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Healthy Lifestyles on Decline in U.S.

By Kristina Fiore, Staff Writer, MedPage Today

Published: May 28, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

LITTLE FALLS, N.J., May 28 -- Far fewer Americans are engaging in healthy lifestyles than there were just two decades ago, researchers say.
Action Points
Only 8% of today's patients engage in all five healthy behaviors -- maintaining a healthy weight, eating fruits and
vegetables, drinking alcohol in moderation, exercising, and not smoking -- compared with 15% in 1988, Dana E.
King, M.D., of the Medical University of South Carolina, and colleagues reported online in the American Journal of
Medicine.
Explain that fewer
Americans are adhering to
five major tenets of a
The findings have implications for the overall future risk of cardiovascular disease in adults, they said. healthy lifestyle, including
eating at least five
"These findings should provide new motivation for an increasing commitment to promoting healthy lifestyles for servings of fruits and
the public good," the researchers said. vegetables per day,
exercising at least 12
times per month,
They compared rates of healthy lifestyle habits in patients ages 40 to 74 who participated in the National Health maintaining a healthy
and Nutrition Examination Survey (NHANES) in 1988-1994 and 2001-2006. body weight.

They analyzed adherence to five healthy lifestyle recommendations: eating at least five servings of fruits and
Note that the findings
vegetables per day, exercising at least 12 times per month, maintaining a healthy body weight, drinking could have implications
moderately (up to one drink a day for women, two for men), and not smoking. for future risk of
cardiovascular disease.

The researchers found that over the last 18 years, the percentage of adults ages 40 to 74 with a BMI greater than
30 has increased from 28% to 36% (P<0.05).

The proportion who engage in physical activity 12 times a month or more has decreased from 53% to 43% (P<0.05).

Smoking rates have not changed, remaining constant at about 26.5%.

The proportion who eat five or more fruits and vegetables a day has decreased from 42% to 26% (P<0.05).

And moderate alcohol use has increased from 40% to 51% (P<0.05).

Overall adherence to all five healthy behaviors fell from 15% to 8% over the study period (P<0.05).

When analyzed by race and ethnicity, non-Hispanic whites have shown the greatest decrease in overall healthy lifestyle behaviors, the
researchers said.

Also, those with hypertension, diabetes, or cardiovascular disease were no more likely to stick to a healthy lifestyle than those without these
conditions -- a finding the researchers called concerning.

They said they're not sure of the reasons for the decline of healthy lifestyles, but suggestions included changes in social attitudes toward the
importance of a healthy diet and physical activity, gender differences in willingness to change, and low self-assessments of cardiovascular risk
despite statistical evidence to the contrary.

Another possibility is increased reliance on cars instead of walking or biking, the researchers said.

They warned that future healthcare costs are likely to continue to increase "if middle-aged adults do not increasingly adopt a healthy lifestyle as
the primary approach to prevention and treatment of hypertension, diabetes, and hyperlipidemia."

A limitation of the study, according to the researchers, is that physical activity habits in the NHANES survey are from patient self-reports and could
thus be inaccurate or biased.
The researchers reported no conflicts of interest.

Primary source: American Journal of Medicine

Source reference:
King DE, et al "Adherence to healthy lifestyle habits in U.S. adults, 1988-2006" Am J Med 2009; 122: 528-34.
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