Laura Vater, MD
THE SMILE SCALE™
Prioritizing our health helps us live longer and feel happier. It gives us energy and vitality.
But it often feels challenging to prioritize our health. Even when we try to make healthier choices, the information we read can be conflicting and overwhelming. Often, we don’t know where to start. Or how to start.
During my training, I created a tool to help me prioritize my health, called the SMILE Scale™. It is a daily self-assessment. Each letter (S, M, I, L, E) represents one healthy habit and counts as one point.
The daily scale ranges from 0 to 5. When my score is high (4 or 5), I often feel better. When my score is low (0 to 2), my energy and mood are also lower.
This tool gives me a consistent strategy to prioritize and advocate for my health. I hope it will help you too.
S - Sleep enough. Did I sleep 7-9 hours today? Was my sleep restorative?
Sleep is essential for health.
Sleep deprivation not only compromises our immune system and increases the risk of getting sick, it also makes us more likely to feel depressed and to overeat.
Chronic sleep deprivation is linked to obesity, diabetes, heart disease, high blood pressure, and stroke. Further, when we don’t sleep enough or feel restored in the morning, we may not have the energy or motivation to make other healthy choices.
There are many reasons why we don’t get the recommended 7 to 8.5 hours of sleep per night. Stress, anxiety, artificial light at night, shift work or long working hours, too much caffeine, chronic pain, and urinary issues can all contribute.
These strategies can help improve sleep:
Keep your bedroom dark, quiet, and cool. Keep the television out of the bedroom and turn off audible phone notifications.
Be consistent. Go to bed and arise at the same times each day. If you are a shift worker or work long hours (like I do), prioritize sleep when you can.
Reduce your exposure to artificial light at night by decreasing evening screen usage, turning on the night shift feature on your phone, or by wearing blue-light blocking glasses.
If you have a medical reason for not sleeping well, such as chronic pain, anxiety, frequent urination, sleep apnea, or hot flashes, talk to your doctor about strategies to help.
M- Move my body. Was I physically active for 30 minutes or more today?
Regular physical activity helps us live longer.
It decreases risk for heart disease, diabetes, dementia, and some cancers. It also reduces the risk of osteoporosis and falls in older adults. In the short term, it boosts mood and energy, improves sleep, and reduces stress.
Current guidelines recommend that adults get at least 150 minutes of moderate-intensity exercise (such as brisk walking) or 75 minutes of vigorous-intensity exercise per week. Adults should perform strengthening activities at least twice per week.
Here are some ways to be more active:
If you have time constraints, add small amounts of exercise into your routine. Do 10 minutes of yoga or strength-training before showering, or add 20 minutes of stairs at lunchtime. Consider adding a brisk evening walk to your routine.
If you get easily bored with exercise, vary your workout routine. Consider interval training, group fitness classes, or asking a friend to join you.
If you have a chronic condition or disability, work with a physical therapist to determine which activities are best.
I - Inhale. Exhale. Did I find healthy ways to reduce stress today?
Research has shown that meditation increases the level of neurochemicals in our brain that decrease anxiety and stress. Meditation has also been shown to improve sleep, reduce pain, and increase creativity.
There are many types of meditation, and there is no right or wrong way to meditate. Components of meditation can include breathing deeply, focusing on different parts of the body to increase awareness, repeating a mantra, praying, walking in nature, focusing on gratitude, or even reflecting on literature.
If you are new to meditation, consider taking a group class or using an app to help guide you. Start with a few minutes each day and see how it makes you feel.
L - Love and connect. Did I meaningfully connect with someone today?
Social connection is essential for health and longevity.
It strengthens our immune system and decreases anxiety and depression. Studies have shown that lack of social connection is more harmful to our health than obesity or smoking.
It is important to foster connections with others, and it is not the quantity, but the quality of relationships that matters most. Consider calling a loved one, saying a kind word to your spouse, spending intentional time with your children, or having coffee with a friend. Even small connections with your colleagues, patients, or clients can provide meaning at work and added health benefits.
If you do not have close connections, it is never too late to foster relationships. Find new ways to connect with others, such as joining a faith group or community organization.
E - Eat to nourish. Did I choose foods that nourish my body?
The choices we make about food affect our health to a high degree.
Unhealthy eating habits are linked to diabetes, heart disease, stroke, and certain types of cancer. Eating well can decrease inflammation in our bodies, improve energy levels, and prolong our lives.
Nutritional recommendations can be conflicting and confusing at times. The good news is that emerging data provides a simpler message: we should consume mostly plant-based foods that are not highly processed.
This means getting most of our nutrition from vegetables, nuts, legumes (such as beans or lentils), fruits, and whole grains. We should also try to eat in moderation, limit sugar-filled beverages, and choose organic and local foods whenever possible.
Medical Student &
I love this so much and use it a lot! I shared it with my fellow medical school friends as we start Step 1 studying. Thank you for your creativity
and positive light.
Spiritual Care Practitioner,
Psychotherapist, & Patient
It is a great tool for those in the midst of rigorous training and professional caregiving. A reminder that you matter, that your resilience and health matters - not only to you and your families, but to your patient as well.
Jeanne Rosner, MD
Physician, Educator, and
This mnemonic is spot on. It should be shared throughout the medical community.
Since I learned about it,
I use it every day
and I am teaching it to
all my students.
Shanika Es, MD
This is such an important reminder and checklist for anyone in healthcare at any stage in their career. Love your perspective and thanks for sharing!