The SMILE Score Laura Vater, MD, MPH
Updated: Aug 16, 2021
With busy schedules at work and at home, 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. Sometimes we don’t know where to start. I am a physician with many demands on my time. I’m also a wife and a mother. Despite having a medical degree and extensive knowledge about the human body, I have often struggled to prioritize my health. Last year during a particularly hard month, I found myself feeling even more anxious and exhausted. I knew I needed to take care of my health, but I was tired and inconsistent. I started to search for ways to simplify my approach. As I explored the data on habits that promote health, I found a clear message: get enough sleep, be physically active, find healthy ways to de-stress (such as meditate), connect with others, and eat a mostly plant-based diet. I wanted to find a memory tool to reinforce this information, especially after spending years synthesizing complex information with the help of memory aids. Frustrated that I could find none, I decided to create one—what I have named the SMILE Score. This simple tool has changed how I think about health. It serves as a daily self-assessment and provides a consistent strategy to get back on track. Each letter (S, M, I, L, E) represents one healthy habit and counts as one point (see figure below). The daily score ranges from 0 to 5. I have found that if 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. The SMILE Score has helped me reliably live healthier and feel happier, and I hope it will help you too.
S – Sleep Enough. Did I rest 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, but 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.
Here are some strategies to 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 possible. 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. Did I exercise 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 meditate today? Research has shown that meditation increases the level of neurochemicals in our brain that decreases anxiety and stress. Meditation has also been shown to improve sleep, reduce pain and enhance 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 & 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 a 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 healthy foods today? 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. 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.
Try to eat in moderation.
Limit sugar-filled beverages.
Choose organic and local foods whenever possible.
In my mind, the key to nutritious eating is finding true enjoyment of real food.
It is important to find simple strategies that help prioritize health.
Sleep, exercise, meditation, connection with others and nutrition are essential for optimal physical and mental health.
The SMILE Score is a memory tool that can help you consistently live healthier and feel happier.
Masters P. Insomnia. Annals of Internal Medicine. 2014;161(7). annals.org/aim/fullarticle/1912399/insomnia
Seppala E. Connectedness & Health: The Science of Social Connection. 2016. ccare.stanford.edu/uncategorized/connectedness-health-the-science-of-social-connection-infographic/
The American Heart Association. Recommendations for Physical Activity in Adults and Kids. heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
Harvard Health. What is a plant-based diet and why should you try it? 2018. health.harvard.edu/blog/what-is-a-plant-based-diet-and-why-should-you-try-it-2018092614760
The Mayo Clinic. Meditation: A simple, fast way to reduce stress. Overview. 2019. mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858
A meditation guide: https://naturesoundretreat.com/benefits-of-meditation/
Laura B. Vater, MD, MPH
Laura B. Vater is an Internal Medicine resident physician at Indiana University. She plans to pursue a fellowship in adult Hematology/Oncology. She earned a Bachelor of Science from the University of Notre Dame, a Master of Public Health from the University of Pittsburgh, and a Doctor of Medicine from Indiana University School of Medicine. Dr. Vater's work is focused on helping patients live the best quality of life possible, even in the midst of serious illness. Her research interests include prevention and early detection of cancer, health disparities, health communication, and clinician well-being. She developed the SMILE Score to help patients and health care providers simplify, prioritize and advocate for their health. This tool is starting to be used in wellness training programs, clinics, and schools across the U.S. Website: www.thesmilescore.com Email: firstname.lastname@example.org
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