America is not a healthy nation. The US spends more on health care than any other high-income country but still has the lowest life expectancy at birth and the highest rate of people with multiple chronic diseases, according to a 2023 report from The Commonwealth Fund, an independent research group. In fact, America is ranked No. 35 out of 169 countries in terms of overall citizen health, according to the Bloomberg Healthiest Country Index. This means that 34 countries are ahead of us.
It’s easy to see why. Nearly 60% adults in the United States have at least one chronic disease, with the most common being heart disease, cancer, diabetes, arthritis, and obesity, according to the CDC. Consequently, biomarkers — objective measures of normal or abnormal processes or conditions or diseases —really matter. These might include blood pressure, resting heart rate, blood sugar levels, cholesterol levels, and body fat percentage, for example.
Essentially half (47%) of American adults have high blood pressure (hypertension), according to the American Heart Association. That amounts to a whopping 122.4 million people. A normal blood pressure is less than 120/80 mmHg. A blood pressure of 140/90 mmHg or more is too high. People with levels from 120/80 mmHg to 139/89 mmHg have a condition called pre-hypertension, which means they are at high risk for high blood pressure.
Having high blood pressure puts you at risk for heart disease and stroke, which are leading causes of death in the United States. However, most people who have hypertension do not experience any symptoms. People usually discover that they have hypertension following a routine blood pressure check.
Another all-too-common disease in the US is diabetes, which is diagnosed when a person’s A1C levels are 6.5% or higher.
According to the CDC, 11.3% of the US population has diabetes, and 23% of adults are undiagnosed. This means that more 34% of the adult population likely has diabetes. Yet, about 90-95% of people with diabetes have type-2, which is preventable. Additionally, about 98 million American adults (more than 1 in 3) have pre-diabetes. If you get the sense that diabetes is a crisis in the US, you’re right. Having diabetes also raises the risks for other chronic conditions.
For example, if you have diabetes, you are twice as likely to have high blood pressure. Chronic diseases are often linked.
Diabetes is the top cause of kidney failure, causing nearly half (47%) of new cases. About 1 in 3 adults with diabetes may have kidney disease. High blood pressure is the second most common cause of kidney failure, causing 27% of new cases. In fact, 1 in 5 adults with high blood pressure may have kidney disease. Are you getting the sense that many of the most common chronic diseases are linked?
Quite astonishingly, as many as 37 million Americans have kidney disease, meaning it affects 14% of American adults. In fact, kidney disease is the fastest-growing noncommunicable disease in the US, and it’s one of the top 10 causes of death.
The kicker is that all of the above are preventable; it’s within our hands to heal or prevent them. But there’s more.
High LDL (bad) cholesterol levels in the bloodstream may increase the risk of heart disease and cardiovascular events like stroke. Normal cholesterol in adults is less than 200 mg/dL; borderline high is 200 to 239 mg/dL. Yet, about 86 million US adults age 20 or older have total cholesterol levels above 200 mg/dL, according to the CDC. And nearly 25 million adults in the US have total cholesterol levels above 240 mg/dL.
The latest data indicate that 39.6% of US adults are obese, and another 31.6% are overweight. Taken together, 71.2%, or nearly three-quarters, of American adults are either overweight or obese. This comes at a tremendous cost to our national wellbeing. Overweight and obesity may increase your risk for developing health problems, such as diabetes, heart disease, stroke, and certain cancers, according to the National Institutes of Health.
Excess body fat is associated with high levels of LDL (bad) cholesterol and triglycerides, as well as low levels of HDL (good) cholesterol. It also impairs the body’s responsiveness to insulin, raising blood sugar and insulin levels. Excess body fat contributes to major causes of death and disability, including heart attacks, strokes, high blood pressure, cancer, diabetes, osteoarthritis, fatty liver, and depression. Yet, when it comes to health, the issue is not how much you weigh but how much abdominal fat you have. Research shows that abdominal fat is the worst of the worst because it is a major contributor to cardiovascular disease.
Waist circumference is an indicator of the health risks associated with excess fat around the waist. A waist circumference of 40 inches or more in men, or 35 inches or more in women, is associated with health problems such as type 2 diabetes, heart disease, and high blood pressure. Ideally, everyone should aim to keep their waist measurement less than half that of their height, according to scientists. That means a 6ft (72 inch) tall man should aim to keep his waist less than 36 inches, while a 5ft 4in (64 inch) woman should keep hers under 32 inches.
Metabolic syndrome is a cluster of conditions that increases the risk of heart disease, stroke and diabetes. Metabolic syndrome includes obesity, high blood pressure, high blood sugar, high triglycerides, and irregular cholesterol levels. The risk of metabolic syndrome increases with age, and about 1 in 3 adults have metabolic syndrome.
Heart disease remains the leading cause of death in the US, as it has been for the past 100 years. Stroke is the fifth leading cause of death. Together, they claimed more lives in 2021 in the U.S. than all forms of cancer and chronic lower respiratory disease combined. High blood pressure, high blood cholesterol, and smoking are key risk factors for heart disease. Yet, diabetes, overweight and obesity can also put people at a higher risk for heart disease.
The links between all of these chronic diseases is striking. Having high blood pressure puts you at risk for heart disease and stroke. If you have diabetes, you are twice as likely to have high blood pressure. Yet, people with high blood pressure usually have insulin resistance and have an increased risk of developing diabetes compared to those with normal blood pressure. So the relationship between diabetes and high blood pressure is a two-way street. Diabetes is the top cause of kidney failure. High blood pressure is the second most common cause of kidney failure. High LDL (bad) cholesterol levels in the bloodstream may increase the risk of heart disease and stroke. Overweight and obesity may increase your risk for developing a wide array health problems, such as diabetes, heart disease, stroke, and certain cancers.
Link after link after link. The connection between chronic conditions is stark.
Yet, being thin doesn’t necessarily mean that you’re healthy. Thin people might still have cancer, diabetes or heart disease, for example.
Health is comprehensive and encompasses a number of factors including nutrition, exercise, sleep, stress levels, lifestyle choices, and more. Weight is just one small piece of the puzzle and should never be used as the sole indicator of overall health.
Wellness requires us to think holistically and address all indicators of health. Obsessing and stressing over one factor, such as weight status, can stunt progress and lead to decreased mental wellbeing.
It’s important to recognize that medical interventions contribute less than 10% to overall health. Meanwhile, nutritional status accounts for a remarkable 80%. Nutrition addresses the root causes of diseases, whereas drugs often only alleviate symptoms. What we eat really matters… a lot.
We know that exercise certainly improves health and wellness. Yet, a staggering 80% of US adults and adolescents are insufficiently active, according to the Journal of the American Medical Association. What’s more, those leading sedentary lifestyles face a 20-30% higher risk of mortality compared to those who participate in at least 30 minutes of moderate exercise most days of the week, according to the World Health Organization.
Numerous studies show that consistent exercise decreases the risk of cardiovascular disease, type 2 diabetes, many cancers, cognitive decline and mental illness. Meanwhile, a sedentary life is associated with an increase in cardiometabolic disease and shortened lifespans.
While there are many reasons that people exercise, in my view it shouldn’t be about having the best butt or bigger biceps; it’s about being a happier, more fulfilled, more self-satisfied person. Everyone recognizes that exercise can change your body, but it can also change your mood, your attitude, and even your mind.
Wellbeing is not just the absence of disease or illness. It’s a complex combination of a person’s physical, mental, emotional, and social health factors. Wellbeing is strongly linked to happiness and life satisfaction. In short, wellbeing could be described as how you feel about yourself and your life.
Researchers agree that health-related quality of life is multi-dimensional and includes domains that are related to physical, mental, emotional and social functioning, and the social context in which people live. That said, loneliness and social disconnectedness are two of the greatest challenges of the modern era. Social isolation and loneliness are now considered demonstrated risk factors for depression and cancer. Our social connections, or lack thereof, really affect our health.
Loneliness takes a toll on our health. It can lead to high blood pressure, and an increased risk of cardiovascular disease and stroke. Loneliness has been linked to the progression of Alzheimer’s, raising the likelihood of dementia by 40%. And it can also double the risk of Type-2 diabetes. One study found that loneliness can be as much of a long-term risk factor as smoking. As a consequence, chronically lonely people tend to have an 83% higher mortality risk than those who feel less isolated.
Brigham Young University researchers have revealed that loneliness is deadlier than obesity and should now be considered a major public health hazard. They discovered that lonely people had a 50% increased risk of early death, compared to those with good social connections. In contrast, obesity raises the chance of dying before the age of 70 by around 30%. Humans are social animals. We need community, we need friends. While solitude may be nice sometimes, loneliness isn’t.
Research also shows that mindset really matters when it comes to health, and it can even extend your life. A classic study found that people who were optimistic about aging lived seven and a half years longer than those who had negative perceptions of it.
The takeaway is that our health is mostly in our own hands. We can be proactive and we can largely control our own destiny. We are not fated to ill health, even if our parents or grandparents had specific diseases. Most of the diseases that modern Americans suffer from are lifestyle disease, meaning they’re the result of the way we live and the choices we make.
We can make better choices to improve our health, the quality of our life, and even our life expectancy. We also need to remember that stress reduction and social connection play a big role in our wellbeing. We can do better, and we must do better. Our very lives depend on it.
It’s preferable that your doctor tells you that you look better on the inside than on the outside. Your biomarkers really matter, and you should know them.
