When you go to a health screening or to your healthcare provider for a wellness exam, often a lot of numbers are thrown at you. Height, weight, lab results, and blood pressure to name a few. What do these numbers mean and why are they important? Here’s some information to provide you with a better understanding of your wellness exam.
Most people seem to have at least a basic understanding of some of these health measurements, for example knowing that high blood pressure or cholesterol is bad for your heart, or that a high BMI means you’re not at a “healthy” weight. Today I wanted to give you a little more clarity on what these numbers mean and why it’s important to have them checked.
The first numbers I see when someone comes in for a wellness visit (also referred to as a physical or checkup) are their vital signs, which include height, weight, calculated BMI, blood pressure, and heart rate among others. The second big set of numbers I look at are usually labs which typically include a fasting blood sugar and a cholesterol panel.
In an otherwise healthy individual, I use these numbers to determine their risk of developing chronic diseases, namely heart disease and diabetes. Essentially my number one goal is to keep your heart healthy and ticking for as long as possible, without developing a heart attack or stroke. This may not seem like that big of a deal for someone that is relatively healthy and young, however, these risks often go undetected because people don’t always feel bad. And it’s really the chronic damage over years that becomes an issue. And trust me, these issues are definitely present in many unassuming 20 and 30-somethings.
Some of these risks we can’t control, like age, gender, and family history. A middle-aged male with a strong family history of heart disease has 3 strikes against him already. The ones we can control are smoking, blood pressure, blood sugar, and cholesterol. The more uncontrolled risk factors someone has, the higher their chance of developing chronic diseases. It’s not rocket science. Let’s look at some of the measurements you might see.
For most people, the goal is less than 120/80. If blood pressure is consistently elevated above this, it’s causing damage to the cardiovascular system. Imagine your blood vessels like a water hose. Now, picture water turned on to the highest pressure all the time. The walls of the hose expand to accommodate the increased pressure and volume, and over time this wears the hose out, causing cracking and splitting. Think about turning the water down to a low flow. The pressure inside is minimal and doesn’t really cause any wear and tear. A lot of my patients don’t think “a little high” blood pressure is that big of a deal, but over time it is a big deal and needs to be controlled. The good news is for many people blood pressure responds well to positive lifestyle changes like diet and exercise.
Diabetes is a complex disease and certainly, the details are beyond the scope of this post. A very simple explanation would be when the body has been stressed with too much sugar over years, it becomes resistant to processing that sugar. This leads to a cascade of other problems include a weakened immune system, nerve damage, and chronic inflammation. The early stages of this are insulin resistance or pre-diabetes. Ideally, a fasting blood sugar is between 70-100. If it’s 100-125, this is a huge range of what we call impaired fasting blood sugar. At this state diet and exercise can have a significant impact on delaying or stopping the progression to diabetes, so it’s important to catch this and start managing it with lifestyle changes early on. Diabetes is not a pleasant disease to have (if there is such a thing) and preventing this for my patients is extremely important to me.
For years it’s believed that elevated cholesterol levels increase the risk of developing heart disease. At this time, it’s still best practice to assess a basic cholesterol panel and treat people who have high cholesterol with either medication or lifestyle counseling. A lot is being discovered and studies being done about more specific types of cholesterol that are likely to play a key role in developing heart disease, and the basic panel we collect now may not showcase that very well. And depending on what studies you look at, some providers pay more attention to LDLs (the “bad” cholesterol), others on different ratios of triglycerides, HDLs (the “good” cholesterol) and other measurements. As of now, the numbers you’re most likely to see are a total cholesterol, which the goal is under 200, HDL with a goal above 40, and LDL with a goal of less than 130.
If someone’s blood pressure, blood sugar, and cholesterol levels are high, this is a big indication to me their metabolic health is in jeopardy and they’re at risk of developing diabetes or cardiovascular disease. Unfortunately, I see this in a lot of young adults in their 20’s, 30’s and 40’s who feel perfectly fine. They may be a little overweight but don’t really think it’s that big of an issue to their health “yet.” I try to have very candid discussions that if this continues it’s putting a chronic strain on their cardiovascular system.
The good news is, all of these issues- blood pressure, blood sugar, and cholesterol levels- have a great response to positive lifestyle changes like eating healthier and exercising. This typically means cutting down on highly processed foods and excess sugars and starches, and increasing activity. I tell my patients you don’t have to join a gym, simply going for a walk for 10-15 minutes most days and eating more fruits and vegetables can have an impact.
You may notice weight was not mentioned above as one of the most important numbers I look at. That’s because as it turns out, weight is not known to be a direct cause of heart disease or diabetes. It is certainly correlated but is not necessarily directly causative. I say that because I want my patients to understand it’s very possible they could start eating better, exercising, and return to my office and find all of their labs have improved but their weight has barely changed. This actually happens often. I tell them they are exponentially more healthy than they were before, even though their weight hasn’t changed. I’d rather see normal labs and blood pressure than weight loss. Weight is not always a direct measurement of health and it’s definitely possible to be overweight or even obese, but healthy. I’m not saying that’s always the case, again there is a correlation between weight and chronic disease. But I do want people to know that it’s much more important to focus on healthy habits like eating well and exercising than to focus on the scale, and not to be discouraged and give up if their weight doesn’t change significantly. I typically look at my patient’s weight trend. Are they slowly trending up 2-4 pounds at every visit, or are they relatively stable? If their weight is stable, they’re focused on healthy habits, and their labs and vital signs are improving, I’m just not that worried.
Yearly wellness exams are important to screen for these issues, even if you feel fine. Remember there’s almost nothing that isn’t improved with healthy eating and an active lifestyle so finding out how that best fits in your life is the most important thing you can do for your health!