Real Age Comes Of Age

[This post first appeared at on November 3, 2014.]

I’m struck by the number of references to links between behavior and life span that I encounter every week. Recent examples:

•  “Drinking a can of soda every day takes two years off your life.” [That made me reach for a bottle of water.]

•  “Obesity adds disease burden to your body equivalent to ten years of age.”

•  “Sitting is the new smoking.” (And smoking takes 10 years off your life.)

These statements are oversimplified and/or hyped, but this thinking has a basis in medical knowledge. For example, John Kitzhaber, a physician who is now governor of Oregon (and hence head of a large health plan) lays it out simply in a speech on his web site: how we behave is 4x more important to our health status than the quality/quantity of medical care that we receive (see chart below). Toby Cosgrove, a cardiac surgeon who is now CEO of Cleveland Clinic, a leading integrated health system, made a similar point is his speech at the 2014 JP Morgan healthcare conference.

Data via Dr. John Kitzhaber.

Data via Dr. John Kitzhaber.

Real Age is an assessment of health status that comes down to one number: an increase/decrease to your chronological age to get to your “Real Age”. For example, John Smith’s chronological age is 63 but he is fit and has taken care of his body and mind. As a result his expected life span and quality of life are equivalent to the average 58 year old: his “Real Age” is 58. Bob Jones, a life-long smoker is chronologically 63 but has a Real Age of 73: his quality of life is probably deteriorating fast.

Real Age connects popular thinking and medical thinking. The average person has limited knowledge of medicine and does not want to think of him or herself as a “sick person”. So we often go on doing what we do until a serious health problem erupts. But we all understand age, and most people over 40 would like to age less rapidly. The Real Age metric makes the issue immediate: “smoking takes ten years off your life” is a future problem that many will ignore; “smoking makes you ten years older” is an immediate problem. The best communication strategies boil a complex subject, like health, down to a simple, mostly correct idea that motivates many people. Real age does that.

Current demographic trends make real age top-of-mind. The large cohort of baby boomers (1) is entering retirement and Medicare. “How long will I live”, “what quality of life can I expect”, and “what medical care will I need” become big issues when you cross life’s Rubicon at age 65. How well you take care of yourself, life-long and particularly as you enter your sixth decade when chronic diseases often to show up, is a big influence on those outcomes. Real age measures this.

Millennials, the generation now entering adulthood, are health-conscious. They are hitting the health club and trading in cars for bicycles in large numbers, as one can’t help but notice in Cambridge, Mass any day at rush hour. Quite a few Gen Xers (3) are joining that trend, perhaps because they want to appear younger and hip.
Quantified self is a third force converging with medical knowledge and demographics. Activity trackers are here in a big way: 17% of U.S. adults have bought one, of whom 30%-40% use them long term. While they don’t provide the accuracy expected from clinical devices, activity trackers do provide useful feedback on level of activity. And self-measurement devices are poised to improve rapidly. Apple’s impending iWatch will raise the bar, it’s HealthKit creates a platform on which others can innovate, and many companies such as Qanttus, a start-up in Cambridge, Ma, are working on next-generation wearable sensors that will improve both the accuracy and range of wearable biometrics dramatically. In popular terms, imagine a network-connected tricorder (4) on your wrist all the time.

Proactive medicine is the fourth leg of the stool. This is the idea that investment of time and effort in the proactive parts of the health care system, like primary care and public health, will do more to improve quality and cost of health care than equal investment in better cures.

The Real Age meme creates huge opportunity for innovation. It motivates people to get proactive about health. Companies and technologies can support this behavior in many ways: sensors; devices for daily wear, home, or medical offices; applications to make data useful; systems that connect people and their medical providers; and big-data technologies that deliver insights from behavior patterns of populations. There is lots of running room for entrepreneurs here.

“Age is just a number” is a popular saying; it suggests that you ignore your age and go on with life. I like “60 is the new 50” better; it suggests that people who take care of themselves can live longer and healthier lives.



  1. Boomers (children of the post-war baby boom) means people born from 1946-1965.
  2. Millennials means people born from 1986-2005.
  3. Gen X (generation X) refers to people born from 1966 and 1985.
  4. The health scanner used by Dr. McCoy in Star Trek

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