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Healthy Lifestyles Declining in U.S.

Posted: Wednesday, June 10, 2009

Far fewer Americans are engaging in healthy lifestyles than there were just two decades ago, researchers say. So it is not hard to see why a diabetes epidemic is at our doorstep.

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.

The findings have implications for the overall future risk of cardiovascular disease in adults, they said.

"These findings should provide new motivation for an increasing commitment to promoting healthy lifestyles for the public good," the researchers said.

They compared rates of healthy lifestyle habits in patients ages 40 to 74 who participated in the National Health and Nutrition Examination Survey (NHANES) in 1988-1994 and 2001-2006.

They analyzed adherence to five healthy lifestyle recommendations: eating at least five servings of fruits and vegetables per day, exercising at least 12 times per month, maintaining a healthy body weight, drinking moderately (up to one drink a day for women, two for men), and not smoking.

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."
Practice Pearls:

Explain that fewer Americans are adhering to the five major tenets of a healthy lifestyle, including eating at least five servings of fruits and vegetables per day, exercising at least 12 times per month, maintaining a healthy body weight, drinking moderately (up to one drink a day for women, two for men), and not smoking.

Note that the findings could have implications for future risk of cardiovascular disease.