For most people, the first two things that come to mind when thinking about how to improve their health are eating better and improving fitness levels. Physical activity and balanced nutrition are cornerstones of our health and wellness. But, food and exercise aren’t the only things that matter when it comes to our health. In fact, for some people, other factors, several of which they have no control over, may have a greater influence on health and wellbeing than food and exercise. While some nutrition and fitness coaches may naturally be focused on working with clients to build lifestyle habits that will help them gain a better sense of wellbeing, it is important to be aware of the several factors that influence a person’s health and wellness that are unrelated to lifestyle factors.
In this article, we introduce you to the internal and external factors that may be influencing your client’s health and wellbeing. We also introduce you to objective and subjective measures of health and how they can work together to gain a better understanding of a person’s health status.
Factors that Affect a Person’s Health and Wellbeing
The factors that affect a person’s health and wellbeing can be broadly placed in three interconnected categories: biological and genetic factors, environmental, and behavioral factors.
Biology and Genetics
From even before a person is born, their genes hold secrets for their predisposition to certain conditions.
Genes are essentially the “instructions” for how your body needs to function. You inherit your genes, which are made up of DNA, from your biological parents. Genetic makeup is one of the biggest factors when it comes to a predisposition of the development of conditions and diseases, just as they can also be protective against them. When a gene increases your risk of developing a health condition, it is referred to as a genetic risk factor.
Individual biology and genetics influence:
Keep in mind that even if you have a gene that increases your vulnerability to developing a disease, it doesn’t necessarily mean you will develop it. For example, research has demonstrated that people who have one or more of the genetic markers HLA-DQA1, HLA-DQB1, or HLA-DRB1 are at risk for developing type 1 diabetes. While having these genetic markers increases your risk of type 1 diabetes, scientists have identified people with these genetic markers who never develop the condition. This is because a person’s environment has a fundamental role in whether a person develops the condition or not. The same is true of the BRCA1 and BRCA2 genes in breast cancer.
Environmental factors are complex and vary widely. The environment refers to where individuals live, work, and through which people move. Sometimes, these factors are called the “health ecosystem.”
Some environmental factors include:
Exposure to environmental toxins
Access to healthcare
Exposure to disease agents (like bacteria, fungus, and viruses)
Sociocultural factors and discrimination (sometimes called social determinants of health)
Exposure to toxic stress
Exposure to chronic stress
All living things, not only humans, are called “plastic,” especially in the early stages of development. Extensive research has been carried out on how adverse childhood events, like experiencing abuse, being affected by natural disasters, and living in areas where violence is predominant, not only affect a person’s psychological development but also their physical development, to the point where they have a significantly greater probability of developing chronic disease.
Other environmental factors that have a direct effect on a person’s health and wellbeing include access to safe outdoor spaces, access to low-cost and nutritious food, and access to well-paying jobs with time for recreation. In the US and many parts of the world, there are significant disparities between access to health-promoting environments for people of different races.
Black and Brown people often experience environmental racism, where they are more likely to live in environments that have a negative impact on their health and wellbeing.
The environment has a significant, often overlooked, influence on our health. Unfortunately, there are limited things people can do on an individual level to modify their environment, which is why advocates like health coaches and public policy are so important.
Behaviors and Lifestyle
What we do, out of choice or not, is another complex factor that influences our health. Nutrition and exercise usually fall into this category.
However, it is incorrect to assume that lifestyle and behaviors are completely in a person’s control or determined solely by choice.
While personal likes, dislikes, values, knowledge, and desires impact our behaviors, they are not the only things. Sometimes, environmental and biological factors are much stronger forces for people than what they actually desire to do.
There are entire research groups and schools dedicated to health behavior change theory. You can learn more by reading these articles:
Health Behavior Science and Why It’s Important for Health Coaches
Behavior Change vs. Mindset Change: Using Design Thinking to Develop Healthy Habits That Stick
How Dietary Factors Influence Disease Risk: How to Integrate Knowledge and Practice
Objective vs. Subjective Measures of Health and Wellness
Health is multifaceted and complex. While some aspects of health can be measured, more importantly, health is experienced. The different factors that affect our health and wellbeing that we mention above may be able to be detected and improved when health professionals value and utilize both subjective and objective measures of health.
Subjective Measures of Health
“Measures” is, perhaps, too technical a word to describe how we feel about our health since it implies a specific numerical rating related to different indexes. From a subjective perspective, health is felt, not weighed, timed, or analyzed in a lab.
Subjective measures of health are based on individual awareness and experience.
Dr. Howard Koh wrote in his article “The Ultimate Measures of Health” in the Journal of Public Health Reports, “Health arises not just from a doctor's office, but also from our homes, jobs, schools, communities, and places of worship—in short, where we live, labor, learn, play, and pray. All of these conditions determine whether we can fully be healthy…”
How you feel may be is just as important, if not more important, than what your lab tests say. In fact, research has demonstrated that general perceived health predicts for morbidity and mortality, even after controlling for health problems. In other words, regardless of your “measurable” health status, how healthy and well you feel is an incredibly good predictor of whether you are sick and how long you have to live.
Some of the challenges of depending on subjective measures of health are:
Symptoms of specific biomedical conditions may be different for everyone.
Some diseases and conditions can be developing before a person experiences symptoms, so subjective measures may not be as effective for preventative measures of health.
Some health professionals question the usefulness of subjective measures of health, which may lead to a dismissal of your experience, feeling, or intuition. This is one form of medical gaslighting.
They don’t necessarily lead to a clear treatment or management path, though other sciences may be able to learn a lot from psychology to find ways to do this more effectively.
Keep in mind that some subjective measures of health and wellbeing may be translated into numerical measures that could give health professionals an idea of the best way to move forward in a coaching or treatment plant. Indicators of trauma, such as the Adverse Childhood Events (ACE’s), is a great example.
Objective Measures of Health
Objective measures of health are those that can be tested or numerically measured. In general, results are compared to a standard or a range that is considered healthy.
Some of the gold standards in objective measures of health from a clinical perspective include those related to preventative and diagnostic health screenings.
Complete blood counts
Cultures (urine and stool)
Tests are vital for detecting several chronic diseases and other conditions early on, such as cancer, pre-diabetes and diabetes, osteoporosis, STDs, polycystic ovarian syndrome, depression, high blood pressure, multiple sclerosis, and high cholesterol. In most cases, physicians, psychiatrists, and nurse practitioners can only give a person a prescription for pharmaceutical medication after having the lab work as evidence to demonstrate that the prescription will likely be effective to treat what is going on in the body.
While objective measures of health are useful to understand what is going on inside the body in ways we can’t see to determine an effective line of treatment, they have several drawbacks.
There aren’t objective measures in most dimensions of wellness (though some researchers are trying to get there).
It depends on the healthcare team to know what to measure and how to measure it. If a healthcare team doesn’t see any red flags in whatever they measured, a person’s lack of wellness may be dismissed.
They focus significantly more on physical and biological health measures than on other aspects of health and wellness.
Finally, in some cases, objective measures of health may be misguided in their use. Below we provide one example of a potentially misguided measure of health.
Case Study: BMI as a Misused Objective Measure of Health
One of the drawbacks of objective measures of health is that they may be misguided. For example, the use of body mass index has been used for generations as a way to indirectly determine a person’s health risk. However, there are numerous flaws with the use of BMI, especially when a person seeks support for their health on a personal level such as in a health coaching or physician setting.
First, BMI is what is called a “doubly-indirect” measure. It is supposed to be an indicator of body composition, but it doesn’t actually differentiate between fat, muscle, bone, and other tissues.
Second, BMI was never intended to be used in clinical settings. It was designed to gain a better understanding of the proportions of an “average” Belgian male body.
As Stephen Humphreys points out in a rather famous article published in the British Journal of General Practice in 2010, “In short, it was designed with Belgians in mind, and does not work so straightforwardly on such populations as Bangladeshis, Botswanans, or boxers.” BMI may sometimes be useful for public health approaches because you don’t prick anyone with a needle or spend money on labs. However, there are more direct and accurate measures of body composition, and without a doubt, of health. On an individual level, BMI has poor sensitivity and is inaccurate when body composition is relevant.
And, while there may be a correlation (not causation) between BMI and some measures of health on population levels, there are still significant gaps in the understanding of those relationships.
What are the alternatives to BMI?
For athletes, body composition may be important, in which case more accurate tools like skinfolds, hydrostatic weighing, bod pods, and bioelectrical impedance analysis may be considered. For most people, however, body composition isn’t as important as are more specific measures of health, like blood pressure, cholesterol and triglyceride levels, blood glucose levels, and subjective measures of health.
Improving nutrition and fitness tend to be what first comes to mind when we think about “getting healthy.” However, while food and exercise habits both have an important role in lifestyle factors that affect our health, these are only two of the multiple, complex factors that determine someone’s health status—something that can be measured using both objective and subjective measures of health.
Additionally, just as physicians and health coaches can work together to support people on a path to health and wellness, subjective measures and objective measures of health can be complementary in understanding what is going on inside a person’s body and how to provide bodies and minds with tools to establish balance and support people in feeling well.
BY: TIMOTHY FRIE, M.S.