Americans may say they want long and healthy lives, but in terms of their actions, the record is mixed. In the late 1990s, the U.S. Department of Health and Human Services gathered experts from across the country to document Americans' health and habits and determine what improvements they hoped to see over the next decade. The initiative, known as Healthy People 2010 (for when the targets would ideally be reached), continues similar programs from 10 and 20 years earlier.
The initiative set out to track progress nationally and by geography, ethnicity, and age. Although final results are not yet in (data of this scope typically lag by several years), the trends are clear—and the news is both very good and awful. As of mid-2009, there was success in reaching 117 of the 635 targets, or over 18 percent, including important markers like age-adjusted death rates for heart disease. But for many other indicators, especially lifestyle-related issues, the numbers are moving in the wrong direction.
"There's a saying: An ounce of prevention is sometimes a ton of work," says Howard Koh, assistant secretary for health at HHS, who oversees the program. "It's a challenge when any individual tries to change behavior, let alone trying to change it for an entire country."
The federal government bolsters the effort by awarding millions of dollars in grants to state and community programs that align with the Healthy People 2010 objectives, Koh says. Healthy People 2020—targets are expected to be set by winter—will continue this endeavor, with the overall goals of increasing the length and quality of healthy life for Americans and eliminating health disparities (such as by race, income level, or location).Yet individuals in midlife (40s to mid-60s) need to make adjustments on their own, experts say, because this is when risks increase for conditions like heart disease, diabetes, and cancer—all of which can greatly affect one's retirement years. "Medical interventions like pharmaceuticals and cardiovascular stents can forestall death, but they don't instill health. Vitality is something that is achieved by improving lifestyle," says David Katz, director of the Yale Prevention Research Center.
Here are federal targets (covering all ages) for several important lifestyle issues, where middle-age Americans stood when the 2010 goals were set, and where they stand now, according to the most recent data. (Because the numbers come from various sources, the "middle age" grouping will vary.)
Target: 60 percent of people at healthy weight
Then: 35 percent of people over 40 Now: 27 percent
Ideally, every person would see a pleasing number on the bathroom scale. When setting objectives, however, government officials balance the aspirational with the achievable. "We want the targets to motivate action, not be viewed as something beyond reach," Koh says. Yet Americans over 40 are adding, rather than subtracting, pounds. (So too are people ages 20 to 39, although 39 percent are now at healthy weight, defined for all adults as a body mass index equal to or greater than 18.5 and less than 25.) Worse, more than a third of people in their 40s and 50s can be classified as obese (BMI of 30 or more), up from 28 percent a decade ago.
"It's particularly ironic that America's waistlines are increasing in parallel with our knowledge about the dangers of obesity," says JoAnn Manson, chief of the division of preventive medicine at Harvard's Brigham and Women's Hospital. But in this age of ubiquitous fatty food, knowing what to do is not enough. "I do think people should take personal responsibility for things that lead to an ideal weight, like eating a healthy diet and exercising, but the environment also has to change to support that," Manson says. One step in that direction: a requirement in the new health reform law that chain restaurants and vending machines display nutritional information starting next year.
Target: 80 percent of people engaged in leisure-time physical activity
Then: 58 percent of people 45 to 64 Now: 63 percent
More than a third of Americans in middle age do not perform even 10 minutes of light or moderate physical activity each day. And while that's an improvement from a decade ago—and better than their older counterparts (46 percent of those ages 65 to 74 are inactive)—it's not conducive to long-term health. "Even independent of body weight, we know that physical activity reduces risk of heart disease, stroke, and diabetes," Manson says.
Here too, experts place at least some blame on the environment. The Centers for Disease Control and Prevention recommends that midlife adults do 2½ hours of moderate-intensity movement (like brisk walking) each week, in addition to muscle-strengthening activities. "But it's very difficult for people to follow these recommendations when they don't have sidewalks in their communities, well-lit parks, or other safe areas," Manson says. Health experts have taken note: One new goal expected to be part of Healthy People 2020 is creating social and physical environments that promote good health. For now, those whose neighborhoods aren't conducive to outside activities should consider joining a gym or community sports league, walking laps at an indoor mall, or working out to an exercise DVD at home.
Target: 25 cases per 1,000 people
Then: 76 per 1,000 people 45 to 64 Now: 120
Until the obesity and exercise numbers improve, it's unlikely the numbers for diabetes will either. "I tell my patients, 'To avoid diabetes, if you want to eat like you live on a farm, you have to work like you live on a farm.' How many of us do that?" says Stuart Weiss, clinical assistant professor of medicine at New York University School of Medicine.
People with a diagnosis of diabetes must take immediate action to control their glucose, which means losing excess weight, improving their diet, starting an exercise routine, and taking medication if necessary. "The research is clear that early and aggressive management of the disease prevents complications more than anything a person might do later," Weiss says. These complications can include heart disease, stroke, kidney failure, blindness, and nerve damage. Weiss advocates getting help from a nutritionist (typically covered by insurance) and a support group at a hospital or other institution. One key to staving off the disease is keeping weight under control. A recent study by University of Washington researchers found that, similar to previous reports on younger adults, weight gain after age 50 increases diabetes risk.
Fruits and vegetables
Target: 75 percent eating sufficient fruit; 50 percent for vegetables
Then: 39 percent for fruit, 4 percent for vegetables (all ages) Now: For fruit: 38 percent of men and 39 percent of women ages 40 to 59. For veggies: 6 percent of men and 4 percent of women
Just two daily servings of fruit and three of vegetables (one being dark green or orange) are enough to meet the target, yet few people get there. "Even that figure is inflated, because juices count as fruits although they're not as healthful," says Katz of the Yale center.
To reach this goal, people need to overhaul their eating patterns. "Rather than meat and potatoes, we have to start thinking of plant-based foods as the foundation of our diets," Katz says. Load berries onto morning cereal, begin supper with a veggie-rich salad, and think of stir fries and stews as dinnertime staples. Take fruit and sliced raw vegetables for a snack at work. (It's also fine to toss a little Parmesan cheese or some herbs in olive oil on top of those veggies.) "Sure, you could go out and buy a banana in the middle of the afternoon, but at that point you'll be more likely to dash out for a doughnut," Manson says. If you think you don't like a certain vegetable, try it again. "We tell parents to give a food to their child six or seven times before their palate comes to accept it. The same repetition is necessary for adults," Katz says.
Target: 65 percent consuming less than 2,400 mg. daily
Then: 15 percent (all ages) Now: 18 percent of women, 2 percent of men 40 to 59
Too much salt in the diet has been linked to many serious diseases. A recent study by researchers at the University of California–San Francisco found that cutting sodium consumption by 1,200 mg. (about a half teaspoon) each day would slash strokes in the United States by up to 66,000 annually and deaths by up to 92,000.
The overwhelming majority of sodium in the American diet comes from processed foods. In April, the Institute of Medicine, the independent health research arm of the National Academy of Sciences, called on the U.S. Food and Drug Administration to gradually curb the maximum amount of salt that manufacturers can add to foods, beverages, and meals. The institute suggested "incremental reductions" to give consumers' taste buds time to adjust. (The FDA has yet to take regulatory action.)Though some low-salt products are available, perhaps the best way to reduce sodium is to eliminate most processed foods from the diet in favor of home-cooked meals heavy on fresh produce. This would not only bring more Americans below the 2,400 mg. daily threshold, it would also move them toward the more healthful level that the Institute of Medicine considers "adequate intake": 1,500 mg. a day, and even less for people over 50.
Target: 12 percent still smoking
Then: 25 percent of people 45 to 64 smoked cigarettes Now: 23 percent
Nobody has to tell middle-age people who still smoke that they're increasing their risk for lung cancer, emphysema, heart disease, and stroke. Many have been trying to quit for decades. Those who haven't succeeded don't necessarily have less willpower, however; they might just have a different brain biology, says Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic. "People who have the most trouble quitting have more nicotine receptors in their brains—sometimes billions more than others, which can make withdrawal symptoms more intense," he explains.
Experts recommend that long-term smokers enlist multiple methods to stop: behavioral counseling to develop a detailed quit plan (via phone "quitlines" or online sites such as the American Legacy Foundation's BecomeAnEx.org), medications (prescription drugs include Chantix and Zyban), and nicotine replacement (gums, lozenges, patches, and the like). "We're finding that combining different methods makes them more effective," Hurt says.
For those who don't think quitting is worth the hassle, consider that only 9 percent of Americans over 65 remain smokers. Many finally force themselves to give up the habit after they've been hospitalized for a smoking-related illness. But many others, Hurt says, die before they reach retirement age.