Healthy lifestyle: 5 keys to a longer life

Monique Tello, MD, MPH

Contributing Editor

How is it that the United States spends the most money on healthcare, and yet still has the one of the lowest life expectancies of all developed nations? (To be specific: $9,400 per capita, 79 years, and 31st.)

Maybe those of us in healthcare have been looking at it all wrong, for too long.

Healthy lifestyle and longevity

Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.

The researchers looked at NHS and HPFS data on diet, physical activity, body weight, smoking, and alcohol consumption that had been collected from regularly administered, validated questionnaires.

What is a healthy lifestyle, exactly?

These five areas were chosen because prior studies have shown them to have a large impact on risk of premature death. Here is how these healthy habits were defined and measured:

1.   Healthy diet, which was calculated and rated based on the reported intake of healthy foods like vegetables, fruits, nuts, whole grains, healthy fats, and omega-3 fatty acids, and unhealthy foods like red and processed meats, sugar-sweetened beverages, trans fat, and sodium.

2.  Healthy physical activity level, which was measured as at least 30 minutes per day of moderate to vigorous activity daily.

3.   Healthy body weight, defined as a normal body mass index (BMI), which is between 18.5 and 24.9.

4.   Smoking, well, there is no healthy amount of smoking. “Healthy” here meant never having smoked.

5.   Moderate alcohol intake, which was measured as between 5 and 15 grams per day for women, and 5 to 30 grams per day for men. Generally, one drink contains about 14 grams of pure alcohol. That’s 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

Researchers also looked at data on age, ethnicity, and medication use, as well as comparison data from the National Health and Nutrition Examination Surveys and the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research.

Does a healthy lifestyle make a difference?

As it turns out, healthy habits make a big difference. According to this analysis, people who met criteria for all five habits enjoyed significantly, impressively longer lives than those who had none: 14 years for women and 12 years for men (if they had these habits at age 50). People who had none of these habits were far more likely to die prematurely from cancer or cardiovascular disease.

Study investigators also calculated life expectancy by how many of these five healthy habits people had. Just one healthy habit (and it didn’t matter which one) … just one… extended life expectancy by two years in men and women. Not surprisingly, the more healthy habits people had, the longer their lifespan. This is one of those situations where I wish I could reprint their graphs for you, because they’re so cool. (But if you’re very curious, the article is available online, and the graphs are on page 7. Check out Graph B, “Estimated life expectancy at age 50 according to the number of low-risk factors.”)

This is huge. And, it confirms prior similar research — a lot of prior similar research. A 2017 study using data from the Health and Retirement Study found that people 50 and older who were normal weight, had never smoked, and drank alcohol in moderation lived on average seven years longer. A 2012 mega-analysis of 15 international studies that included over 500,000 participants found that over half of premature deaths were due to unhealthy lifestyle factors such as poor diet, inactivity, obesity, excessive alcohol intake, and smoking. And the list of supporting research goes on.

So what’s our (big) problem?

As the authors of this study point out, in the US we tend to spend outlandishly on developing fancy drugs and other treatments for diseases, rather than on trying to prevent them. This is a big problem.

Experts have suggested that the best way to help people make healthy diet and lifestyle change is at the large-scale, population level, through public health efforts and policy changes. (Kind of like motorcycle helmets and seat belt legislation…) We have made a little progress with tobacco and trans-fat legislation.

There’s a lot of pushback from big industry on that, of course. If we have guidelines and laws helping us to live healthier, big companies aren’t going to sell as much fast food, chips, and soda. And for companies hell-bent on making money at the cost of human life, well, that makes them very angry.

Follow me on Twitter @drmoniquetello

Sources

Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, April 2018.

National Institute on Alcohol Abuse and Alcoholism, What is a standard drink?

The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed. Health Affairs, August 2017.

The combined effects of healthy lifestyle behaviors on all-cause mortality: a systematic review and meta-analysis. Preventive Medicine, September 2012.

Changing minds about changing behavior. Lancet, January 2018.

The US Food and Drug Administration (FDA) Final Determination regarding Partially Hydrogenated Oils (trans fat)

The US Food and Drug Administration (FDA) Family Smoking Prevention and Tobacco Control Act- An Overview

Comments:

  1. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks Frances, Yes, this is part of the healthy lifestyle generally!

  2. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Yes, There is evidence to suggest that artificial sweeteners are unhealthy in many ways, and they definitely are not associated with weight loss.

  3. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Dear S, I agree that a high-quality diet and healthy lifestyle are more important than weight as a number. But if a person is suffering from a disease that can respond well to weight loss, then it only makes sense to include healthy weight loss as part of the plan. This can be done safely, without fad diets.

  4. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Bob, that was well-stated. Yes, it’s hard to look at the numbers, but even harder to look at my patient with multiple serious chronic illnesses and disability due to poor diet and lifestyle, which could have been prevented. Time for us all to wisen up.

  5. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Sorry, Jen, for wanting to help you to live the healthiest, happiest, longest life you possibly can! Promoting the healthiest options for people is what doctoring is all about.

  6. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Carolyn, agree completely, a plant-based Mediterranean style diet is the best diet for health. That includes some whole grains, ideally in intact form (such as farro, quinoa, and brown rice), some healthy proteins and fats (legumes, nuts, seeds, fish, chicken), and mostly fruits and veggies. Refined grains, like white flour and sugar, and everything made from them (bread, pastas, backed goods, cereals, et cetera) are the real culprit.

  7. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Hi, No. Our bodies handle intact whole grains very differently from processed whole grains, and handles those very differently than refined grains. Check out the HSPH Nutrition Source website on this: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/

  8. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Yes, regular intake of one drink or fewer per day of alcohol can increase the risk of cancer in certain individuals, slightly.
    The summary statement from one of the main research summaries on this is:
    “Clearly, the greatest cancer risks are concentrated in the heavy and moderate drinker categories. Nevertheless, some cancer risk persists even at low levels of consumption. A meta-analysis that focused solely on cancer risks associated with drinking one drink or fewer per day observed that this level of alcohol consumption was still associated with some elevated risk for squamous cell carcinoma of the esophagus, oropharyngeal cancer, and breast cancer, but no discernable associations were seen for cancers of the colorectum, larynx, and liver. On the basis of the lesser overall cancer risk at the lower end of the dose-response continuum, the World Cancer Research Fund/AICR made the following recommendation: ‘If alcoholic drinks are consumed, limit consumption to two drinks a day for men and one drink a day for women.'” You can check out the entire article here: http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155

  9. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Good for you! It may be a combination of factors.

  10. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    You are welcome!

  11. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks Peter, Yes, prevention is key, and I think the tide is turning on that. I will tell you that as a physician, I recommend to people that they get their fiber from a health diet rather than supplements, preferably.

  12. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks so much and agree with all of your suggestions.

  13. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Hi Walter, Yes, there are no less than a gazillion research studies linking tobacco and cancer with fairly accurate quantification of the risks. Check out the Cancer.gov website (part of the National Institutes of Health) link below for some referenced information:
    https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet

  14. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Hi Carl, I can’t speak for these industries, but I can imagine which type of innovation would be ore highly profitable over the long term.

  15. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks Jim, I agree, prescribers really had no financial incentive. There was a huge push to prescribe these based on erroneous ideas about the risks and benefits, many of which were promoted by the pharmaceuticals industry, who had very clear (and large) financial incentives.

  16. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Hi Tom, Yes, as reported: “Study investigators also calculated life expectancy by how many of these five healthy habits people had. Just one healthy habit (and it didn’t matter which one) … just one… extended life expectancy by two years in men and women. Not surprisingly, the more healthy habits people had, the longer their lifespan.” All of these results were statistically significant. There is a link to the actual study at the bottom of the post, it’s very clearly written, take a look.

  17. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks NutritionWHIT, appreciated! MT

  18. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    Thanks, Peter, really appreciated! MT

  19. Monique Tello, MD, MPH
    Monique Tello, MD, MPH

    I agree with you that there is big industry interest in maintaining the current unhealthy Western lifestyle, Azure. I also agree that certain pharmaceuticals manufacturers profited off of the popularity of opioids. Not sure how you can state the same of the prescribers, as I can’t see how there could have been a direct (or even indirect) financial incentive.

  20. Carolyn

    I agree with David (9th July comment) with regard to diet. Whole grains can indeed have the effect of spiking blood sugar (whole grain bread as just one example) and creating gut inflammation, and therefore low-grade, sub-acute inflammation in general. This is the biggest contributor to chronic disease that we are facing, long-term inflammation. The standard food pyramid is, in my opinion, all wrong. I believe we should eat a more Mediterranean diet, and minimise the grain-based carbohydrates, and the sugars. Then we are considerably further down the track towards a healthy diet that promotes longevity. Of course, all of the other factors mentioned are important as well, but what we put into our mouths is probably the most important, given the skyrocketing rates of obesity first world countries are facing, and now even asian countries as well, who are well and truly catching up.

  21. Jen

    Very clear informative article. My only problem is her support a broad scale public policy that would tell people what to eat. We are not a communist country. The United States is a republic – a constitutional republic where people believe that they can govern themselves. The notion that government should tell me what to eat is the absolute tyranny and tells me that this doctor needs to have a lesson in civics as well the pitfalls of scientism. I suspect she is thinking in terms of cost of care which is a utilitarian Marxist approach to human life. I don’t know what happened to this generation that they are so ignorant when it comes to Liberty and freedom versus government encroachment and parenting.

  22. Bob

    A very good read. I think you hit the nail on the head and perhaps a few people’s fingers with your comments. USA has about 5% of the world’s population yet issues about 50% of all medical prescriptions worldwide. Common sense would tell us that the more people are well the less the need for public health, medicines and health facilities. An inverse relationship exists which implies an impressive health bill an indication of sickness not wellness. Public health can only be realistically addressed by governments acting in the public’s interest. The amount of money paid to political parties by lobbyists is very tiny compared to the money paid by the health budget and tax payer. Corporations need a cultural shift and to be aware of the growing dissatisfaction by health advocates trying to protect the general public.

  23. S

    Not everyone can be in the “healthy body weight”. each person has their own set point of weight. Some research shows that what is called “overwieght” BMI is also OK. For an Obese Nation like the US, setting the “normal” BMI as a goal is too much, and sends many people to dangerous fad diets or straight to the fridge…
    To have a better life style one should not focus on results like BMI, but on the changes and the way to get them.

  24. Laxman Gaddamwar

    Another factor often overlooked is the rampant use of artificial flavours synthesised in laboratories and used to fool people with respect to the natural flavours derived from fresh fruits and vegetables.
    This fools the human olfactory system to devour more and probably is at the heart of addictive eating patterns of unhealthy fast food.

  25. Frances Affandy0

    To which i would add Good Night’s Sleep and Being Useful everyday

  26. Jerry

    What role does nationality or culture play? For example Norwegian ancestry versus Irish ancestry or Japanese ancestry

  27. David

    I see you tout “whole grains” over “processed foods” – don’t these have very similar blood sugar GI impacts and thus spike blood sugar and inflammation?

  28. Brian C Whitaker

    Under “moderate alcohol intake” it doesn’t say if zero is bad or good (it’s outside the stated range).

  29. Jon Blair

    What about the the recent research that shows that even moderate drinking – such as one glass of beer or wine per day – increases the risk of cancer?

    Is this research significant?

  30. Ann

    Newsflash from an 88 year old female who looks 74 ! No one
    believes my age, as I am mentally alert as well as physically well
    For my age. I have no idea why I am so fortunate. Could it be
    Genetic? Or life style ? Or perhaps nutrition? I even drive at night !

  31. Waris kazi

    Thanks so much for this article.

  32. Peter

    I got a degree in Health Education in 1978 because it seemed obvious to me that “soon” lots of money and health resources would go toward preventive health care. 40 years later, that still hasn’t happened, as the article points out!
    I feel good that during my life, I have been able to help with preventive health care in a different way. I was able to help sell millions of bottles of dietary fiber supplements, which do have a significant preventive health benefit for people who use them.

  33. TC

    Yes, spend money on prevention to reduce money on treatment in the first place. And, can you legislate portion sizes? It’s no secret that restaurants in America pride themselves on huge portions of food and people scratch their heads at the insane obesity levels in America. The American thinking of bigger and more is always better is just sending people to an earlier grave and only big business seems to care more about protecting it’s right vs politicians caring about the health of a nation.

    It’s not just the US though, obviously. It’s a worldwide problem in many countries. America just seems to be the front-runner. Well, that’s not something to be proud of as ‘title holder’.

  34. Walter Ferine

    Very valuable . Is there a study of the affects of smoking based on the number of years an individual had smoked and the number of years that the individual had not smoked?

  35. Carl

    Does that mean drug companies are interested in finding cures or only therapies. Which is more profitable? I will let you answer that question!

  36. Jim Brown

    Most of the opioids come into the U.S. and are made in and shipped from China. They are ordered via the internet. The opiod crisis isn’t just from physicians prescribing these drugs.

  37. Tom

    The article reports the lifespan difference between those with all 5 habits versus none (14 years for women and 12 years for men). This sounds impressive, but what’s the difference between those at the middle (3 good habits) versus those with all 5? How many years and is it even statistically significant? Articles like these should focus on not only the most dramatic headline number, but also the more realistic gains achievable by average people making smaller improvements in their lifestyles.

  38. NutritionWHIT

    Thank you for putting together this blog post. Very clear and concise information. Detailed statistics ect. And yet not to long lol. Cheers,
    -NutritionWhit

  39. Peter

    I wondered upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I’ll be subscribing to your feed and I hope you post again soon.

  40. azure

    You forgot the auto industry, pesticide manufacturers, plastics manufacturers, BigPharma, and who knows what other industry “sectors” that benefit from the mainstream US “lifestyle” including addiction to a variety of substances. Greedy physicians bear some of the responsibility as well, they’re the ones who have overprescribed opoids.

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