answer “yes” to any of the questions, sit down and take a seat at that point.

Here are the questions:

1. Do you smoke cigarettes? – Sit down if you are a smoker.

2. Is your BMI (Body Mass Index) equal to or greater than 25kg/m2? – Underweight is <18.5; Normal weight = 18.5 – 24.9; Overweight = 25 – 29.9; Obesity = BMI of 30 or greater.

3. Do you eat less than 5 servings of fruits and vegetables/day? – If yes, then sit down.

4. Do you drink more than one drink a day? – “One drink” = 12 ounces of regular beer; 5 ounces of red wine; 1.5 ounces of liquor.

5. Do you do less than 150 minutes/week of physical activity/exercise? – If you are a bit of a couch potato, take a seat…OK to be a couch potato for a moment as you look around and see if anyone is still standing.

6. Finally do you sleep less than 6-7 hours/night? – If you aren’t getting enough sleep at night, that is a tough lifestyle change in our fast paced, over-packed lives.

When I did this with a large group, I know I wasn’t the last person standing; and there were very few excellent specimens of lifestyle role models standing after just those six questions. How did you rate with your own health habits and lifestyle?

The secret of success is to aim low – so don’t try to change your lifestyle all at once. This is where BJ Fogg, PhD has some great advice –


Take a look at Tiny Habits ® and become inspired to start with just your 2% or a tiny habit.

As Dr. Phillips said, maybe you could start with just 500 steps per day, not 10,000 a day. Or choosing not to take that last cookie or last spoonful of desert rather than promise to never eat desert for the next year.

There are a number of methods on the same theme, but here is the Fogg Method:

Step 1: Get specific about what lifestyle change you want to make (e.g., do some push-ups to strengthen my biceps and core.)

Step 2: Make it easy (e.g., plan on a tiny habit of just two push-ups to start with.)

Step 3: Trigger the behavior – what will prompt yourself to remember to do the tiny habit (e.g., after I brush my teeth, I will do two push-ups.)

Why is it always hard to obtain as much respect for prevention and lifestyle change as it is for a new surgical laser machine or a state-of-the-art center for cancer treatment? Yet lifestyle change can make such a difference to your health and health care costs.

We preach what we need to learn – and I am learning too.


It is so fascinating to me to travel the world and see new places and cultures. So here are some “culture shocks” I noted on my first trip to Seoul – SOUL from Seoul if you like. From the variety of people I spoke with, there seemed to be consensus that these observations were true and typical:

  • It is not intrusive or discourteous to ask a person you just met how old they are. In fact, a person may introduce themselves as “I’m David and I am a psychiatrist living in California and I’m 66.” The person’s age tells you how you should address them in the hierarchy of respect. It is not comfortable to address an older person as “David” even if I invite a more familiar greeting
  • People (and I mean adults and children) work long hours. Adults may stay until 8 or 9 PM or even later and it does not look good to leave on time at the end of the day even if you have your work done. Some would never leave before their manager; and it is expected that you go out to meal or drinking with your manager and to stay late if asked – no overtime.
  • Children in high school and even earlier grades finish school in the afternoon and then often attend another afterschool academic program studying until 10 or even 11 PM. This is to achieve excellent grades to compete for the top universities in Seoul that is considered the only acceptable path to getting a good job after graduation.
  • Not unrelated perhaps, the suicide rate in South Korea is the highest among Organization for Economic Cooperation and Development (OECD) countries. 

On the healthcare front there were some surprises too:

  • I sat in on a Laughter Therapy group where cancer patients and others spend an hour a day laughing their heads off as part of their healing process. We actually have this too in the USA, (Google Laughter Therapy and you’ll see Cancer Treatment Centers of America uses it).
  • I visited a post-natal unit on the hospital grounds where mothers can stay for two weeks to rest after delivering their baby. Educational sessions, relaxation, and recuperation prepare the housewife to be ready to take up her busy care of the family.
  • Finally, Seoul has become the plastic surgery capital of the world with many adolescent girls, women and some men having a variety of procedures to create double eyelids and open up their eyes to be wider and more western looking. Nose reshaping; and chin surgeries to create a more V-shape. Coincidentally, I heard an October 20 segment on National Public Radio’s Here and Now program all about this. You can listen in for yourself at:

There is much more SOUL from Seoul that I could share. But this gives you a taste of South Korea, not to mention my trip to the Demilitarized Zone (DMZ) between South and North Korea. I looked out onto North Korea and wondered if Kim Jong-un, Supreme Leader of North Korea, was staring back at me.

I don’t think so.

sharing solutions

As you contemplate your own lifestyle, I want you to know about the Institute for Wellness Education of which I am one of the co-founders. Our desire is to drive cultural transformation so health and wellness become the norm for individuals, communities, and the nation:

You may be interested in taking the Level 1 fundamentals course: “Take Charge of Your Life: Be Well to Do Well.” This includes Interactive Journaling using “My Personal Health Journal.” Take a look at the 10 modules in the Level 1 course at:

Here’s to your health and well-being.

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