Your list of New Year's resolutions probably includes at least one of the following: Lose weight, exercise every day, get more sleep, decrease the stress in your life, and start wearing sunscreen every time you step outside. And while a case can be made for those and other health prescriptions, two pre-eminent health experts, breast surgeon Susan Love and psychologist/stress expert Alice (Ali) Domar, are here to tell you that perhaps you don't need to adhere to them as strictly as you've been told. In their new book, Live a Little! Breaking the Rules Won't Break Your Health (Crown), they say perfect health isn't a reasonable—or even possible—goal, and instead we should focus on getting "pretty healthy." U.S. News chatted with Domar and Love about what that means. Here are some edited excerpts.
The book advises women that with a few exceptions, they should generally chill out about their health. Was there one study or silly piece of health advice that inspired you to write the book?
Domar: A group of us [health experts from LLuminari, a health and wellness company cofounded by Love] got together; we wanted to look at the science and get the correct information out to women about what they can do for their health. So we started looking at studies about things like sleep, relationships, and stress. After the second or third topic, it became clear that with every area, there's a U-shaped curve [either extreme is unhealthy]. What you want to do is stay in the middle zone, and that middle zone is pretty large. With weight, for example, having a BMI of between 25 and 29 [considered "overweight" but not obese] is not associated with a shorter length of life. I'd far rather you be 10 pounds overweight than 10 pounds underweight. [Being underweight has been associated with a shorter life and can be dangerous in old age because it offers little protection in a fall.] Women are obsessing with their health, their weight, their exercise routine. What are the health risks of constantly worrying about your health?
Do you find that many women think they have total control over their health, if they just do the "right" things?
Domar: Isn't that the message we keep on getting? We have this idea that if you're thin and you exercise, you are immune to disease.
Love: I think we need to continually acknowledge that we are not in control. Let go. If you think you're in control of everything and you aren't doing all the right things, that's much more stressful. Instead, leave room for the vagaries of life. Say, "I'm going to do the best I can and enjoy my life while I've got it."
Surely there are some rock-hard rules that we really should all follow.
Domar: There's no getting around it: If you smoke, don't practice safe sex, or don't use a seat belt, you are putting your life in jeopardy. There's a whole lot more wiggle room on a lot of other "rules." Even with [now demonized] hormone therapy, if you have really bad menopausal symptoms, one or two years of it is likely not going to harm you. One thing I learned from looking at the data is how big that healthy middle zone is.
What's the big picture on what we should eat? And where is the evidence from?
Domar: The [low-sodium] DASH diet, the Mediterranean diet—those are good diets. But much of the evidence about diet comes from epidemiological research [which cannot prove cause and effect]. So we really can't say with regards to you and me whether something like the Mediterranean diet will make a difference. Is it the diet or the fact that people who are Greek have close family ties? It's really hard to tell. One of the big issues with things like nutrition is that they'd have to be 20- or 25-year studies. That's how long it will take to see if a diet has an impact on cancer and heart disease. And how do you know if people will follow the diet? You have to look at these things in the real world: A 25-year-old is not going to follow the DASH diet. Instead, you have to have common sense. Women get this. We know that chocolate cake isn't as good for us as carrots.
[See a one-day sample DASH diet menu.]
You two say your biggest personal disagreement was over the importance of exercise. Susan said if you can walk a mile in 20 minutes, you're pretty fit and healthy; Ali thought that the process of exercise itself is also key to health.
Love: The answer turns out to be that both of us are right. It depends on age. When you're young, it's more important to be fit. The additional benefits of actively exercising are not major. The body is more forgiving. [Though you do set habits that may be hard to change later on.] As you get older, the practice of exercise becomes more important. That's when you get to the "use it or lose it" point. I didn't start running until I was 50, and I lost some weight after menopause.
Domar: Women feel incredibly guilty if they don't exercise, but if you have a toddler, you're probably running around after the kid all the time. The human body isn't designed to go the gym for 50 minutes every day. It's designed to be naturally active throughout the day.
Any other areas of controversy among the experts?
Domar: We disagreed about the importance of the annual physical. I think it's a good idea to check in with your physician once a year.
Love: But there's no data supporting an annual physical, and with the amount of time physicians have to actually spend with you…it's not likely to be useful.
What about mammograms? Your book went to press before the United States Preventive Services Task Force came out with its new recommendations that women in their 40s should make individual decisions whether to get screened and that women from 50 to 74 should be screened every two years.
Love: There wasn't controversy among us. [The book says women in their 40s without a family history of breast cancer can get a mammogram every two to three years.] These [new] guidelines are not anything new. They're the guidelines that most of the world already uses. We've oversold mammography. The question isn't whether young women get breast cancer; it's whether mammographic screening is going to make that much difference.
How do you suggest women approach health claims—about exercise, diet, procedures, or whatever?
Love: I think you have to look as critically at medical information as at everything else. If someone says, "Drive this car and you'll be sexy and get a good husband," you recognize that they're trying to sell you something. You have to look at medical information as critically. Was research done in people? Who paid for it?
What do you two prioritize, healthwise?
Love: I worry about trying to get in some exercise at least every other day, and I do try not to gain weight. Those are really the two things I feel strongly about. I'd love not only to live to see my grandchildren, but to be able to play with them. I'd love to meditate if it weren't so stressful to find time to do it! And I play piano—I started taking lessons when I was 55.
Domar: Exercise is the one thing I really push to make time for. It's associated with a decreased risk of many diseases, and it's the best stress reliever I know. It would be pretty ironic if my stress level was high and I was advising people on how to reduce stress. I'd literally skip a meal rather than miss exercise.
[Read about 4 diets that are really good for you. And check out why women might want to focus on strength training.]