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Heatlh Guidelines: It's Tough Keeping Up

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Milwaukee mother Linda Blake-DeLeo'n, 33, has struggled for years to do what the federal government advised: exercise for at least 30 minutes a day. But when a new set of standards last fall raised the bar to an hour a day, she felt like hanging up her walking shoes and cracking open a gallon of ice cream.

She's also battling unsuccessfully to control her high blood pressure. So what happens? Medical experts set the country's blood pressure goals lower than ever.

She resents that these guidelines keep changing and that the bar for what constitutes good health keeps going up. ''It's very discouraging,'' says Blake-DeLeo'n, who figures she's about 40 pounds overweight.

After a hard day selling classified ads and running four children around, all she wants to do in the evening is sit. ''Some days I can't even find time to do 15 minutes of exercise, let alone an hour,'' she says. ''I walk into my bedroom and see that treadmill and think, 'I can't do it today.' ''

Like Blake-DeLeo'n, many Americans feel they're losing the numbers game when it comes to their bodies. They say it's too hard to make the lifestyle changes necessary to conform to the ever-stricter definition of healthy. Consider:

* Not long ago, a blood pressure of 130/85 was normal. But just last month, new guidelines from the government's National High Blood Pressure Education Program shoved 45 million Americans from the security of the normal range into a new ''prehypertension'' category. The new normal? A blood pressure below 120/80.

* The government has told people for several years to aim for at least 30 minutes of activity most days of the week. Then last fall, the National Academies' Institute of Medicine issued recommendations advising an hour of moderate activity a day for weight control. Only about a third of Americans even met the lower standard.

* People used to be either diabetic or not diabetic. Last year, though, new government guidelines labeled a chunk of seemingly healthy people as ''prediabetic'' and at an elevated risk of diabetes.

* Until 1998, a 5-foot-5 woman who weighed 164 pounds was considered normal. Then the official body mass index (weight/height) criteria changed, and all of a sudden she was considered overweight if she weighed 150 pounds. The guidelines labeled another 29 million people as overweight. Now, almost 65% of Americans weigh too much.

* Most people already find it difficult to eat three or more servings of vegetables and at least two of fruit a day. Now the government is revising its Food Guide Pyramid -- new guidelines are due in 2005 -- and some nutrition experts are pressuring health officials to recommend even more fruits and vegetables.

Listen to doctors and patients, and you quickly get the sense that these moving health targets are raising the level of tension between the preachers of good health and their congregations. But the stakes are clearly high: New estimates on obesity say the malady costs the nation $93 billion in annual medical bills.

Guideline authors say new research ---- not a desire to torture people -- prompted such revisions. Some folks, though, view these goals as impossible dreams.

Dave Barnett, 55, a sales productivity consultant and author in Dallas, is skeptical of the guidelines. ''The longer I live and see these cycles and always-changing guidelines, the more cynical I get. I don't pay any attention anymore. How could you? Only the neurotic and obsessive-compulsive pay attention to this stuff.''

It's just too hard to meet most of these standards, especially the exercise and weight ones, he says.

''You could run from Dallas to Detroit and not burn enough calories to maintain your weight,'' says Barnett, who is 40 pounds overweight and describes himself as having a ''healthy paunch.''

He says meeting all these guidelines is impossible for many people, except perhaps the wealthy. ''Look, Oprah has a personal trainer and personal cook. What have I got? Hamburger Helper.''

Doctors say they're hearing things like this in their practices.

''People blame the messenger,'' says George Blackburn, associate director of the division of nutrition at Harvard Medical School. ''They blame their parents, the doctors, the environment, fast-food restaurants, anybody but themselves.''

The fact that the rules have changed over the years gives them extra fuel for their arguments. ''They say, 'Can't you guys get the information straight? Here you go again changing a guideline. We just get to point X and you change the rules so now we're not healthy. It's your fault,' '' he says.

Reach for the 'brass ring'

But Blackburn and other doctors say people have to get a grip on how important these things are if they want a long, healthy life, and they should start with small changes. ''It doesn't matter how far up the brass ring is; you've got to get up on the merry-go-round and start reaching.''

Some even wonder why we need these guidelines anyway. For a nation of chubby couch potatoes, we're living longer than ever. Over the past century, life expectancy jumped 30 years to age 74 for men and 80 for women, thanks to progress in treating diseases and public health measures to prevent them, such as clean water and childhood immunizations.

''If we weren't in the middle of this obesity epidemic, we'd be living even longer and suffering from fewer chronic diseases,'' says Tim Byers, a professor in the department of preventive medicine at the University of Colorado School of Medicine in Denver. He is co-chair of the American Cancer Society's cancer prevention guideline committee.

Many people just ignore the rules of good health. ''The general public doesn't pay as much attention to these guidelines as we think,'' Byers says. ''We issue a guideline, and we think the world is going to change by next Tuesday, but it doesn't.''

And some patients find doctors with a sympathetic ear. Take Steven Woolf, a primary-care doctor, who says he has to prioritize his patients' health problems.

''It's already a difficult enough challenge for patients to lose a few pounds, to adopt a regular exercise program,'' says Woolf, a professor of family practice at Virginia Commonwealth University and a member of the U.S. Preventive Services Task Force. ''Those are things we were focusing on already. Calling it prehypertension doesn't make it any easier.''

Calling a blood pressure of 120/80 prehypertension instead of normal probably isn't going to make much of a difference to patients who have been hovering around 160/90, says Vincenza Snow, an internist in Philadelphia.

On the other hand, Snow says, ''you're going to see patients who have really been working hard. Maybe they've reached 130 over 80 and are feeling pretty good about it. And then this comes around and bursts their bubble.''

In some cases, the doctor isn't going to argue. David Lubin, a family-practice physician in Tampa, says: ''The longer you practice, the sooner you go 'Hmmph. I'm not going to change my ways.' I've been in practice 27 years. It's hard for me to change conceptually what I do.''

But many doctors say they need guidelines to hold up as ideals to patients.

''As more evidence becomes available on what's necessary for good health, we have to deal with it,'' says Robert Bonow, president of the American Heart Association and chief of the division of cardiology at Northwestern University Medical School. ''Goals are goals. Not everyone can achieve every one of them. These should be things people aim for. We are trying to steer toward a healthier society, and we realize we are swimming upstream.''

And many people, like Bill Paprota, 52, an attorney in Overland Park, Kan., say the standards serve a purpose. ''They give us broad parameters, and you can gauge with your doctor where you fall. You want to know what the experts are thinking so you can go to your doctor and ask halfway decent questions. Knowledge is power.''

But, says Paprota, who maintains a healthy weight and exercises regularly: ''I hope they don't keep changing the rules so everyone has high blood pressure.''

Thomas Stone, 50, of Cincinnati is a trim 6-foot-2, 170 pounds, but that didn't stop him from developing high blood pressure a few years ago. Stone says he has controlled it fairly well with medication, but he acknowledges that the new hypertension guidelines have gotten him to think about exercising more.

''I think, ultimately, these numbers will force me to be more diligent,'' Stone says.

One day at a time

Blackburn advises patients to take one day at a time. He tells them: ''Today is the day you have to have some control. Yesterday is history, and tomorrow is a mystery, but today you are this number, and you want to make it better.''

He has patients aim for a 5% to 10% weight loss, since studies show that people who lose as little as 5% to 6% of their weight (only 10 to 12 pounds for someone who weighs 200 pounds) experience significant improvements in their blood pressure, cholesterol and blood-sugar levels. Then they can aim for another 5% and another 5% and so on, he says.

''With weight loss, 10% goes a long way toward looking good and feeling good; however, the key is keeping it off,'' Blackburn says. ''There are no points for taking it off. The points are for keeping it off.''

Many of the goals can be achieved with the same rather simple lifestyle changes, says Bonow of the heart association. For example, exercise and eating fruits and vegetables and less saturated fat can help control blood pressure, obesity and cholesterol and lower the risk of heart disease.

Patients are overwhelmed

General internist Linda Stern says many of her patients at the Philadelphia Veterans Affairs Medical Center have all but given up on their health. Their lives are too overwhelming to worry about anything else. Sometimes she asks patients to tell her about a typical day, and they break down in tears.

''People just have too much stress in their lives. We all have too many balls in the air,'' Stern says. ''They are working hard. They come home exhausted.''

Working with a ''unique'' population at the VA, however, Stern uses patients' service background to remind them how they felt when they were ''in fighting shape'' and lighter on their feet.

Blake-DeLeo'n, the working mother in Milwaukee, says the difficult part about exercising is forcing herself to get on the treadmill. ''It's a mind thing. Once I get started, I like it.''

Exercising is one of the hardest things to motivate people to do, and the recent change in numbers has discouraged people, says John Foreyt, director of the Behavioral Medicine Research Center at Baylor College of Medicine in Houston.

He has spent years studying motivation and believes the drive to be physically active is low among people in the USA. ''They say, 'We don't have the time. We work two jobs, and we're dead tired when we get home.' ''

It's hard to go home and put on your jogging clothes and go jogging, Foreyt says. It's easier to swing by a fast-food restaurant and watch TV or a movie. ''Many people have simply given up.''

If there were one guideline Byers of the cancer society wishes people would take seriously, it is the original federal guideline to do at least 30 minutes of moderate activity most days of the week. It can be done in 10- to 15-minute increments. Any activity is better than none, and more is better than a little, he says.

''Of all the behaviors that are health related, physical activity is by far the most important. It's strongly protective for heart disease, diabetes and some types of cancer, and regular physical activity is essential for a lifetime of weight control.''

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