If a primary care doc were to try to come up with a list of the top 100 health promoting behaviors, it would be at once reductionist and holistic, ambitious and hubristic, useful and foolish.
Let’s go for it.
This post was inspired by The New York Times releasing a list of the top 100 movies of the 21st century. They leveraged input from actors, writers, filmmakers and influential fans. I’m leveraging scientific evidence, research, and clinical consensus.
I also want to qualify this list by stating that sometimes we are just trying to survive. So if you’re not currently in a place where chasing lifespan, healthspan, and joyspan inspires you… that’s ok to acknowledge. Nonetheless, perhaps we can use such a compilation like a packing list, with boxes to consider checking as we continue each day’s journey.
This post is part one of two. It is the individualistic and actionable one, but we should understand that sustainably good health truly does take a village beyond ourselves. That will be post number 2.
How this list works
Let’s break this down into four tiers.
Tier 1 (1-10): Foundational High-Impact Behaviors. These represent the most crucial factors with the strongest evidence for improving health outcomes.
Tier 2 (11-30): Essential Preventative & Lifestyle Practices: Critical practices for disease prevention and daily health maintenance.
Tier 3 (31-70): Important Supporting Behaviors: Specific actions that support and enhance the benefits of higher-tier behaviors.
Tier 4 (71-100): Specialized & Emerging Health Practices: sometimes our favorite movies barely make the top 100, but just making it to the list is validating.
I have written about many of these behaviors and practices along the way over these four long years. Feel free to check out the reading room for some deep dives and accumulated family doc wisdom at the end of this post.
⭐️ THE COMPLETE TOP 100 LIST ⭐️
And so without further delay.
Action!
THE FOUNDATION (1-10)
1. Avoid tobacco and smoking completely.
Prevents and reduces 12+ cancers, cardiovascular disease, respiratory disease. This may be the strongest single health intervention we can make if we are smoking. Unlikely to be a news flash, but we cannot overlook this one.
2. Engage in regular physical activity
The usual recommendation is 150+ minutes of moderate exercise weekly. Reduces all-cause mortality by 20-50%, helps prevent cardiovascular disease, diabetes, cancer, depression, dementia.
3. Maintain adequate sleep
This means shooting for 7-9 hours nightly. It also means not obsessing about sleep, but instead equating good rest with sleep if that helps psychologically. Essential for immune function, cognitive performance, cardiovascular health, mental wellbeing.
4. Follow a healthy dietary pattern rich in fruits, vegetables, whole grains
As Michael Pollan wrote: eat food, not too much, mostly plants. Some sources estimate a healthy diet prevents more deaths than any other risk factor globally. Reduces cardiovascular disease, diabetes, cancer.
5. Maintain strong social connections and relationships
Loneliness increases mortality risk equivalent to smoking 15 cigarettes daily. See number one about smoking above.
6. Effectively manage and reduce chronic stress
Chronic stress increases inflammation, cardiovascular disease, immune dysfunction, accelerates aging. We simply cannot escape stress, yet we can cultivate ways of dealing with it.
7. Maintain or work on achieving a healthy body weight
Even 5% weight loss significantly improves metabolic health. Obesity increases risk of diabetes, cardiovascular disease, 13+ cancers.
8. Stay adequately hydrated
Some say we should shoot for 8+ glasses water daily, but since each day is different I think drinking enough water so that our urine stays a pale yellow is a good shorthand. Prevents kidney stones, supports weight management, improves cognitive function, maintains cardiovascular health.
9. Practice good hand hygiene and infection prevention
Prevents up to 50% of healthcare-associated infections, reduces transmission of infectious diseases. On a day seeing 20 patients in the office I wash my hands at least 40 times (mostly for them). A good quality mask is your prerogative, too, whenever you want to wear one, like when rates are high and you are a sitting duck in an airplane.
10A. Get regular preventive healthcare screenings
Number ten has two parts. First, the most impactful health screenings to reduce death and serious disease are those with strong evidence for lowering disease-specific mortality. Screening for colorectal, breast, cervical, and lung cancer in eligible adults is supported by the U.S. Preventive Services Task Force (even as RFK Jr et al. plan to ruin it) and major medical societies. Cardiovascular risk factor screening—including blood pressure, diabetes, and lipid assessment—remains essential, as cardiovascular disease is the leading cause of death. Screening for HIV and hepatitis C in at-risk populations, and osteoporosis in older adults, also provides significant benefit. However, all screening carries potential harms, such as false positives and procedure-related complications, which must be balanced against benefits. Full body scans are just such a risk.
10B. Stay up to date with recommended vaccinations
Vaccines have saved 154 million lives over the past 50 years, representing one of medicine’s greatest achievements. My favorite vaccinations include shots against influenza, Covid, pneumonia, shingles, measles, polio, HPV, and the rest. We are so incredibly fortunate to have these tools. Don’t let fringe fools without medical degrees or PhDs tell you otherwise, and be even more suspicious of those with credentials who obsess about rare, or even worse, hypothetical risks. Vaccinations protect both individuals and communities. Benefits » Risks
ESSENTIAL PRACTICES (11-30)
What do you think so far? Do you agree with the top ten? Here are some more excellent health ideas. FYI the number 11 movie on the NYT list was Mad Max: Fury Road. I think it should have been Office Space, which did not even make the list!
11. Limit alcohol consumption
Most guidelines state ≤1 drink/day women, ≤2 drinks/day men… but the evolving answer is the less the better all the way down to zero. Everyone agrees that drinking excessive alcohol is the main problem, as this increases liver disease, cancer risk, cardiovascular problems.
12. Avoid processed and ultra-processed foods
Ultra-processed foods increase risk of cardiovascular disease, diabetes, mental health disorders. TastyKakes are gross once you lose the taste for them, even here in Philly.
13. Get adequate sunlight exposure
This is a tricky one, but the zeitgeist is increasingly pointing out that the benefits of a little sun exposure (without burns) outweighs the risks of living in a cave. I’ll circle back on this in a future post, but I did write about it last summer. Sunlight supports bone health, immune function, mental health, and reduces all-cause mortality risk in ways that have countries like Australia liberalizing their UV exposure advice, contingent upon skin types.
14. Practice stress-reduction techniques
Meditation. Mindfulness. Reduces cortisol, inflammation, improves mental health outcomes.
15. Maintain consistent sleep schedule and good sleep hygiene
To add even more spontaneity-killing burden, just hitting 7-9 hours is not perfection. Regular sleep patterns and consistent bedtimes improve sleep quality, support circadian rhythm health and all that goes with it.
16. Eat adequate protein
They say to aim for 0.8-1.2g per kg body weight. Essential for muscle maintenance, immune function, healthy aging. Goes well with exercise, and umami is yummy.
17. Reduce sodium intake
Reduces blood pressure and cardiovascular disease risk. Ultra processed and restaurant food can sometimes have staggering amounts of sodium. For example, a single slice of pizza can range from 565mg to over 900mg, with the potential to easily exceed recommended daily sodium intake when multiple slices are consumed.
18. Include omega-3 fatty acids in diet
Think fish, nuts, seeds, olive oil. Consuming nuts is associated with a longer lifespan and a reduced risk of premature death. Studies have shown that people who regularly eat nuts, such as a handful a day, tend to have a lower risk of dying from heart disease, cancer, and respiratory illnesses. Reduces inflammation.
19. Practice safe sex and maintain sexual health
Prevents sexually transmitted infections, supports overall wellbeing. Cuddling up to someone works, too. Oxytocin, dopamine, cozyamine.
20. Avoid environmental toxins and pollutants when possible
Reduces cancer risk, supports respiratory and cardiovascular health. Here we are at the mercy of good/ bad, altruistic/extractive leadership. We use reverse osmosis for drinking water, and watch the Air Quality Index when exercising outdoors (or not).
21. Maintain good posture and ergonomics
Prevents musculoskeletal disorders and chronic pain. Although keeping our backs straight as we age is not completely under our control, a good deal is.
22. Practice deep breathing exercises
Activates parasympathetic nervous system, reduces stress. 5 seconds in, 7 out for me works wonders.
23. Get adequate fiber intake
Fruits and vegetables and legumes and 25-35g daily. Supports digestive health and microbiome, reduces cardiovascular disease and colon cancer risk.
24. Limit sugar intake, especially added sugars
Reduces diabetes risk, dental problems, supports weight management. This is tough, as sugar is addictive and ubiquitous
25. Practice good dental hygiene
This includes brushing, flossing, and some regular cleanings. Prevents dental disease, reduces cardiovascular disease risk, systemic inflammation
26. Engage in strength training
Maybe hit 2+ times per week. Maintains muscle mass, bone density, metabolic health. Larger muscles are hungrier muscles. Our own body weight can be leveraged with exercises like squats, lunges, push ups (from our knees ok), etc. Getting swole is not just for the manosphere.
27. Take breaks from prolonged sitting
As they say, being sedentary is the new smoking. Activity reduces cardiovascular risk, improves metabolic health, keeps joints happier which paradoxically get worse when we rest them too much
28. Maintain healthy blood pressure
<120/80 is the new goal, though higher levels are typical and acceptable as we get older to prevent lightheadedness. Prevents heart disease, stroke, kidney disease.
29. Keep cholesterol levels in healthy range
Some is under our control, other times our genes keep LDL, apolipoprotein B, or Lp (a) higher than we want. Statins are a net positive for many people. Reduces cardiovascular disease risk.
30. Garden if you can
Improves mental wellbeing, supports physical health, connects us with our world and the biology of life. Plus, there is perhaps no joy greater than eating the fruits of our labor. God bless the sun eaters.
IMPORTANT SUPPORTING BEHAVIORS (31-70)
Need a break? Still with me? In that top 100 movie list, The Departed came in at #31. It’s about an Irish gang in Boston. Screen time is ironically #31 in the Examined list of top 100 healthy behaviors. This tier is all about specific actions that support and enhance the benefits of higher-tier behaviors.
31. Limit screen time, especially before bed
Improves sleep quality, reduces eye strain, improves mental health. Many of us have lost sleep to this regime, often precipitated by checking the headlines before bed. The average kid these days spends a shocking, tragic amount of their childhood staring into a screen, and even seeing the world through that camera.
32. Eat mindfully and avoid overeating
Slowing down can provide earlier satiety, pleasure, and supports healthy weight and digestive health.
33. Stay mentally active and engage in lifelong learning
Reduces dementia risk, supports cognitive function. Turns out even old dogs could and should learn new tricks, skills, instruments, and hobbies. Crossword puzzles are good but insufficient.
34. Maintain work-life balance
Reduces stress, improves overall wellbeing. I cut my hours a little when our daughter was born, and though I paid a professional price, I have no regrets and gave zero fecks.
35. Practice safe driving and wear seatbelts
Prevents injury and death from accidents. Public health mandates work, and we should stop it already with the excessive, toxic American hyper-individualism all the time.
36. Use sunscreen, UV protective clothing
The amount of sun we can safely absorb depends on our skin type, latitude, season, etc… but avoiding too much UV prevents skin cancer while allowing some vitamin D synthesis (among other UV stimulated biochemical synthetic processes in the largest organ of the body).
37. Reduce exposure to micro and nanoplastics
An evolving science consistently reveals that we are taking in microplastics into our bodies, and this is associated with chronic diseases like cancers, CV disease, and even dementia. Try to use less plastic, recycle, wear real fabrics in clothing, reverse osmosis your drinking water.
38. Get adequate calcium and vitamin D for bone health
Helps prevent osteoporosis and fractures.
39. Practice emotional regulation and coping skills
Improves resilience and mental health outcomes. Self help books sell for good reason, counseling is cool, and mental health is even one of the four main drivers of longevity as outlined in Peter Attia’s book Outlive.
40. Avoid secondhand smoke exposure
Help others quit if you can. Reduces cancer and cardiovascular disease risk.
41. Take appropriate vitamins/supplements when deficient
A few studies have shown a multivitamin as we all get older is probably worth it. Corrects nutritional deficiencies, supports health. Just don’t rely on this over a well balanced, healthy diet.
42. Practice food safety and proper food handling
Cooking is good. Raw milk is straight from the udder. Prevents foodborne illness. Salmonella will mess you up.
43. Maintain healthy blood sugar levels
Prevents diabetes complications, and dovetails with much of the above about sugar intake, exercise, weight control, etc.
44. Get regular eye exams
Early detection of eye diseases, especially as we get older.
45. Practice good respiratory hygiene
Cover coughs/sneezes. Please. Helps prevent spread of respiratory infections. Pay it forward, and stay home when sick, a revolutionary idea.
46. Engage in enjoyable hobbies and activities
Reduces stress, improves quality of life. Keeps the brain healthy.
47. Limit caffeine intake, especially late in day
Coffee in the morning can be healthy, unless it contributes to palpitations or anxiety. Moderation and early day consumption improves sleep quality.
48. Practice portion control
The carbohydrate portion of the plate should shrink for many of us. Supports healthy weight management. Eating to the point of 80% full can be practiced and normalized.
49. Maintain good air quality in living spaces
Forget air freshener chemicals. Crack windows. Vacuum and consider air filtration. Supports respiratory health.
50. Practice balance exercises to prevent falls
Prevents injuries, especially in older adults. Use it or lose it faster.
51. Cook meals at home more often
Better control over ingredients and portions.
52. Stretch regularly to maintain flexibility
Personally I don’t like stretching, but it can help prevent injury, maintain mobility. I do like slow warm ups before exercise, and a little stretch after I’m done.
53. Practice time management and organization
Why is this on the list? Because many of these 100 require some planning and intention. Reduces stress, improves productivity, facilitates execution.
54. Limit exposure to loud noises
Prevents hearing loss. Think traffic, concerts, movies, airplanes, lawnmowers.
55. Take regular breaks during work
Circuit breakers help. Damn companies that track workers’ eyeballs and keystrokes. Reduces fatigue, improves performance.
56. Practice good workspace ergonomics
I bought myself a standing desk for my back and core. I bought myself a special kind of mouse for my wrist. Prevents repetitive strain injuries.
57. Maintain a clean living environment
Reduces allergens and infection risk. This doesn’t mean cleaning everything with chemicals all the time. Tidiness over sterilization.
58. Learn and practice first aid
You never know. Can save lives in emergency situations. Calling 911 and giving compressions are 90% of the battle.
59. Use proper lifting techniques
It just takes that one suitcase. Prevents back injury, etc.
60. Practice temperature regulation and avoid extreme exposures
Though many like saunas and ice water plunges, these can be dangerous shocks to the system for most of us as we get older in particular. Avoid extreme summer heat and prolonged winter cold. Prevents heat stroke and hypothermia.
61. Engage in outdoor activities and nature exposure
The color green. The color blue. Breezes. Birdsong. Reduces stress, improves mood.
62. Maintain proper medication management
Ensures therapeutic effectiveness and safety. Not all medical errors are committed by clinicians, and compliance is a keystone.
63. Practice good financial health and planning
Reduces stress, improves access to healthcare. Credit cards are candy, and we should all be paid more when we look around and see the immoral, orders of magnitude wealth inequality.
64. Wear appropriate protective equipment for activities
Prevents injuries during sports/work. Maybe not so cool, but crucial.
65. Practice deep and diaphragmatic breathing
I kind of already wrote this one, but specifically engaging one’s diaphragm while breathing takes practice. Improves oxygen delivery, reduces stress.
66. Maintain good circulation through movement
The natural corollary of not sitting all day. Prevents blood clots, supports heart health.
67. Practice moderation in all lifestyle choices
Health recommendations change over the years as we figure things out. Hedging our bets can work. Prevents extremes that may harm health.
68. Learn stress management techniques
Provides tools for handling life challenges.
69. Maintain intellectual curiosity and mental challenges
The brain has neuroplasticity, and we would be foolish to think learning is something we only do as kids. Supports brain health and cognitive reserve, and this universe is incredibly fascinating. I want to know as much about it as I can before I die.
70. Practice good communication skills
Listening. Do you want to be helped, heard, or hugged? Improves relationships, reduces conflict.
SPECIALIZED & EMERGING PRACTICES (71-100)
We are now in the homestretch. If you are still reading please know that you are now in the Examined elite club. In that NYT Top 100 movies list, Ocean’s Eleven comes in at #71. Brad Pitt and Don Cheadle have great skin.
71. Take care of skin health
As a man, have you ever used lotion on your legs after a shower? Incredible! Prevents skin diseases, supports appearance.
72. Practice energy conservation techniques
I’m including this one especially in the age of long Covid. Prevents fatigue, maintains stamina. Especially for older people, it’s ok to intuit what we can do that still feels good and constructive versus what feels like too much.
73. Maintain good indoor lighting
Supports circadian rhythm, prevents eye strain. Houses should be darker at night, and window shades open in the morning.
74. Practice pet therapy or animal interaction
We don’t have a pet right now, but I did meet a really cute little dog named Emmy yesterday. I enjoyed petting her and everyone around was smiling and fawning. Reduces stress, improves mood.
75. Engage in creative activities
Paint. Write. Weave. Tell stories. Supports cognitive function and wellbeing, even when said creations are not masterpieces.
76. Practice water safety
Prevents drowning and water-related injuries. The buddy system, don’t turn your back on the ocean, understand riptides.
77. Maintain good gut health through pre- and probiotics
Fiber. Greek yogurt. Some fermented stuff. Maybe a little Visbiome. Supports immune function and digestion, and probably everything.
78. Practice mindful technology use
I need to stop writing this, but I only have 22 more to go with you! Prevents digital addiction, improves focus and attention. Our lives are the sum of what we pay attention to.
79. Learn proper body mechanics
Physical therapy can help. We can educate ourselves, too. Prevents injury during daily activities. Good posture but also good movement.
80. Practice environmental consciousness
Who knew that giving a damn about the environment would actually be important for human civilization and health. Turns out they’ve been screaming this for decades. Too few have listened. Supports planetary and personal health.
81. Maintain regular daily routines
This is not possible for everyone, and I excuse myself from this unattainable goal. But for many, structure reduces anxiety and gives a sense of purpose and grounding.
82. Practice good nail and hair hygiene
Prevents infections, maintains appearance. The world under our fingernails is a jungle. Just ask the women in labor and patients undergoing surgery before doctors and midwives finally started washing their hands.
83. Learn about your family health history
This should probably be in the top ten. Helps identify genetic risk factors.
84. Perhaps don’t own a gun
Studies have shown that living with a gun owner doubles your risk of dying by homicide, and as a female spouse you have 8X the risk of dying from a spouse/intimate partner shooting you.
85. Cultivate a resilient personal narrative
The stories we tell ourselves — daily, lifelong, and intergenerational stories — help make sense of the world and tame chaos. But they can also imprison and defeat us. Trying to be the hero in our own personal journey can reframe a lot, and lead to resilience and meaning.
86. Practice good foot care
Pretty mundane stuff, but preventing foot problems maintains mobility, which under girds so much. Good shoes, and a good podiatrist/foot orthopedist when needed.
87. Listen to music
From Elvis to Chopin to Radiohead, music can help reduce anxiety and stress, improve mood, and even enhance cognitive functions. Taking up, or keeping up with an instrument supports cognition. Playing the drums is highly recommended. More on that in a future post.
88. Practice good travel health measures
Did you know that the CDC maintains (for now) a great resource about health and infectious disease-related recommendations for each country in the world? I often consult with my patients who are traveling abroad, and there are dedicated travel medicine clinics in many cities. Some pregaming can prevent serious travel-related illnesses.
89. Have a good primary care doc and medical home base
Studies show that primary care, though not glamorous, delivers better quality care and better clinical outcomes at a lower price than specialist-only health care. We love our specialists and rely on them… but having a doctor who sees the big, broad picture, who emphasizes prevention, and who ideally knows you over time makes a measurable difference.
90. Go for a walk after meals if you can
This lowers blood sugars, has been shown to help control diabetes, and makes a significant difference in fat deposition after meals
91. Learn to recognize health warning signs
There is a fine line between hypervigilance and blowing off medical symptoms. But when you find yourself rationalizing potentially serious symptoms, err on the side of checking in with that family doc I was just talking about. Enables early intervention for health problems.
92. Practice regular self-examination (skin, breasts, etc.)
Early detection of abnormalities. Most of the time it’s the patient who finds things, not the doctor.
93. Maintain good car safety practices
Prevents motor vehicle injuries. This includes not texting, drinking alcohol, and diagnosing/treating sleep apnea if you are suffering from unexplained daytime sleepiness
94. Practice good seasonal health adjustments
Adapting your health behaviors to address the unique challenges each season brings, such as increasing vitamin D in winter due to less sunlight, managing spring allergies, protecting against heat and dehydration in summer, and getting flu shots in fall.
95. Use appropriate home safety measures
Prevents home-related injuries. Fire and carbon monoxide alarms, fire plans, fall-proofing homes for older folks, securing medications away from kids.
96. Practice good phone and computer posture
Prevents neck and back problems. I actually see a good deal of phone related wrist and thumb tendon problems. Keeping your screen at eye level, maintaining a straight back with shoulders relaxed, keeping feet flat on the floor, and holding phones up rather than looking down to prevent “text neck.”
97. Maintain regular contact with healthcare providers
Ensures continuity of care. Also, after three years, you become a “new patient” per billing protocols, which often means you go to the back of the line with all the other “new patients.” I’ve been burned by this multiple times myself!
98. Practice good shoe selection
Supports proper alignment, prevents pain. High heels are terrible. My new favorite shoe is made by Oofos brand. Old-fashioned and specialized shoe stores are worth the time and investment. We have Carl’s Shoes in South Jersey and Philly Runners in Philly for example.
99. Cultivate a sense of purpose and meaning in life
Associated with longevity and life satisfaction. I could have become an investment banker instead of a family doc, but I don’t think I personally would have found purpose in that. But when I launch my new crypto currency called $Examined$, I will donate my billions to environmental charities.
100. Practice gratitude and maintain optimism
I am really happy this top 100 project is nearly done! It seemed like a good idea when I started it, and then I realized how big a number 100 really can be! Gratitude and optimism are in short supply these days here in 2025, but we must stubbornly hold onto them and invite people in. They enhance mental well being and improve physical health outcomes… and that is our only hope. That, and Obi Wan.
No Star Wars sequels on the top 100 movie list?
Conclusion
I hope you enjoyed this monster installment, which I really did pare down mercilessly. I have written about many of these behaviors and practices in various long form, creative, and data driven ways over these four long years. Feel free to check out my reading room for some deep dives and related, accumulated family doc wisdom.
This post was first dropped on Monday on my substack, and photo credits are there, too.
Like all top 10 to 100 lists, I’ve surely missed some items along the way, or omitted ones that you might find deserving. Nonetheless, from avoiding that first cigarette (#1) to cultivating gratitude (#100), each behavior on this list is a small investment that pays dividends in how we feel, how long we might live, and how much we enjoy the journey.
Stay tuned for part two in which I’ll check on how we are doing as a village caring for each other and therefore ourselves.
Spoiler alert: it’s not so good, but we can still effect change.
Tap this Substack link to add your email, and I’ll make sure future posts land in your inbox.
Happy 100 🙂
And I hope nobody’s got a case of the Mondays.
It’s Friday already!
Have a great weekend if you can.