Health & Nutrition
Self-Management - The Key To Control
Over the upcoming months I hope to talk about some topics related to health and nutrition. While I will be speaking from the perspective of a physician, I am not your physician. Your doctor is the only one who has your detailed medical history and can help you make the best decisions in regard to your health. So if there is anything in my articles that you wish to incorporate in your life, you should check with your doctor first to see if it’s right for you.
As an Internist, I have always believed very strongly in patient self-management so I thought that would be a great topic for the first few issues. By self-management I mean the ability of the person with a chronic condition, such as hypertension or diabetes, to be able to follow a plan developed with their physician to keep that condition under control as best as possible. Usually, the better the control of one of these common conditions, the fewer the complications a person will experience and the more normal a life they can lead.
So, what does a plan for self-management look like? Well, such a plan includes:
- Monitoring some control indicator of the specific condition
- Knowledge of the normal targets for that indicator
- Knowledge of where your result is for that indicator
- Knowledge of what you can do to improve your indicator, and
- What to do if the indicator significantly goes out of the normal range
An example of this is the blood sugar monitoring that a person with diabetes does on a regular basis according to their doctor’s instructions. They are also told what to do if their sugars are higher or lower than a certain value. This allows better control for a condition that can have disastrous consequences if left unchecked.
Measures To Track - Weight & BMI
The reality is that even if you don’t have one of the chronic conditions, you probably should be keeping track of your weight, blood pressure and the lipid levels in your blood. As a member you’re checking your weight at least weekly at our Inches-A-Weigh Center, but some people find it useful to check it more frequently, even daily. While your weight at home may not exactly match your weight at the Center, the important piece of information is the trend. Are you going up or down? The tricky thing about weight is that what’s a normal weight for you is based upon your height and body build. A man who is 6’2” tall with a weight of 194 lbs. is considered to have a normal weight, but another individual who is 5’8” tall would be considered overweight if he weighed that same 194 lbs. This is where the BMI (Body Mass Index) comes in. The BMI assesses whether a person’s weight is in a healthy range for their height. BMI is calculated by dividing your weight in kilograms by your height in meters squared. That number should be between 18.5 and 24.9. The National Institutes of Health has defined certain classifications of weight based upon the BMI:
Classification
|
BMI Range |
Underweight |
Less than 18.5 |
Normal |
18.5 - 24.9 |
Overweight |
25.0 - 29.9 |
Obese |
30.0 - 39.9 |
Extreme Obesity |
Greater than 39.9 |
You should discuss with your physician whether your goal should be to attain a normal BMI. For people with a lot of muscle mass, such as trained athletes, a healthy BMI may actually be somewhat higher than what the table would indicate. For most people, however, these categories are a useful guide
Other Measures To Track - BP & Lipids
As mentioned above, you should also track your blood pressure and blood lipid levels. If your blood pressure is normal, checking it at each doctor’s appointment is probably all you need to do. But if you have hypertension (high blood pressure), more frequent measurement is a good idea for a couple of reasons. First of all, since blood pressures changes constantly, the more readings you have taken at various times of the day, the more accurate a picture you will have of how well it is controlled. Second, since most blood pressure medications are designed to control blood pressure throughout a 24 hour period, it’s important to check it before you take your morning medications, when the medication’s effect is at its lowest, to make sure your blood pressure is controlled for the entire 24 hours.
Those lipid levels include the Total Cholesterol, the LDL (bad cholesterol), HDL (good cholesterol) and the triglycerides. The table below gives the usual normal ranges for these. Under certain circumstances your physician may recommend different targets for you, so check with him or her at your next visit.
Control Indicator |
Normal Values |
Blood Pressure (BP) |
- Less than 120/80 for most healthy individuals
- Prehypertension is defined as BP between 120/80 and 139/89
- Less than 130/85 if you have heart failure
- Less than 130/80 if you have diabetes or kidney failure
|
Total Cholesterol |
|
LDL |
- Less than 100 mg/dL is optimal. The significance of higher levels is dependent on your other risk factors for heart disease so a discussion with your doctor is recommended.
|
HDL (Women) |
|
HDL (Men) |
|
Triglycerides |
|
These are the key measures that most healthy adults should be tracking and working towards keeping within the normal range. Check with your doctor to see if there are others on which you should focus. Proper nutrition & exercise can improve these. Many of our members have experienced such improvements in their blood pressure, blood sugar and cholesterol as they have shed pounds. In the next issue, we'll look at this effect in more detail. Meanwhile, take care and stick with the program!
For Your Health - Dr. Bob
