Understanding risk factors can help individuals to identify the lifestyle changes needed to make a positive difference. The lifestyle risk factors include smoking, nutrition, alcohol and physical activity (aka SNAP). Each of the SNAP risk factors is associated with many diseases and often interrelate throughout the lifecycle. It is therefore important to manage risk factors collectively and not in isolation.
The Risk Factors
1 Smoking - Smoking is estimated to kill approximately half of all long-term users, causing 40% of deaths in men and 20% of deaths in women before the age of 65. Smoking is the risk factor responsible for the greatest burden of disease in the country (9.7%). Factors that influence smokers to quit are health effects and substantial costs. Smoking within 30 minutes of waking, smoking more than 10 cigarettes per day and history of withdrawal symptoms in previous quit attempts are all markers of nicotine dependence.
Pharmacotherapy for dependent smokers is proven to double the chances of successfully quitting. Programs eg Quitline can assist individuals to cease smoking. Behaviour support is recommended in assisting individuals to cease smoking.
2 Overweight and obesity - People who are overweight have a higher risk of disease, including coronary heart disease, diabetes, dyslipidaemia, hypertension, and bone and joint disorders. The presence of excess fat in the abdomen is an independent predictor of morbidity.
Weight reduction can be achieved in a variety of ways, eg by reducing fat (especially saturated fats), carbohydrate, protein or alcohol intake, in combination with smaller serve sizes. Any changes must be maintainable over the long term. Fad diets are not recommended for long-term weight loss. People trying to reduce weight should read food labels and limit consumption of processed foods that may be high in added salt and sugar.
Waist circumference is a strong predictor of health problems such as cardiovascular disease (CVD), diabetes and metabolic syndrome. Body mass index (BMI) and waist circumference should be measured and noted. Waist measurements for Increased risk – males > 94cm and females > 80cm; High risk – males > 102cm and females > 88cm. BMI: normal – between 18.5 and 24.9.
BMI on its own may be misleading, especially in older people and muscular individuals, and classifications may need to be adjusted for some ethnic groups.
BMI may not correspond to the same degree of risk in different populations due, in part, to different body proportions. In Asian populations, for example, BMI greater than 23 may convey increased risk.
3 Nutrition - Diet is a key contributor to optimum health throughout every stage of the lifespan. Exclusive breastfeeding for at least the first six months of life offers considerable health benefits to infants and, in the long term, to children and adults. Diets low in fruit and vegetables have been causally linked to cancer and CVD. Most Australians (91%) do not eat enough vegetables and only half eat enough fruit.
Enjoy eating from the five food groups every day (vegetables, fruit, grains, lean meats and dairy). Diet is an important risk factor, independent of weight. The daily intake of fruit and vegetables is considered an important indicator in the Australian diet.
The Australian Dietary Guidelines make five key recommendations:
• To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.
• Enjoy a wide variety of nutritious foods from the five food groups every day
• Limit intake of foods containing saturated fat, added salt, added sugars and alcohol
• Encourage, support and promote breastfeeding
• Care for your food; prepare and store it safely
4 Alcohol - Alcohol consumption accounted for 3.3% of the total burden of disease and injury in Australia. Even though moderate alcohol intake may have beneficial effects at middle and older ages, alcohol is harmful when consumed in excess at all ages. Alcohol is responsible for the majority of drug related deaths and hospital episodes among people aged 15–34, causing more deaths and hospitalisations in this age group than tobacco or all illicit drugs.
The lifetime risk of harm from drinking alcohol increases with the amount consumed. The risk of an alcohol-related problem increases dramatically with an increase in the number of drinks consumed.
For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury. Short-term risks stem from the risks of accidents and injuries occurring immediately after drinking.
Alcohol consumption is calculated from the amount of alcoholic beverages, such as beer, cider, wine, spirits and mixed drinks, typically consumed in a day, combined with the number of days per week in which alcohol is usually consumed. Alcohol consumption is most often measured in standard drinks. An Australian standard drink contains 10 g of alcohol, which is equivalent to 12.5 mL of alcohol.
5 Physical Activity - Physical inactivity is responsible for nearly 7% of the total burden of disease and injury. Based on data from the 2007–08 National Health Survey, almost 60% of Australians aged 15 and older do not undertake sufficient physical activity to confer a health benefit. Physical activity is an important part of a healthy lifestyle. It may reduce the risk of developing conditions such as CVD, diabetes and certain types of cancer. Approximately 300 minutes of moderate-intensity activity, 150 minutes of vigorous activity, or an equivalent combination of both, each week, combined with reduced dietary intake.
Working with your GP can form the basis for sustainable behaviour change and determine your risks for many diseases.