Although the twentieth century experienced remarkable improvements in health care, a review of the health status in the United States over recent years reveals alarming trends. About two thirds of Americans are overweight, and poor diet and lack of physical activity threaten to pass tobacco use as the leading cause of preventable death.
Chronic diseases, which are responsible for the majority of sickness and death, are caused by many factors. Some of these factors, like age, heredity, and gender, cannot be controlled; however, an overwhelming amount of evidence indicates that lifestyle modifications such as exercise, diet, and not smoking are key to preventing and controlling disease. Why then, despite clinical and public health recommendations, do so few Americans engage in lifestyle behaviors that could improve their health?
In the April 25, 2005, edition of the
Archives of Internal Medicine,
researchers, interested in this question, published their study on the prevalence of healthful lifestyle characteristics among American adults, as well as on their search for a single indicator of a healthful lifestyle.
About the Study
Researchers at Michigan State University and the Michigan Department of Community Health identified four healthful lifestyle characteristics—1) nonsmoking, 2) healthy weight, 3) fruit and vegetable consumption, and 4) regular physical activity—which, when considered together, provided a single indicator of a healthful lifestyle.
In order to determine the prevalence of the four healthful lifestyle characteristics (HLCs) in the American population, researchers analyzed data on 153,000 people, age 18 to 74 years, from the 2000 Behavioral Risk Factor Surveillance System (BRFSS). This annual telephone survey, conducted by state public health officials, includes questions on weight and height, food consumption, leisure time activity, and tobacco use.
Respondents were given a score of 0-4 using an index that assigned one point for each of their HCLs.
The results of the study showed that a dismal 3% of American adults adhere to all four HLCs. Seventy-six percent of respondents didn't smoke cigarettes, a trend that has been consistent for years. Only 40% had a healthy weight (slightly better than other surveys), 23% consumed adequate amounts of fruits and vegetables, and 22% got enough exercise. Almost 10% had an HLC score of zero.
When they analyzed the data by demographics (age, gender, income, etc.), investigators didn't find any sub-group that scored significantly better than the group as a whole.
There were several limitations to the study: self-reported data is less reliable than actually measuring subject behavior, and the BRFSS is known to underestimate exercise time and food consumption when compared to more comprehensive studies regarding those behaviors. Also, the data did not allow the researchers to draw any conclusions about the causes of their alarming observations.
How Does This Affect You?
The results of this study make it clear that Americans have a lot of room for improvement when it comes to their health. The reasons for this discouraging state of affairs are complex and often beyond the immediate control of the people who could most benefit from healthier lifestyles. While it is easy to simply tell 97% of population that they ought to behave differently, it's important to acknowledge that our social and cultural priorities often discourage “healthy” choices.
Small changes producing positive results, however, can provide an incentive for people to make even bigger changes. Many people benefit from personal or professional support. There are many, widely available programs designed to aid smoking cessation and weight loss efforts. In addition, therapists, nutritionists, personal trainers, books, web sites, and television shows can inform and motivate people to make healthful lifestyle modifications. Anyone embarking on an aggressive exercise or weight loss program should consult a doctor before proceeding.
U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. Public Health Service, Office of the Surgeon General; 2001. (Available at
accessed April 25, 2005).
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a