How Unhealthy Are We?

How unhealthy are we?

Some recent studies have come out that don’t make things look too good.

According to a recently published study only 6.8% of US adults have “optimal” cardiometabolic health as of 2017-2018^[1]. The US population was 326 million people in 2018, that means roughly 22 million people have optimal cardiometabolic health.

Your first question might be what is considered “optimal” cardiometabolic health. Here are the standards they used in this paper.

Your next question might be, how does this compare to prior years? Here is a nice graph from the paper that looks at the trends over the past several years.

It’s also interesting to take each of these cardiometabolic components and look at the trends over time.

While I think we can say there is a slight decline in the number of people with optimal cardiometabolic health over the past few decades, maybe at its best it was 7-8% and now its at 6.8%, its not like it was a HUGE drop off (not that 7-8% is anything to brag about either).

In the individual component graphs we do see what I would consider “bad” trends in adiposity and blood glucose, those are certainly something to be concerned about.

The second study that came out looked at the cardiovascular health of the US. It used a scoring system from 0-100, kind of like a grade in school. This study found that the mean cardiovascular health score for the US was 64.7 . Only 0.45% of adults scored 100, 19.6% had a high score (>=80), 62.5% had a moderate score (50-79) , and 17.9% had a low score (<50). Children had an average score of 65.5 ^[2].

Pretty bleak right? The most shocking and concerning thing was the score for children!

This study looked at 8 different health categories to assess cardiovascular health: diet, physical activity, tobacco/nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure.

If you want to nerd out on how each of these were assessed you can read more here, however I will tell you upfront the researchers used fairly “standard” ranges for most things. The one thing I will mention here is that they use the DASH diet, a diet typically recommended to lower blood pressure, as a way of assessing diet quality.

If you are curious how your own cardiovascular health stacks up using these criteria you can actually answer a few questions by visiting the American Heart Association site and get your own score.

Given these two studies things look pretty bleak from a health perspective for those of us in the US.

At the same time I think it is fair to question some of the metrics used to assess our health.

Both studies used things like BMI, blood glucose, blood pressure, and blood lipids.

The problem with using blood glucose, blood pressure, and blood lipids is that they are a snapshot in time. We can easily see acute changes in all of these things based on several factors. For example, someone could be nervous going in to get the blood drawn or blood pressure measured and that anxiety can make these measurements look worse than they actually are. In other words, without a trend of these metrics over time, its kind of hard to say if they are accurate or not.

BMI also has its fair share of flaws. BMI stands for body mass index. In the metric system BMI is calculated using the formula weight (kg) / [height (m)]². In the imperial system BMI is calculated using the formula weight (lb) / [height (in)]² x 703. The resulting number is then used to determine your “weight status”.

There are three main problems with BMI.

First it says nothing about the tissue that makes up your weight. Is it mostly muscle or fat? Many well muscled people may be considered overweight or obese, yet they have visible muscle definition when you look at them.

The second problem is that BMI does not always correlate with health. My good buddies Doctor Dr. Tommy Wood (that is not a typo he has 2 doctorates) and Dr. Ben House used the same dataset as the two studies above and found that only 20% of males who have a normal BMI would be considered metabolically healthy. They also found that only 29.5% of females with a normal BMI would be considered metabolically healthy. Given this data it looks like BMI does not correlate very well with metabolic health.

The final problem with BMI is that you may have a normal BMI but have poor muscle mass and/or may have a lot of fat stored around your organs. Muscle mass is going to do wonders for your metabolic health and having too little of it or storing it around your organs is going to be quite detrimental.

The major criticism of the cardiovascular health study above was their use of the DASH Diet as the diet standard.

If you look at the graphic above I agree with 90% of the eat this and not this categories. There is probably 5% of those foods that could be “good or bad” depending on the context of the individual and there is another 5% of those foods which I think are flat out miscategorized.

However I also realize how ironic those past few sentences are…why is what I consider an optimal diet the right diet for everyone?

The truth is there is no one diet to rule them all. We can all agree that everyone’s diet should consist of mostly whole natural unprocessed foods. Whether that means all vegetables and no meat, all meat and nothing else, little sodium, lots of fatty cuts of meat, low fat or high fat dairy, whole grains, beans, legumes or anything else really depends on the individual.

So while we can clearly pick apart these two studies and criticize the metrics and methodologies they use, I don’t think we need a study to tell us that many of the people in the Western world could be doing better from a health perspective.

To that end I would like to end this post on things you can do to improve your health.

We covered diet above, but just to be clear what we want to encourage people to do is to eat whole natural foods. Think of things you find in the outside aisles of the grocery store, meat, vegetables, fruits, eggs, chicken, turkey, dairy products (in their natural form), throw in some seed, nuts, legumes, and even grains if you tolerate them. Just start there, we can make it much more complicated and there is for sure much more to discuss in terms of diet, but it all needs to be built upon a diet based around whole foods.

Sleep is pretty straightforward, strive for 7-8 hours a night if you can. That is easier said than done, but I have some good posts on sleep you can read to help improve your sleep if you need help in that area.

Sleep: The Cornerstone Of Your Health

Optimize Your Sleep Environment

The Twelve Hours Before Bed Can Make Or Break Your Sleep

Move your body. Plain and simple, the most important thing you can do is move your body. The recommendation is 150 minutes a week of moderate intensity exercise. That’s a little more than a 20 minute walk a day. Frankly I think you will be much better off striving for more, but if you need to start at a 20 minute walk a day, start there! Ultimately I think the goal should be to walk 7-10 thousand steps a day. That will be three to four 20 minute walks a day. Again start small and build. If you can then layer on top of that 3 days a week of resistance training, you are golden! For more details on how to construct a proper movement and exercise routine check out this post.

Finally, stress is quite a problem for many of us today, and it plays a big role in many of the metrics that we talked about in this post. I have recently done a deep dive into stress so I will point you to the following posts to learn more about stress and what you can do to improve your total stress load.

How Stress Impacts Your Health And Sabotages Your Goals

The Goldilocks Zone Of Stress

A Must Do Stress Management Exercise

In The Trenches Tools To Combat Stress

We know many people can use help improving their health, we don’t need studies to tell us how bad it is. Frankly people know they could probably do better, they don’t need people on social media yelling at them about how bad things are. What they need are the tools to help them do better. I hope that the last part of this blog post does exactly that. If you want more tools to help you on your journey to improve your health sign up for my newsletter using the link below and I put useful actionable information in your inbox each week to help you out!

1. (2022, July 12). Trends and Disparities in Cardiometabolic Health Among U.S. …. Retrieved August 23, 2022, from https://pubmed.ncbi.nlm.nih.gov/35798448/ ↑
2. (n.d.). Status of Cardiovascular Health in US Adults and Children Using the …. Retrieved August 23, 2022, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060911 ↑