Prioritizing health interventions

Imagine you’re sailing in warm water on a beautiful sunny day when you suddenly realize there is a hole in your boat and it’s sinking. You have only a few minutes to grab supplies. What do you take?

Around you are the following: a liferaft, water, food, oars, sunglasses, an insulating blanket, and a book. The rational choices are obvious: no one would grab the book before they got the liferaft, water, and food. 

Now let’s say instead of warm water, your ship is sinking in icy water and the air temperature is approaching freezing. The first few choices remain the same, but the order after that changes. Suddenly, the insulating blanket moves much higher on the list and may be critical for survival. 

The ship is still sinking, but the environment has changed. 

When the scenario is laid out this way, you don’t need to think very hard to decide what to prioritize. When it comes to our health, however, it’s harder to know where to focus. Unlike the few minutes we have to make a choice before the ship goes under, we have to spend an entire lifetime making health choices. On top of that, no one is standing over the supplies on the ship with big signs trying to argue that you’ll surely drown if you don’t grab the book. The health and wellness industry is packed with so much advertising for so many gadgets and gizmos that it can be hard to remember which things actually deserve our attention.

Choosing our supplies wisely 

We need to choose health interventions the way we grab supplies from a sinking ship. We have finite time, attention, money, and effort, so interventions are effectively competing with one another for those resources. The first question we should ask is: how large is the expected effect for me? Interventions capable of producing large benefits over the course of a lifetime form the foundation. Managing lipids, blood pressure, and metabolic health, getting regular exercise, eating well, and getting enough sleep are like the liferaft, water, and food. These are among the interventions capable of producing the largest effects on long-term health and they should take priority over those with far less potential benefit.

That does not make the prioritization or implementation one-size-fits-all. Someone with elevated Lp(a) or LDL-C may need a very different lipid management strategy than someone with low baseline risk, for example.

Similarly, adding a 20-minute walk per day may have an enormous benefit for someone who does not currently exercise, whereas the benefit will likely be much smaller for someone who is already highly active. The intervention hasn’t changed; the person—and therefore the expected effect—has.

Once we’ve established those foundational pieces, we can move on to things that are useful, but less crucial for survival. As we work further down the list, the expected benefit of each intervention generally gets smaller. This brings us to the second question: what do I give up by choosing this? 

With unlimited time and space on our life raft, maybe we would grab the book, but if space is at a premium or the ship is sinking too quickly, no rational person would spend precious time collecting comfort items before securing the things that determine survival. The same is true when it comes to health. Red light therapy, peptides, supplements, longevity gadgets, and other interventions may provide some benefit, but their value has to be considered relative to what remains undone. Spending time and money pursuing a marginal benefit makes little sense if you are still sleeping five hours a night, exercising inconsistently, or walking around with untreated hypertension. Every hour and dollar spent on one intervention is an hour or dollar that can’t be spent elsewhere. This is how we end up majoring in the minor and minoring in the major.

This kind of misplaced prioritization isn’t limited to questionable or trendy interventions, though. We can make this same mistake when we try too hard to optimize an effective intervention, and forget the much larger benefit of simply doing something good consistently. 

Take exercise. Someone who currently exercises sporadically could spend hours deciding on the perfect training split, the ideal ratio of Zone 2 to higher-intensity work, or the optimal set and rep scheme. Those details can matter, particularly as someone becomes more advanced. But if the complexity of the “perfect” program means exercising three times one week and not at all the next, the optimization has defeated the purpose. For that person, the difference between exercising consistently and inconsistently is almost certainly more important than the difference between two reasonable exercise programs.

Diet is another example. It’s easy to bounce from low-fat to ketogenic to intermittent fasting to whatever eating strategy is currently getting the most attention, searching for the optimal diet. Yet for most people, the larger gains are likely to come from finding a broadly nutritious way of eating that provides adequate protein and micronutrients, supports appropriate energy intake, and, critically, can be sustained. Continually swapping one reasonable diet for another in pursuit of a marginal theoretical advantage may accomplish less than simply adhering to a good one.

This is, in part, a consequence of diminishing returns. Moving from no exercise to regular exercise can produce a much larger gain than moving from a good exercise program to a theoretically perfect one. Likewise, moving from a poor diet to a good diet matters far more than endlessly fine-tuning an already good diet. Optimization isn’t pointless; it simply belongs farther down the list. Capture the large effect first, then worry about the smaller increments.n.

Spotting the trap 

This may seem like common sense on the surface, but in a world where the right marketing strategy can make just about anything sell, it’s worth understanding why so many of us fall into the trap despite our best intentions. When you look closely, a few patterns emerge. 

Novelty: New things tend to feel especially appealing, but “new” usually means a shorter track record and less accumulated evidence. That an intervention is new doesn’t mean it’s useless—and it may in fact be an excellent option—but “new” and “better” are not automatically synonyms. Splashy early findings may fail to replicate, whereas long-standing findings have had more opportunities to be tested, challenged, and refined.

Ease: We are a species wired to conserve energy. Swallowing a multivitamin is much easier than committing to a nutritious diet, and taking an NAD+ booster or purported mitochondrial energizer is easier than VO2 max training, but that doesn’t make the two equivalent. Ease is a perfectly reasonable thing to value, but we should be especially skeptical when an easy intervention is marketed as a substitute for one with substantially better evidence and a larger expected effect.

Marketing: Many of the highest-yield interventions are difficult to package into a proprietary solution. Getting enough sleep or exercising consistently doesn’t require a novel product, whereas there is far more commercial opportunity in selling something that promises to “optimize” your circadian rhythm or is “proven” to reduce fatigue. Technical or scientific-sounding language can further lend an intervention an air of credibility, even when the supporting evidence is limited. Marketing doesn’t make an intervention useless, but the intensity or sophistication of the marketing tells us very little about the size of the benefit.

Instant gratification: An intervention that promises rapid results feels compelling, and some popular therapies marketed for longevity (such as cold plunges) even deliver an immediate sense of renewal and well-being that can make you feel like you must be getting health benefits. But immediate rewards don’t always compound into long-term dividends. Longevity is all about playing the long game. Many of the interventions with the largest effects work quietly, with benefits that accumulate over years or decades rather than announcing themselves after a single session. 

The bottom line

The modern health and longevity marketplace offers an almost unlimited number of things we could do. The challenge is figuring out which ones deserve priority.

The exact order will differ from person to person, but the overarching principle remains the same: identify the interventions with the largest expected benefit for you and make sure you are actually doing them. Then work your way down the list. There may eventually be room for interventions with smaller or more speculative benefits, but they should earn their place only after the higher-impact priorities have been addressed.

Ultimately, the sunglasses may be useful. The novel may even be nice to have. Just make sure you’re already in the liferaft.

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