TIME Diet/Nutrition

Soda May Age You as Much as Smoking, Study Says

The link between soda and telomere length

Nobody would mistake sugary soda for a health food, but a new study published in the American Journal of Public Health just found that a daily soda habit can age your immune cells almost two years.

Senior study author Elissa Epel, PhD, professor of psychiatry at University of California San Francisco, wanted to look at the mechanisms behind soda’s storied link to conditions like diabetes, heart attack, obesity, and even higher rates of death. She studied telomeres, the caps at the end of chromosomes in every cell in our body, from white blood cells. Shorter telomeres have been linked to health detriments like shorter lifespans and more stress, cardiovascular disease, diabetes and cancer, the study notes.

Epel and her team analyzed data from 5,309 adults in the National Health and Nutrition Examination Survey (NHANES) from about 14 years ago. They found that people who drank more sugary soda tended to have shorter telomeres. Drinking an 8-ounce daily serving of soda corresponded to 1.9 years of additional aging, and drinking a daily 20-ounce serving was linked to 4.6 more years of aging. The latter, the authors point out, is exactly the same association found between telomere length and smoking.

Only the sugary, bubbly stuff showed this effect. Epel didn’t see any association between telomere length and diet soda intake. “The extremely high dose of sugar that we can put into our body within seconds by drinking sugared beverages is uniquely toxic to metabolism,” she says.

She also didn’t see a significant link between non-carbonated sugary beverages, like fruit juice, which Epel says surprised her. But she thinks the results might be different if the data were more modern. “We think that the jury’s still out on sugared beverages—theoretically they’re just as bad,” she says. “But 14 years ago people were drinking a lot less sugared beverages…they were mostly drinking soda.” At the time of the study, 21% of adults in the study reported consuming 20 ounces or more of sugar-sweetened soda each day, but soda consumption has been on the decline for years.

Telomere length dwindles naturally as we age, but it may not be an irreversible process. Previous research shows that it’s possible to increase telomere length by as much as 10% over 5 years by stressing less and eating a healthy diet—no soda included.

Read next: Here’s How to Stop Teens From Drinking Soda

TIME Diet/Nutrition

How Healthy Are ‘Secret Menus’ at Restaurants?

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The answer is more complicated than we expected

For years, Jamba Juice has marketed healthy and nutritious smoothies blended with 100% fruit juice. But the website Hack the Menu points out a “secret menu” with items like “Red Gummy Bear” and “Pink Starburst“—both allegedly blended to taste like their candy namesakes. The rumored off-menu offerings sound a little sweeter, but potentially less healthy.

Jamba Juice is not alone in its reputation for having a secret menu: according to Hack the Menu, restaurant chains like Starbucks, In-N-Out Burger and Chipotle also oblige off-menu requests for those in the know. TIME looked into why restaurants might bother with a whole other menu, and whether secret menu options are always less healthy than their advertised counterparts. The answer is more complicated than we expected.

MORE: Try Ordering These Delicious-Sounding Drinks From Starbucks’ Secret Menu

Surprisingly, most nutritionists we spoke to had never heard of the concept of secret menus. Their feelings were mixed, but most said they were concerned about the lack of readily accessible nutritional information for off-menu items.

“So many consumers are looking for transparency,” said Keri Gans, a registered dietitian and author of The Small Change Diet. “If you want a secret menu, at least make it obvious what the calories are and [put] the nutrition analysis where it’s available for people to see.”

MORE: There’s a $10 Secret Menu Item At Arby’s Called the Meat Mountain

Excluding unhealthy items from a menu helps avoid having to disclose their lack of nutritional value. This is especially true in places like New York, where the law requires restaurant chains to display certain nutritional information in menus. That regulation doesn’t apply to items that aren’t on the menu, or those listed on a menu for less than 30 days, the New York City Department of Health and Mental Hygiene wrote in an e-mail to TIME. Secret menu items “undermine the intention of the rule,” though they’re technically legal, it said.

A lack of transparency becomes a potential problem for people with allergies, who may not be aware of what ingredients are included in the item they’re ordering, nutritionists said.

“To me, the most important thing is that the staff would be educated on what the ingredients are,” said Gans.

Spokespeople for most of the chains contacted by TIME denied the existence of a “secret menu,” but acknowledged that customers can customize their orders.

“Our people are trained to make what customers want with the ingredients we have,” said Chipotle communications director and spokesperson Chris Arnold in a statement. Nachos and a quesarito, a mammoth burrito blanked inside a quesadilla, are among the items that customers order off-menu at Chipotle, according to Hack the Menu.

MORE: Taco Bell Is Adding A Quesarito To Its Menu

But despite their shroud of secrecy, secret menus don’t appear to be all bad news, nutritionists said. Some have options that appear healthy, while others allow customers to modify a menu offering in a way that makes it healthier, said Jessica Levinson, founder of nutrition consulting business Nutritioulicious. She cited an option to swap out mayo for mustard at Burger King as one such option.

Registered dietitian Judy Caplan praised efforts to offer healthy options, but said she wasn’t surprised that some fast food restaurants would offer less healthy options off the menu. While fast food has become more nutritious in recent years, and chains have recently cut calories in new menu items by 12%, there are still many customers who want unhealthy food, she argued.

“When you’re in business,” she said, “the customer is always right.”

TIME Obesity

How Jet Lag Can Contribute to Obesity

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Changing your circadian clock messes with your microbes

Working the night shift has long been linked to an increased risk of obesity, heart attack and breast cancer. One 2011 study even showed that shift work lasting a decade or more boosts your risk for type-2 diabetes by 40%. And new study published in the journal Cell looked at why.

Researchers led by Eran Elinav, MD, PhD, senior scientist in the immunology department at the Weizmann Institute of Science in Israel, suspected the gut microbiome, which he calls “the neglected organ,” might be affected by a disrupted circadian rhythm. It wasn’t an obvious choice. Microbes hang out in the dark of our guts, so they’re never directly exposed to light and dark cycles, he says. That’s why it was surprising to find out that the microbiome is very much affected by disruptions to our bodies’ inner clocks.

Elinav started by making mice work the graveyard shift, subjecting them to a state that would be the equivalent of jet lag from an 8-hour time difference in humans. Mice are nocturnal, so in this case, they stayed awake during the day. “We saw that in the presence of jet lag, their microbes were completely messed up,” he says. The bugs changed in composition and function, losing their circadian rhythm and becoming far less efficient at tasks like cell growth, DNA repair and detoxification. Like humans, mice microbes perform housekeeping and repair functions while they sleep, and growth and energy-promoting functions when they’re awake. But in the study’s graph of these functions in jet-lagged mice, the tasks hardly vary throughout the day and are performed at much lower levels.

These mice were also more susceptible to obesity and diabetes, and when Elinav transferred their gut bacteria into sterile, germ-free mice, they also transferred the heightened risk for disease, “proving that it’s actually their microbes driving this susceptibility,” he says.

Such a theory is much harder to test in humans, of course, but Elinav studied two people traveling from the U.S. to Israel, which induced an 8-hour jet lag similar to the mice. He sampled their gut bacteria three times over two weeks, capturing the main stages of jet lag, and found that their microbes indeed changed in composition, and in ways that were startlingly similar. Elinav even transferred the humans’ jet-lagged bugs into germ-free mice. “We could very nicely see that transferring the gut microbes from the point where jet lag was at its highest induced much more obesity and glucose intolerance,” he says.

Thankfully, the gut microbes of the travelers had returned to normal two weeks after their flight, and transferring their bugs into mice no longer led to increased obesity and glucose intolerance. But the implications of the findings are troublesome for frequent travelers and especially shift workers, whose work demands a consistent disruption of circadian rhythms.

TIME Obesity

How Family Dynamics at the Dinner Table Affect Kids’ Weight

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It's not just what kids eat, but who they eat with that matters when it comes to their weight

“Eat together” is a mantra that doctors and nutritionists use regularly when they talk with families about eating healthy and maintaining normal weight. Children who eat regular family meals tend to have lower rates of obesity and eat more nutritiously. A new study published Monday morning in the journal Pediatrics takes a novel look at why.

A team led by Jerica Berge, in the department of family medicine and community health at University of Minnesota, asked the families of 120 children aged 6 to 12 to record eight days of meals. The families didn’t have to eat every meal together, and didn’t even have to eat dinner together every one of those nights, but did have to share at least three meals during that time. Half of the children were overweight or obese, and half were normal weight.

To tease out what features of the family meal might be influence weight, Berge’s team laboriously coded the interactions occurring at the table into two broad groups — those relating to the emotional atmosphere at the meal, such as how much the family members seemed to be enjoying the time together, how much hostility the diners showed one another, and how many uncomfortable silences or awkward pauses occurred — and those involving food specifically, including how much hostility emerged from discussions about food, including weight issues, and how much the parents controlled or limited what and how much children ate.

Children who were overweight or obese had family meals that included more negative emotional interactions — hostility, poor quality interactions, little communication and more controlling behavior from their parents — compared to children who weren’t obese. Their meals tended to have a warmer, more communicative atmosphere. For example, these children were given positive reinforcements to eat, and were encouraged to eat foods to get stronger or run faster, while heavier children experienced more negative pressures including threats and made to feel guilty about those in the world who can’t afford to eat three meals a day. If parents or caregivers talked constantly throughout the meal about food, and lectured about homework or attempted to control what the children ate, the youngsters were also more likely to be heavy.

“I was surprised by how consistent the patterns were,” says Berge. “Almost every single one of the emotional factors we coded were in the right direction, and there were really clear patterns in how much positive or negative interactions were associated with overweight and non overweight.”

The analysis also revealed other things that distinguished the family meals of overweight children and normal weight youngsters. Heavier children tended to have shorter meals — spending 13.5 minutes on average eating with their family compared to 18.2 minutes for non obese kids. Children who weren’t obese were also more likely to have a father or step-father at the table. The reason, says Berge, may be practical. “It might be a matter of having one more person at the table for crowd control, another person to help make the meal and be a model for children to emulate,” she says.

The team only coded the types of interactions between the family members during the meal, and did not include an in-depth look at what the families were eating. But that’s the focus of their next study.

In the meantime, the current data suggests that simply sitting down at the same table at the same time isn’t enough to influence obesity. And it’s up to pediatricians and family doctors to help families understand how to take full advantage of breaking bread together. “There is clear evidence that family meals are important in protecting kids against overweight,” says Berge, “so it’s important to start the conversation with families. It’s important to focus on making the meal environment more positive.” And, as her study showed, it doesn’t take lengthy repasts either — just 20 minutes as many times a week as possible.

Read next: Why I Don’t Eat With My Kids

TIME Obesity

Why Brown Fat May Be the Key to Weight Loss

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Can you think your way thinner?

Not all fats we eat are created equal. We all know that, trying to dodge the less healthy ones that come from animals and dairy products and load up on those less likely to clog our arteries and add to our waistlines.

But it turns out that even after we consume fat, we store it in different forms as well, and scientists reporting in the journal Cell have identified a pathway in the brain that can direct our bodies to convert stubborn waistline-growing fat into a different fat that’s easier to burn off.

MORE: Having The Right Kind of Fat Can Protect Against Diabetes, Study Says

Brown fat, so-called because it is rich in the darker hued energy factories of cells known as mitochondria, is a calorie-hungry machine. It consumes a lot of energy and generates just as much, mostly in the form of heat. That’s why brown fat is more common in newborns, who need to be protected from getting chilled after nine months in the toasty womb. As we age and are better able to regulate our body temperature, we lose brown fat, and until recently scientists thought most adults had little brown fat, if any.

Now researchers at Yale School of Medicine have identified the process that turns white fat, the more common kind in the average adult body and the primary culprit in weight gain, into the energy-consuming brown fat.

MORE: How Now, Brown Fat? Scientists Are Onto a New Way to Lose Weight

Working with mice, the scientists honed in on a set of neurons in the brain that regulate the body’s energy balance, including the breakdown of glucose, which is the primary source of fuel for most cells. When mice fast, for example, their bodies shift into a type of emergency mode, conserving energy and shutting off systems and cells that require high amounts of energy, such as the heat-generating brown fat cells. Fasting resembles times of starvation, so evolutionarily, this makes sense; when food is scarce, the body shunts its energy toward essential processes, such as keeping the heart pumping and getting oxygen to the brain.

Xiaoyong Yang, an associate professor of comparative medicine and physiology at Yale, showed that this switch to conserve energy is intimately tied to hunger signals in the brain. “We showed that hunger itself is a signal that controls the browning of white fat, so the brain can actually control the browning of white fat.”

That means it’s the brain that regulates what type of fat, and how much of it, is burned. In obese animals, Yang found, these hunger signals are dysfunction; overweight and obese mice eat regardless of whether they are hungry, so the normal physical signals from the stomach don’t function properly. Heavier animals continuously feel hungry, even if they’ve eaten enough for their energy needs. That perpetuates the cycle of obesity, since it shuts off the transformation of white fat into energy-consuming brown fat, and therefore keeps more fat in an inert, pound-packing form.

“Obese animals, and people, lose the response to hunger,” he says. “Although there is plenty of food and plenty of energy, the hunger neurons send a false message that the body needs to conserve energy, not burn it.”

Eventually, he says, it might be possible to intervene with the hunger signal anywhere along its journey from the brain to the fat cells, and that may shift the balance in favor of burning fat rather than storing it, which might open the door to weight loss. But calibrating the switch will be critical, since favoring the burning of fat can also lead to other physiological problems such as wasting and malnutrition. “You don’t want to set the body’s energy balance to zero,” says Yang. “You want to reset it to normal levels.”

TIME health

How to Get Over Your Fear of the Gym

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This article originally appeared on Refinery29.com.

Gym + Intimidation = Gymtimidation, and I’ve had a bad case of it for years. As a big girl, gym culture can be intimidating for a variety of reasons. I know I need to lift weights and build strength, but that testosterone-filled section of the gym doesn’t always feel fat-girl friendly, especially when I’m not exactly sure what I’m doing.

But, it’s not just the free-weight room that gives me anxiety. I’m a strong swimmer, but when I head to my gym’s pool, I’ve had lifeguards ask if I’m looking for the slow lane — before I even get in the water. I’ve noticed that the women who look fit are offered free personal-training sessions, while instructors size me up and simply dismiss me because I’m bigger.

I’m on a plus-size fitness journey, though, which means I need to get comfortable at the gym. In order for me to do this right, I need to work out often and try new things. If I only stick to the exercise classes and workouts I’ve always done, my body’s going to get used to those exercises, essentially making them less effective. And, I intend to meet my fitness goals — not shy away from them.

(MORE: Why Body Confidence is Complicated, No Matter Your Size)

Because of my tendency to get nervous at the gym (and practically run out before I start sweating), there have been many times when I’ve had to give myself a pep talk: “CeCe, get over it!” Lately, when I head to the gym, I have to take a quick minute to remind myself that it’s ok to ask for help. That I must get over my fear of the guys in the weight room. I’m also working on getting more comfortable with getting undressed in the main locker-room area, which is a heck of a lot easier than doing it behind the doors of a cramped stall.

Getting over my gymtimidation is an ongoing process. Every time I think I’ve shed my fears and anxieties, there’s something new I have to conquer: a new machine, a new instructor, or even my desire to try new classes, like Spinning.

When I first braved a Spinning class, I didn’t know anyone in it, so I made sure to arrive 30 seconds before class started to stay as anonymous as possible. I jumped on a bike in the back corner of the room and watched the regulars exchange hugs and kisses before the lights dimmed and class began.

(MORE: Why I Dated a Guy Who Hated My Body)

The next 45 minutes were awful. My shoes got stuck in the pedal straps, I kept turning knobs on my bike without knowing what they did, and, perhaps worst of all, my butt really hurt. When the class ended, I ran out of there as fast as I could and didn’t return.

But, the fact that I couldn’t bring myself to attend another Spinning class meant only one thing to me: I was letting gymtimidation rob me of a good workout. So, last week, I got back on that bike. I arrived early this time, chose a bike in the front row, and when the instructor walked in and asked if I was new, I admitted that I was and asked for help. He taught me how the bike worked and how to set up my seat and handles. The class was definitely intense, but every step of the way, the instructor gave me the attention I needed to keep up. He even instructed me to sit back on the seat a bit, because, as he said, my butt was probably hurting. How did he know?

Forty-five minutes later, I walked out of the studio feeling sweaty, motivated, and, above all, proud of myself. I had finally gotten out of my own way and unlocked a new workout option for myself. Who knew what other workouts I’d try next? As I headed to the locker room, the instructor called out after me: “Great job today! I’m glad you mentioned that you were new; most people don’t do that.” I guess I’m not the only one with gymtimidation!

(MORE: Please Stop Calling Yourself a Fat Girl in Front of Me)

On her blog, Plus Size Princess, CeCe Olisa has detailed everything from what it’s like to be the only big black girl in a yoga class (fine, thanks!), to her adventures in plus-size dating in the Big Apple. Now, the New York City transplant is lending her poignant, often-hilarious voice to R29.

TIME Obesity

Antibiotics Before Age 2 Increase Risk of Childhood Obesity

A potential unintended consequence of the broad-spectrum drugs

Antibiotics, the most commonly prescribed medications in the first two years of life, might come with the unintended consequence of childhood obesity.

By age 2, an astonishing 1 in 10 kids are obese, weighing about 36 pounds. Childhood obesity isn’t a problem with a single cause, but according to a new study published in JAMA Pediatrics, some of it could start at the doctor’s office. Researchers looked at the health records of more than 64,000 children from 2001-2013 and found that using antibiotics before age 2 was associated with an increased risk of obesity by age 5. Almost 70% of the children in the study had taken antibiotics before age 2, with an average of 2.3 courses of the drugs per child. The link was especially strong in children who took four or more courses.

MORE: This Is How Much Childhood Obesity Costs Over a Lifetime

Not all antibiotics had the same effect, however. The association was only significant with broad-spectrum antibiotics—those that wipe out different kinds of bacteria all over the body—but not narrow-spectrum antibiotics, which target only certain families of bacteria. Of the kids in the sample, 41% took broad-spectrum antibiotics at some point.

Doctors prescribe antibiotics for a host of common infections ranging from the mild, like sinus and ear infections, to the more severe, like pneumonia. Broad-spectrum antibiotics are generally recommended only when the narrow-spectrum kind won’t work, like if an infection won’t respond or if the patient has an allergy. But in practice, broad-spectrum antibiotics are being prescribed for a lot of typical childhood infections that might not even need an antibiotic at all, says study author Charles Bailey, MD, PhD of the Children’s Hospital of Philadelphia.

MORE: Antibiotics Overload Is Endangering Our Children

When parents visit the pediatrician with a sick child, they often request antibiotics to help the child feel better faster, Bailey says. “There are these non-medical pressures to use some of the broader-spectrum drugs,” he says. “But if we use broad-spectrum antibiotics a lot of the time, are we creating unintended effects down the road that we didn’t appreciate when we were sitting in the office?”

MORE: Gut Bugs—A Hidden Trigger of Obesity

One of those unintended consequences might be killing off certain kinds of beneficial bacteria in the guts of young kids at an age when their collection of bacteria—or microbiome—is thought to be especially sensitive. Studies have shown that feeding antibiotics to mice around birth alters the kind of microbes that colonize their guts, which in turn changes how they digest food, how many calories they get from their diet and how they extract energy, Bailey says. “Our worry is that we may be seeing some of the same things going on with people.”

Though obesity in early life puts a child at greater risk for obesity in adulthood, it’s still early enough to intervene, Bailey says. “Our hope is that we can find out what the risk factors are in early childhood and do a better job not just at preventing this, but of identifying the kids…who then can change their path by changing their lifestyle and changing the healthcare they get.”

TIME Obesity

Why Cutting Soda Calories Isn’t Such a Sweet Idea

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Civil rights and soda might not seem like a classic combination. But yesterday, as major soda brands announced their goal to reduce beverage calories in the American diet, it seemed to make sense to Wendy Clark, president of sparkling brands and strategic marketing for Coca-Cola North America.

“‘The time is always right to do the right thing’ – MLK” she tweeted. “So proud of our industry.”

That time will come in 2025, the year by which every American will drink 20% fewer soda calories than they do today. In the press release about the announcement, which was made at the Clinton Global Initiative meeting in New York, Coca-Cola, PepsiCo and Dr. Pepper Snapple vowed to make these reductions in part by making containers smaller, as well as focusing marketing efforts and innovation into lower-calorie drinks, no-calorie drinks and water. In the release, President Bill Clinton called the pledge a “critical step in our ongoing fight against obesity.”

But are such premature congratulations merited? Is developing more low- and no-calorie bottled beverages really the way to fight obesity?

Soda consumption has dropped, with sales lower than they have been since 1995. And while we might like to think sippers are swapping soda for water or unsweetened herbal tisane, research shows they’re not. A Pediatrics study published earlier this year that showed while kids aren’t drinking as much soda as they once were, they’re guzzling more energy drinks and coffee beverages—both caffeinated sweetened products with a nutritional profile similar to most sodas. Sales for ready-to-drink tea—most of which is sweetened—are also up by double digits in the Coca-Cola portfolio, reports Forbes.

That’s concerning if we want to seriously address obesity. The jury is out on no-calorie and low-calorie sweeteners, but mounting recent evidence showings sugar substitutes may contribute the very obesity they’re meant to combat. That’s because they appear to fuel sugar cravings and alter the composition of gut microbes, leading to a rise in blood glucose levels. Several studies have found a link between sugar alternatives and weight gain, and research just published in the journal Appetite found that drinking artificially sweetened beverages make you think about food more, choose high-calorie foods more often, and feel less satisfied after eating things sweetened with actual sugar.

“On face value you’re getting a nice sweet taste without calories, but my research shows it might lead to cognitive shifts that might promote overconsumption later,” Sarah Hill, the study author and a psychologist at Texas Christian University, tells TIME.

This all suggests that even if soda slashes calories by 2025 as promised, the replacement ingredients could come with unforeseen consequences.

The idea of tasting something sweet without getting any energy from it is an evolutionarily very novel thing for our bodies to handle, Hill says. “When you have that unnatural pairing of sweetness and no energy increase, it leads the body to perceive an energy crisis,” Hill says. “It triggers thoughts and behaviors consistent with a scarcity mode.”

“I think that the real way to get change is drinking water,” Hill says. Plain, unadulterated, straight-from-the-tap H2O included.

TIME Obesity

Are Diabetes Rates Really “Leveling Off”?

For the first time in several decades, we’re starting to see a slowing of new diabetes diagnoses, suggests new data published in JAMA.

The study authors examined data collected from more than 600,000 adults between ages 20-79 from 1980 to 2012—part of the Centers for Disease Control and Prevention (CDC)’s National Health Interview Survey. A broad view paints a grim picture: From 1990 to 2008, the prevalence of diabetes as well as new cases of the disease both doubled. But from 2008-2012, those rates of change leveled off. So while people are still being diagnosed with diabetes, the rate of growth is decelerating.

“It’s encouraging that we may be seeing this slowing and plateauing,” says Ann Albright, PhD, RD, director of the division of diabetes translation at the CDC and one of the study’s authors. The study cites a slowing of rates of obesity—one of the biggest contributors to type 2 diabetes, found one study—as a partial explanation for the results. Black and Hispanic adults, however, have continued to see a rise in new diabetes cases, and prevalence also grew among people with a high school education or less. These disparities, Albright says, could get worse.

“This data is telling us that we are doing some things right,” Albright says, which is especially important given that the population is aging, and baby boomers are hitting peak years for diabetes. Driving down diabetes prevalence is great, but the best way to get there is to curb new cases—not to have people in the diabetes pool die off early, she adds.

“[This study] is important to note, but it doesn’t mean we have this licked and we’re all done,” she says. “We still have a lot of work to do.”

TIME medicine

When Doctors Ignore Their Own Advice

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What to do about docs who smoke, drink, and tan

I live near a health clinic, and on more than one occasion, have walked by men and women in scrubs smoking cigarettes. No human being is immune to nicotine’s addictiveness, but since health care professionals are supposed to advise patients against such behaviors, it’s extremely hard to justify the habit.

Earlier this month, a report published in The BMJ showed that one in 10 doctors admit to using tanning beds. The survey sample was small at only 163 U.K. doctors, but considering skin cancer is the most common cancer in the U.S., the fact that any physician would choose to partake in an activity that puts them at a direct risk for cancer is pretty mindboggling.

But indoor tanning isn’t the only doctor vice. Smoking, poor eating habits, being sedentary, and heavy drinking–while still not the norm–are behaviors not completely eradicated from the medical community.

An unforgiving culture

“It’s unrealistic to expect that knowledge should prompt physicians to avoid unhealthy behaviors,” says Anthony Montgomery, an associate professor of work and organizational psychology at the University of Macedonia in Greece. “Just like everybody else, they have a low risk perception with regard to their health.”

Montgomery says a big part of the problem is how physicians cope when they encounter health problems. In a 2011 study, Montgomery and his colleagues conducted an analysis published in Occupational Medicine that looked at 27 studies on doctors self-medicating. They wanted to examine the implications of a persisting culture within medicine where doctors do not expect themselves or their colleagues to be sick.

“We found that there was considerable evidence that physicians and medical students engage in high levels of inappropriate self treatment for reasons that include avoiding the patient role and occupational norms–keeping things inside the profession,” he says.

The study concluded that these behaviors could be occupational hazards for doctors, and that these problems are not benign for patients. Congruent research finds that doctors with bad health habits are less likely to counsel their patients on the same issues.

“Fifty years ago smoking was very common among physicians and nurses, though fortunately we’ve reduced that significantly,” says Shiv Gaglani, co-founder of a pledge for medical students called The Patient Promise. “Now however, physicians and nurses have the same level of obesity as the general population. Our caregivers are human too and can succumb to same behaviors that everyone else can.”

Montgomery, who typically studies doctor burnout, is working on a report that collected data from health care professionals in Croatia, Portugal, Macedonia, Greece, Turkey, Romania and Bulgaria and found that the effects of burnout were significant predictors of fast food consumption, infrequent exercise, drinking alcohol and using painkillers.

“Certainly most physicians I’ve met understand the paradox between what they preach and what they practice,” says Gaglani. “Seeking help is often complicated by the fact that you don’t want word to spread about your issues because it would spread within the community you practice. In some cases it could even mean the end of your career.”

Solutions

Gaglani created The Patient Promise in 2008 with his roommate at Johns Hopkins Medical School after they attended a course on obesity and motivational interviewing of patients.

“We realized that many of the harmful lifestyle behaviors we were learning to counsel against as future physicians were actually becoming part of our daily lives,” says Gaglani.

The pressure and stress of medical school was causing Gaglani and his peers to eat less nutritious food, exercise fewer times each week, and get significantly less sleep. “We asked the simple question: How can we counsel patients on important lifestyle behaviors if we couldn’t practice them ourselves?” says Gaglani.

And so the Patient Promise was created, and still serves as a pledge for health care workers to live the lifestyles they are recommending for their patients. The movement calling for doctors to be healthy has spread to many health care facilities.

Some hospitals have even incentivized healthy behaviors, like the Cleveland Clinic, which took staff health to task in 2014 and asked all of its employees to wear an activity tracker called Pebble. Target goals were set across the board, and participating in the program allows employees to get lower health insurance premium rates. So far out of the 26,790 employees and spouses participating, 18,302 have already met their target goal for the year: 100,000 steps a month or 600 activity minutes a month for six months.

The Patient Promise is available for all health care workers to sign as a pledge to patients and themselves. “We believe in the power of partnership and shared accountability between clinicians and their patients to lead healthier lives,” says Gaglani.

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