5 Things Most Americans Aren’t Doing to Promote Health
For decades we've been told that our health was out of our hands — that genetics were at the root of our conditions and diseases. Well, now we know that isn't exactly the case. While genetics do play a role in some conditions, the majority are driven by lifestyle-factors. Just because someone in your family has a disease, doesn't mean you're sure to receive the same diagnosis.
What we're beginning to realize that in many cases, you may be genetically at a higher risk for developing a disease, but your lifestyle and environment are the factors that actually pull the trigger. The interaction between the genetic makeup of our bodies and our environment is called epigenetics. Similarly, the interaction between our genes and our diet is called nutrigenetics. These are two areas of health and scientific research that are still developing, but they’re likely to become integral guides for health and wellness in the near future.
What we do know, is that there are many aspects of lifestyle and environment that we can control, or at least we can impact. There are many behaviors that have been associated with chronic disease development, some of which are: physical activity, diet, tobacco and alcohol usage, safe sexual practices, and sleep. Over the last 20+ years there have been numerous studies to collect data on the health behaviors of Americans. While they don't represent all people, these studies are helpful in drawing conclusions about the overall health of the people in our country.
Show Me the Data
According to the Centers for Disease Control and Prevention (the CDC), there are five key health behaviors to regularly engage in to prevent the development of chronic disease. They’re similar to those mentioned above: avoiding or never smoking, getting regular physical activity, avoid or moderately consume alcohol, maintaining a "normal" body weight (evaluated via the World Health Organization's definitions of BMI), and obtaining a sufficient amount of sleep each night.
The CDC completed a study four years ago based on data collected from the Behavioral Risk Factor Surveillance System from 2013 which consisted of a group of nearly 400,000 adults. The data collected from these adult respondents showed that the majority of them (35.4%) reported engaging in 3 of the 5 mentioned health behaviors regularly, whereas only 6.3% engaged in all 5 (4).
A similar study of health behaviors by Mayo Clinic was based on the 2003-2006 National Health & Nutrition Survey respondent data. In this study, they also looked at health behaviors surrounding the following lifestyle factors: physical activity, healthfulness of the diet, avoidance of smoking, and having a body fat percentage within the recommended range. This study was focused on heart health, so they also looked at several cardiovascular biomarkers such as C-Reactive Protein, total cholesterol, HDL, LDL, triglycerides, and blood sugar values.
The results of their study found that of the over 4,000 respondents, only 2.7% engaged in all 4 of the health behaviors mentioned. They go on to say that of those who reported 3 or 4 behaviors, they also showed overall a better biomarker panel compared to those who reported 2 or fewer health behaviors.
Health Promoting Behaviors
So why are these behaviors important? Well there's extensive research on each topic, but here's a quick summary:
Smoking and Drinking
Today, most people are aware of the health risks associated with smoking. While usage is on the decline, millions of Americans still smoke daily and its still considered the leading cause of preventable disease and death in the US (1, 4). Not only does smoking increase risk for the individual using the cigarette, but second- and third-hand smoke puts others at risk as well. Therefore, the CDC recommends never smoking and if you do currently smoke, it would be beneficial for your health to quit.
Alcohol consumption is another major contributor to death in the US, for a wide variety of reasons (3). Research tells us that heavy, long-term drinking increases your risk for conditions such as high blood pressure, stroke, certain cancers (3). Outside of the risk of disease, death due to alcohol also results from numerous injuries. There are thousands of deaths every year due to alcohol-related car accidents, falls, drownings, homicides, suicides, and more (3). On a population level, recommendations for alcohol usage aren't all inclusive. There are significant differences on the effects of alcohol by sex, age, and across cultural and ethnic groups. Therefore, the CDC gives different alcohol recommendations for men and women, due to the differences in alcohol metabolism. They don't recommend drinking at all, but suggest limiting consumption to 2 drinks/day for men and 1 per day for women (1). Additionally, they discourage binge drinking (consuming more than 4 standard drinks in a 2 hour timespan) and heavy drinking (binge drinking more than 5 days per month).
Physical Activity
Movement, exercise, physical activity — whatever you call it, it's simply moving your body! There are numerous reasons why movement is beneficial for our health physically, mentally, and emotionally. The general recommendations for physical activity are 150 minutes of moderate-intensity activity, 75 minutes of vigorous activity, or a combination of both each week (1). In 2014, it was estimated that less than half of US adults met the minimum weekly recommendation for physical activity (4).
Besides general physical strength and flexibility there are also clinical benefits! Here are a few benefits of exercise on bone health... Strength-training exercises have been shown to be beneficial especially for post-menopausal women to help preserve bone density (3). Additionally, for older adults regular exercise helps reduce the risk of fractures by increasing muscle strength and overall balance, therefore reducing the risk of falling (3).
Body Weight
As many people are aware (or have heard via the media), the prevalence of overweight and obese Americans has been increasing steadily over the last few decades. We know that obesity — carrying an excess amount of body fat — is a health risk for diabetes. There also have been numerous connections made by researchers between excess body weight and other health conditions such as high blood pressure, heart disease, and some cancers for example.
In many studies like those mentioned earlier, they use BMI or Body Mass Index to classify overweight and obesity. While these are helpful tools on a population level, they aren't accurate predictors of health on an individual level. The measurement itself is a pretty simple calculation, it's just a comparison of your body weight to your height. It works as a general guide, but it's not an end-all-be-all. This is because the population data used to determine these ranges was not representative of all adult groups, especially non-whites and women. Additionally, it does not take body composition into consideration, so if you're an individual with a lot of muscle mass, your weight for height will likely classify you as "overweight" based on these numbers alone. For these reasons, it's important to look at your weight on a personal level. Are you at a natural weight for your body? Have you gained weight in recent years that could be related to lifestyle factors?
It's important to also note that there is controversy over the role of body weight and our health. There are many researchers who propose that excess body fat itself isn't the culprit, but the lack of physical activity and an overall poor diet are more likely to be contributing factors (3). Additionally, “body weight” is included in the health-promoting behaviors, but our weight isn’t a behavior. So is our weight really the problem? Or the actual behaviors that drive our body weight?
Sleep
The importance of quality sleep is incredibly underrated when it comes to health promotion! People often don’t consider their sleep habits when thinking about their state of health. In 2015, the American Academy of Sleep Medicine and the Sleep Research Society came to a consensus on sleep recommendations for adults. They state to promote optimal health, that adults should get 7+ hours of sleep per night on a regular basis (7). They go on to explain that sleeping less than 7 hours regularly is associated with a variety of poor health outcomes such as diabetes, heart disease/stroke, depression, high blood pressure, and weight gain (7). In addition, poor sleep habits is also related to impaired immune function, increased pain, and poor performance with a greater chance of errors and accidents (7).
One study reported that individuals who had regular nights with 7-8 hours of sleep had a lower prevalence of using cigarettes, drinking 5+ beverages at a sitting (binge drinking), physical inactivity, and obesity compared to those who get less than 7 hours on a regular basis (1). What constitutes healthy sleep? A duration of 7-9 hours of good quality sleep: uninterrupted, appropriately timed, and regular (7).
Diet
You may have noticed that the CDC didn’t consider a healthful diet in their 2016 health-related behavior study. While they didn’t choose to focus on the participant’s diet quality in this particular study, we know that nutritious food and a balanced overall diet is key to promote health! Poor diet quality is certainly considered a leading risk factor for disease, dysfunction, and death in the US and around the world.
In addition, we know that many Americans still struggle to shift their diet to meet even the minimum recommended servings of whole fruits, vegetables, and grains. What are the daily recommendations? The official recommendation is 1.5-2 cups of fruit and 2-3 cups of vegetables, every day (8). These are modest recommendations, set low enough to be achievable for the average person while still meeting their overall nutrition, vitamin, and mineral needs. Sadly, the vast majority of Americans are nowhere near that goal. In a 2018 report from the CDC, they stated that only 12.2% of US adults met the recommended daily intake of fruit and a mere 9.3% met the minimum recommendation for daily vegetables (8).
It seems like it would be easy to get enough servings of fruits and vegetables, but it’s difficult for many. A good rule of thumb is to have at least half of your plate be vegetables (some of that can be fruit, but don’t crowd out the veggies) at every meal. Using this method, you’d be able to meet (and exceed) the general recommendations if you strive to make half your plate vegetables (and some fruit) at 3 meals, and 1-2 snacks each day.
From a functional medicine perspective, we’d like to see at least 9 cups of fruits and vegetables daily for optimal health! This might seem like a lot, but if you break it down into groups it could be met by eating 1/2 - 1 cup of starchy vegetables, 2 cups of non-starchy vegetables, 4 cups of leafy greens, and 1 cup fruit each day. Choose an area of your plate to put more focus on this week — get creative, and use your plate as a visual guide!
Takeaways
Here's the good news: there's a lot we can do to support our health and well-being! This information can be overwhelming, but it should also be empowering. It should give you confidence that there are always things you can do to support your health. While some factors are out of our control, we can work to promote health by focusing on one thing at a time. Choose an area that resonates most with you, set small, achievable goals in order to better yourself! Every step you take, even a small one, is amazing! Keep working towards your health goals!
References:
Clustering of five health-related behaviors for chronic disease prevention among adults, US, 2016. Centers for Disease Control and Prevention 2016; https://www.cdc.gov/pcd/issues/2016/16_0054.htm
Healthy lifestyle characteristics and their joint association with cardiovascular disease biomarkers in US adults. Mayo Clinic 2016; https://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/pdf
Health and behavior: the interplay of biological, behavioral, and societal influence. Institute of Medicine Committee on Health and Behavior: Research, Practice, and Policy 2001; https://www.ncbi.nlm.nih.gov/books/NBK43744/#a2000495eddd00084
Encourage healthy behaviors and choices. American Public Health Association; https://www.apha.org/what-is-public-health/generation-public-health/our-work/healthy-choices
CDC National Health Report Highlights. Centers for Disease Control and Prevention; https://www.cdc.gov/healthreport/publications/compendium.pdf
Drinking levels defined. National Institute on Alcohol Abuse and Alcoholism; https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, Vol. 38, No. 6, 2015; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434546/pdf/aasm.38.6.843.pdf
State indicator report on fruits and vegetables, 2018. Centers for Disease Control and Prevention, 2018; https://www.cdc.gov/nutrition/downloads/fruits-vegetables/2018/2018-fruit-vegetable-report-508.pdf