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The big picture of keeping healthy beyond 40
2026 09 19 Owen Yang
Before speaking of the big picture, I first hope to remind ourselves of an even bigger picture beyond health. In the post Map to a good life , I mentioned a useful framework of wealth, time, good health, and good relationships. Here I would like to focus on health, but as doctors, we all need to be aware there is a bigger picture in life.
For most people, it seems a critical time to inspect our prospect of health at age 40+.
Big lifestyle factors to keep us young
If we focus on diseases—which is just one perspective, but is the perspective where we have the best evidence—the majority of us in developed countries die of cardiovascular diseases and cancer, and then dementia, or suffer from the consequences of them before we die. To postpone these diseases, it is likely down to the big lifestyle topics: smoking, obesity, alcohol and healthy eating, physical and mental exercise, and sleep and stress. The big picture has always been there if we can come back to our common sense, but I also know it can be over-complicated or even scam-like, as there are more than enough articles, podcasts, and commercial programmes that try to grab our attention to manipulate us.
If we do not just focus on diseases but focus on ‘keeping ourselves biologically young’, my opinion is there has not really been genuine direct evidence for this, except for the claims that may be mixed with commercial or career intentions. I would still advocate that it is likely the similar lifestyle factors that ‘age’ us.
Early detection and its collateral damages
To catch diseases early when they happen, there are ways of early detection and early mitigation such as blood cholesterol, blood pressure, diabetes, and cancer screening. The drawback with trying too hard for early detection is there are always false positives, and the cost of over-reacting to false positives is not just money wasted, but all the unnecessary collateral damage as a result of over-investigation and over-treatment.
If you are a low-risk person, then the false-positive rate is unfortunately very high for you and the true-positive rate extremely low. If something equivalent is found from an MRI that is unnecessarily done, you could be facing a 1 in 100 rate of complications when you do a biopsy for a 1 in 1000 rate of the disease.
However, health decisions are just like financial decisions. We can only accept that risks are possibilities, and make adjustments along the way. Making safe decisions does not guarantee the best return, and there can be a lot of survival biases around us that tempt us to take unnecessary risks.
So my main advice, if any, is not to decide what the best version is for everyone, but to advocate that we start to think about our health in the big picture.