New book (and Web site) use "currency" of aging to guide and motivate healthy choices

February 23, 1999

"It is folly alone that stays the fugue of Youth and beats off louring Old Age. (Erasmus, D. 1509)

"Learn to laugh at yourself and your RealAge will be 1.7 years younger." (Roizen, M. 1999)

A new book that pulls together more than 25,000 studies on health, disease prevention, and longevity not only suggests ways for readers to become "younger" but tells them exactly how much difference each health decision, or combination of decisions, will make.

"RealAge: Are You as Young as You Can Be?" by Michael Roizen, MD, chairman of anesthesiology and critical care at the University of Chicago, consolidates the often conflicting findings concerning the benefits of a healthy diet, regular exercise, and other personal habits or lifestyle choices. In an unusual twist, the costs and benefits of these bad and good habits are calculated according to how they affect the reader's probable lifespan, expressed in terms of what Roizen calls a person's "RealAge."

RealAge begins with a person's chronological age--how long ago they were born--then tacks on months and years for added wear and tear (such as smoking or high blood pressure) or peels off time for superior maintenance (such as regular exercise or low cholesterol).

"Doctors have not done a good enough job of explaining why people should follow our recommendations to motivate people to start and continue healthy choices," said Dr. Roizen. "We wanted to find a way to shift something that was negative and far in the future, like cutting back on dietary fat to avoid a heart attack 20 years from now, into something positive and immediate--like being a little younger next Tuesday."

"RealAge," he explained, "unifies an array of health topics by determining exactly how they affect youth and vigor. It serves as a guide to making informed choices. RealAge places a value on those choices just as a price tag reveals the value of a product."

The idea actually came from a patient--an investment banker with high blood pressure who wasn't taking his medications. Why, Dr. Roizen wondered, would the beneficiary of a lifetime of delayed gratification--a bright, wealthy, highly educated person who clearly understood the consequences--choose to neglect his health?

"I realized he had no way to calibrate the benefits of his medications," Roizen said. "In his terms, he could not assess the 'net present value' of drugs designed not to cure current disease but to prevent it in the distant future. So we did some quick calculations and decided that taking his medicines made him the equivalent of four years younger. Ever since, he has taken them religiously."

In exchange, the banker steered Roizen to the work of Chicago economist Milton Friedman, who won the 1976 Nobel Prize, in part for his research on how investors discount future gains. Friedman found that without a straightforward way to calculate the worth of benefits that would not be received for years, investors tended to undervalue them. Benefits that were more than three years away were often seen as worthless.

So Roizen began to adapt the economist's ideas to health care. He put together a scientific advisory team to comb through the massive literature concerning the relationships between various behaviors and longevity. They asked not just whether specific acts, like aerobic exercise, strength training, wearing a helmet to ride a bicycle or flossing your teeth, could reduce rates of mortality, but by exactly how much?

They came up with 125 behaviors that seemed to play a role, each supported by at least four major studies in humans. Then they developed software to calculate the risks and benefits and how they all fit together.

It turned out to be a wonderful motivational tool, far more effective than doctors' orders, warnings, exhortations, and admonishments. Dr. Roizen soon found himself celebrating "unbirthdays" with his patients as they got healthier, making their RealAge younger, and leading far more vigorous lives.

"With numerical targets, many of them became quite competitive about it," he said, "choosing, and more important, sticking with behaviors that made their RealAge younger. We had struck motivational gold."

The book cites the example of Dr. Roizen's remarkably active 92-year-old father (RealAge 76), the ringleader of a group of 25 retirees who have embraced the RealAge concept--egging each other on to get younger, healthier, and more active and celebrating each other's successes.

At 53, however, Dr. Roizen may be his own best example. Despite a few shortcomings--as head of a nationally ranked academic department in a competitive field, he gets too little sleep and too much stress. He has nevertheless lowered his RealAge to 38.97. A nationally ranked squash player in the over-45 category, despite his RealAge, he tries to eat right, does regular strength and endurance exercises, maintains an active social life, and even reduced his driving speed.

"Anesthesia is all about prevention," said Dr. Roizen. "We predict who is at risk and prevent the discomfort and complications of an invasive procedure. RealAge is just an extension of that targeted at a bigger audience.

"Instead of preventing a problem for one person at a time, I've now got a shot," he said, and only one shot, at changing the health of millions of people by persuading them to improve their health habits. I've spent my career building the necessary credibility, publishing papers, testing new drugs, running a department and taking very good care of patients one at a time. Now's my big chance. I'd better not blow it."

He 's off to a good start. The book, published by Harper Collins, was released March 3, 1999. An appearance on the "Oprah Show" on February 24, 1999 led to rapid early sales, boosting the book to the top of the amazon.com best-seller list for several days after the broadcast.

Anyone interested can determine his or her own RealAge and get personalized recommendations simply by logging on to the RealAge Web site, www.realage.com, and taking the test--which requires about 35 minutes. (The test is most accurate if you know your blood pressure and cholesterol levels.)

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John Easton
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john.easton@uchospitals.edu