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James Hill says that COVID-19 has exposed how the concept of wellness is not well established in the United States. Photo courtesy of James Hill.

For decades, James Hill, PhD, the chair of the nutrition sciences department at the University of Alabama at Birmingham, has focused his career on health and wellness.

His resume includes serving as chair of the World Health Organization’s Consultation on Obesity, along with creating guidelines for the treatment and prevention of obesity in the United States.

Today, he’s delivering the keynote address at the Virtual Annual Meeting of the North American Menopause Society (NAMS) to discuss the concept of wellness.

He says this notion is tough to pin down and that many Americans are failing in their attempts to manage chronic diseases and overall well-being.

Ahead of his address, Hill took the time to speak with Healthline to discuss how the ongoing COVID-19 pandemic has shone a light on the wellness of Americans, the ways the concept of wellness has changed over time, and how people can find the motivation to develop healthier habits.

Your speech at the Virtual Annual Meeting of NAMS focuses on how the concept of wellness is poorly defined. Can you tell us how your field of expertise dovetails with the mission of NAMS?

James Hill: What I have found is that the physicians who are more involved in the total health of the person understand the idea of overall wellness. The OB-GYNs get it because oftentimes, they’re almost providing primary care to their people.

I found that these are the people who understand that you can’t just look at a person’s insulin sensitivity or their blood pressure. Those are important things, but you really need to take on the patient as a whole.

So I found that this group maybe is a little bit more open to thinking that way than some other specialties.

Tell us about how ‘wellness’ is currently defined. How can we do better?

I started out by asking why we need a concept like wellness and I’ll use COVID-19 as an example. We know that people with health disparities, underlying conditions, etc., are more prone to the complications of COVID-19.

Rather than noting that it’s affecting people with diabetes or obesity or heart disease, I think it really shows how all these things are related.

As a country, we’re just not well. We’re suffering from so many of what I call lifestyle-related chronic diseases. I think we definitely need a concept like wellness that can unite obesity, cardiovascular disease, diabetes, and so on.

But then there’s measurement and that’s where I think there’s a real problem.

It started out with assessing the physical part, the mental part, or even the spiritual part. But then people started expanding it, so now there are definitions of obesity that have 5 dimensions, 6 dimensions, 7 dimensions, then 8 dimensions. It gets to the point of almost being too much because you’re trying to measure everything.

So the way we measure it right now is we measure each dimension. We’re measuring financial wellness, social wellness, and so on, and we’re trying to come up with measurements that sort of link some of those things together.

To me, that’s where there’s a real need in the field to develop a simple measurement device that would get at wellness.

The other thing to note is that wellness isn’t just absence of disease. Wellness is more about what’s right with you than what’s wrong with you. That’s a concept that’s resonated with me over the years.

If you talk to people about preventing diabetes or heart disease, you’re still focusing on the bad stuff.

You could be talking about being able to play with your grandkids or be able to go out and take a hike, those kinds of things. People like to talk about that, so when we focus on wellness, it’s in a way, this holistic concept that we need.

The devil’s in the details because unless we can figure out a good way to define it and measure it, it’s going to be tough to get any traction with it.

You mentioned COVID-19. We’re now more than 6 months into the pandemic. What has it taught us about wellness and living with chronic disease?

It points out all the more reason that we have to tackle these lifestyle issues.

I mean, we had plenty of reasons before. I could talk about all the health risks of obesity or I could talk about how living with diabetes really decreases your quality of life.

But I think, more than anything, it shows that as a country, we’re pretty unwell.

When a challenge like COVID-19 comes along, it really exposes that as a problem for our country.

Are there any countries or initiatives you could point to that, in your opinion, do a good job of promoting wellness?

I’m fascinated by what different countries do around the world.

In recent years, I’ve been arguing that happiness is as important as health in overall wellness. You see in all these surveys and studies assessing happiness that the United States is never very good at being happy.

Interestingly, the Scandinavian countries are always high up on the happiness index. People like living there; their quality of life is higher. So I do think there are some things we can learn from countries around the world about that part of it.

Much of your career has been devoted to fostering wellness. How has the concept of wellness changed over the years?

I started out way more focused on physical health: fitness level, risk of diabetes, and so on.

In recent years, what’s become clear to me is that one of the key parts of this is the whole mental or psychological component.

We do a lot of weight loss research. For years, I did weight loss programs and people would lose weight and then regain it. It’s like, “What’s going on? I gave you a good diet and a good exercise plan, so why didn’t you follow it?”

Then, I realized that part of it is that we were making it about weight when what it was really about is how people live their lives.

So that really got us focused on the motivation for all this change, which led us to looking at life purpose.

It sounds funny in a weight loss program because people just want to lose weight, and we’re telling them that they have to understand their life purpose.

Does focusing on overall purpose rather than a specific end goal work well for people?

We found that when people see the disconnect between their purpose in life and how they’re living their life, it’s a huge motivation to change. People realize they’re not living their lives how they want to.

We try to tell people that part of wellness is aligning how you’ve always thought about your reason for being and your purpose in life with how you’re living your life.

When it’s just about weight loss, that person might weigh less and have a lower risk of diabetes or heart disease, but they’re not necessarily going to be well.

So adding the sense of purpose and the mental health part of it is crucial to me.

You promote a proactive approach to creating a culture of wellness, as opposed to a reactive approach of disease management. How does this play out in practice?

You mentioned the word culture, which I think is very, very important.

People talk about how we need to create a culture of health or a culture of wellness, and I don’t think you can do that by focusing on disease. I think motivating against disease isn’t what really gets to people.

I can give you an example in our work in weight management. If you ask people why they want to lose weight, oftentimes what they will tell you is that they want to manage their health or blood pressure.

What we find is that when you dive deeper, that’s rarely the major motivation. Their real motivation is much more emotional than logical.

Yes, preventing disease is a good outcome, but when we ask people what’s great about that, they don’t point to the outcome. They say they’ve gotten their life back or their relationships are better.

These are the things that people value, and I don’t think we can create a culture of valuing that wellness just by focusing on preventing chronic diseases.

For someone who has a generally ‘unhealthy’ routine and wants to change, how can they go about fostering a culture of wellness for themselves or their loved ones?

First step we always ask people to think about is why they want to do it. Why do they want to change anything?

It starts with “why,” and once you do that, there’s motivation for behavioral changes.

So what I would ask people to do is start by acknowledging that they’re not as healthy as they’d like to be, and aren’t living the lifestyle they want to live, and that they’d like to change.

Think about why you want to change and dive deep into thinking about how you want to align how you’re living your life with those things that are most important in your life.

The behavior change can happen. It’s the sustainability of it that’s difficult, and it’s aligning that lifestyle with what we call purpose in life that’s necessary to sustain it.

I’m an optimist. As hard as this can be, I think it could be a game changer if we could actually just start thinking about how to promote what’s right with us rather than just what’s wrong with us.