Lack of exercise (could bring CMD diseases early) because of inflammation and lack of anti-inflammatory chemicals. A smoker who eats fruits and vegetables and who exercises is less likely to have lung cancer than one who smokes but does not eat fruits or vegetables and does not exercise. Different models help a person understand and deal with CMD:

1. Number Model

   BP 140/90 mg or above is HTN; Below 140 / 90 mg is not. Stiffness of the heart muscle and the arterial wall starts before BP reaches 140/ 90. This is caused by unhealthy food in the lack of exercise before the BP goes up. This is called HTN.



2. High risk Low risk Model

   High-risk patients are treated aggressively fair enough. The low-risk patient is treated conservatively; eventually the low-risk becomes high risk. Most of the heart attacks, Strokes and cancers come from low to moderate risk patients because the pools of the low to moderate risk are large. With unhealthy food and the lack of exercise, everybody is at risk.



3. Prevention Model (River Model)

   Unhealthy food, the lack of exercise, and smoking are Upstream.
   
   CMD and its complications require Medical Procedures and gadgets and are all downstream.



4. Symptoms Model

   Unhealthy food and the lack of exercise start the Axes of Damage.
   
   The Axes start the disease processes that bring numbers up (BP of 140 / 90 mg and a HbA1c of 6.5). This brings a “name” to numbers (like HTN and diabetes) then after the disease is established, it may take another 5 to 10 years before symptoms appear. A person with BP of 150/ 100 mg or an HbA1c of 7.0 may be walking around without any symptoms. Kidney disease up to level 5 may not produce symptoms. Level 6 is kidney failure. If insurance deductibles go up, a person may not see the physician before he has symptoms. A person could feel fine one day before a heart attack.



5. Bug Model

   An infection is treated with an antibiotic. HTN and DM are treated with medicines. The patient wants pills. ” Give me the pill.” “Give me the shot?” Folks need to be taught the value of healthy food and exercise. Insulin and some other maintenance drugs are very costly.
   
   The patient must take them for the rest of his life that leads to under treatment of disease and emergence of other CMD.



6. Food Model

   There is no food model. Cutting fat, salt, and sugar is not enough.
   
   The rise in glucose after medicines is not discussed with the patient.
   
   Value of fiber is not reviewed. There is so much craving caused by salt, sugar, and fat, but the patient is simply told to cut down the calories. The synergy between exercise and healthy foods is not discussed. Some folks spend their lives and fortunes trying to lose weight through different “diets” without exercise, they seldom lose the weight.