When “life” gets in the way of good health

Lori Wiviott Tishler, MD, MPH

Assistant Professor of Medicine, Harvard Medical School

A few years ago, I saw a lovely patient who had gained a surprising amount of weight between visits. Surprised, because usually she takes great care of herself, I said, “Wow. You’ve gained 10 pounds since I saw you last. What’s going on?” She looked at me and told me that her finances were in dire straits. She explained that she gained weight because her budget did not allow her to buy healthy food. In fact, she told me that the bagged cookies she purchased at a local dollar store were the least costly way to keep her from feeling hungry.

My heart was heavy that day, as it always is when I hear that my patients are having trouble getting their basic needs met. I am fortunate to work in a practice that has social workers, so I was able to get some urgent help for her food insecurity. And yet I knew that it was going to be hard work to take off those 10 extra pounds, and that those pounds were going to make her knees sore and mess with her blood sugars and blood pressure.

I wish this were an uncommon event, but it’s not. According to a NEJM Catalyst blog post, social, environmental, and behavioral factors account for up to 60% of people’s health needs. The things we focus on so often in medicine account for just 10%.

One organization’s story: Stepping forward and making a change

Kaiser Permanente, a health care organization based in California, recognized that nations that focus on social needs — housing, food, transportation — often spend less on health care. So they decided to act on behalf of their patients and tackled the idea of meeting a patient’s social needs to help provide better health care. They didn’t build houses or grocery stores, but they did develop a system that engaged with existing community resources to help reach their neediest patients. By partnering with an exciting social enterprise organization called Health Leads, Kaiser developed a call center to help reach out to people who use a lot of health care resources. They found three out of every four patients they reached had at least one unmet social need. The most common were food insecurity, transportation problems, and difficulty paying utility bills. Kaiser’s program then connected these people with established community organizations who could help.

Putting “health” in a broader perspective

Perhaps few of you taking the time to read this blog have the kind of dire unmet social needs I mention above. But, I bet that every one of you has had a social need or a life challenge that has impacted your ability to take care of yourself. I see it all the time in parents of young children, caregivers of seniors — and, really, almost everyone I meet.

Our ability to be healthy depends on our ability to meet our own basic social, emotional, and physical needs. Articles like this one help us think about health a little bit more broadly. As the World Health Organization says, health is not just the absence of disease, but the presence of physical, mental, and social well-being. Doctors, nurses, and all health care providers need to engage with patients around their unmet needs — big and small — to help engage their patients to enhance their health and feel able to make important physical and behavioral changes.

Related Information: A Plan for Successful Aging


  1. Nora Vardon

    Healthy food is more affordable then processed food. It takes initiative and commitment to buy the fresh, or frozen fruits and vegetables and take time to find healthy recipes and prepare meals. Time and time again I see people in line at the grocery story with their government subsidized EBT debit cards buying premade cakes, cookies, soda, frozen pizza, etc. Everyone, especially those receiving government subsidy, need to prepare good healthy meals. Why are we paying for them to buy junk food, so they get ill, overweight, diabetic, heart problems.

  2. angela amy

    There really is cheap food out there.
    A bag of frozen veggies at most stores is .99 cents.
    An apple is also cheaper. So are most canned veggies.
    I’m not falling for the junk food is cheaper excuse.

  3. Maria Jasmine Freeman

    A v critical issue u have brought up.; thanks.
    What surprises me though is how could healthy crude food be more costly than processed food! I am not sure it is so in my country, for example, or in many others.
    Besides, I doubt that was the only reason for that lady’s weight gain as described- though does not sound excessive. Was she closing-in to menopause?! In this connection my weight gain was alarming at that stage( from a nimble figure to morbid obesity, acutely in one year!), while only vomiting and having diarrhea. She may also have some missed endocrine abnormality, etc…
    Dr Hana Fayyad, pediatrician( Maria Jasmine Freeman, published author).

  4. πίνακας Μαρκαδόρου

    Great information. Take care myself is a key word that we have to take it very seriously before it;s too late..

  5. Annemarie

    Excellent article.

    It isn’t always weight gain that’s the issue. I’ve been a family caregiver for 12 years — 7 years with my parents (both had dementia at the same time), one year with another relative (cancer), and now my mom’s brother and sister (dementia again). There are no other relatives.

    And I have mid-stage young onset Parkinson’s. I am not well myself and concerned about the family dementia showing up in me. All the stress is not helping, although I am using community options…just because a relative is in a nursing home doesn’t mean you have no responsibility. And dementia is so hard on the family.

  6. Trevor Davis

    George Orwell wrote in the “Road to Wigan Pier” that people who are hard up do not appreciate lettuce as a healthy option. Their lives were so miserable during the 1930’s that a fish and chips take-away were something that cheered them up and warmed them. It is very sad that some of the problems of the 1930’s remain in so called civilised society. When people are less stressed and more prosperous, it is easier to make healthier lifestyle choices. There are healthy distractions rather than stressful immediate needs, which means that there is not the obsession with using food as a comfort.

  7. June O Esque

    10 lbs is a “surprising” amount of weight? Good grief! Then we wonder why people get eating disorders like anorexia! Doctors don’t help with that attitude. 🙁

    • greg

      Ten pounds is a LOT of weight-trust me, I’ve been there. That much fat on you makes it harder to breathe (and sing, which I like to do to reduce my stress and because its fun), makes it impossible to fit in to lots of the nice clothes I spent $$$ on, ramps up inflammation throughout the body-which accelerates aging. And that big tire around your waist just looks dopey. It’s not easy to keep it off as you get older, we all know that. And you have to exercise and drink lots of water, eat very nutritious and TASTY food-even if you have to spend lots of time making it yourself. I definitely eat pretzels and chewy well done bagels with the stuffing removed sometimes-but never any cookies, cake or candy! Those things are caloric bombshells! Lots of fruit, plain popcorn, iced flavored seltzer, plain coffee, salsa in egg white omelets, fine ground scottish oatmeal with blackstrap molasses. You can do it!

  8. dianrib

    GOP has busted labor unions for years & want to continue to do so. Those policies, deregulation, war debt , trade deals , have led to lower wages, lost pensions.. even after working hard for many years. US has barely any safeguards for workers, middle class, seniors on low income. Corp Loopholes, subsides, tax cuts go to the top few percent. Yes the system stem is Rigged / Unfair as are laws like ‘ Citizens United ‘ Corp America, lobbyists, NRA, billionaires run – own our country !!

  9. mary coakley

    I feel so sad that in a country that seems to have so much that senior citizens do not have the money to purchase good food for themselves.It should be a basic right for every citizen,and I feel sure this happens in lots of countries.These people worked hard,much more than present generations and deserve to be cherised not just for their health but for the history and their stories they have so much to give.Its great that a system has been set up to help

  10. Ann

    Capitalism and competition rather than compassion and courage


    Being overweight is not just due to what you eat it is how much stress you are under. Cortisol is what causes weight gain from stress. I am not poor, I just do not have enough time in my life to get everything done and that is what causes stress. I work all day, grocery shop on my lunch break, come home try to cook a decent meal, clean up, get some laundry done, and go to bed to start is all again the next day. Cooking a healthy meal takes time – a lot of time. Processed foods take less time to prepare but are not healthy. Women seem to be stretched to the limit. I am not sure equal rights are equal. Seems to me women now can have a career and come home and do everything they used to do all day at home in just a few hours. Also, computer jobs are not helping any of us. Sitting all day is slowly killing us all 🙁 Debbie Downer

    • Printz

      Thumb up on your comments, Debbie!

    • Maria

      Amen! I gained quite a lot of weight on my last job due to constant conflict with my boss, and endless worries about when the other shoe will drop in terms of layoffs. Finally, last year my boss did something heinous that pretty much was the straw the broke this camel’s back, and I had an anxiety attack right there at work! I realized this had to stop, so I said “f” this! I next wrote my resignation letter, gave my two weeks notice! Got home and cried, partly from fear but mostly from relief. I had broken free. I quit the job I held for nearly 15 years and had grown to hate, the one I thought I would retire from. Next I let my family know I was moving closer to them, so I bought a one way Amtrak ticket, and I moved to a different part of the country with a much better climate. Two months later, I got a much better job where people don’t treat ya like crap! Seems so sudden, I know, but sometimes ya just gotta take a leap of faith and go for the devil you don’t know vs putting up with the devils you do know. In the past year, I’ve encountered no more devils! I’ve not only gained a better outlook on life, I’ve grown a lot closer to my family since I’m living a lot closer to them. I’ve also lost nearly 30 lbs because I’m now walking more, eating right and I just don’t have all the stress and crap that was going on for almost two years on the last job. Still have a ways to go in terms of weight loss, but I know I’ll make it.

      • Terry

        An inspiring story, Maria. Well done! There is a close connection between over eating or eating wrongly and feeling negative about a bad situation. Everyone should be aware of this link and the need to tackle the cause (a bad situation) and not just the symptom (gaining weight). It’s why we have an obesity crisis throughout the West. We need to democratise our work places. No more diktats, dictators or dictatorship! We can always do what you have done – and vote with our feet by walking out and walking on with our lives. I salute you.

  12. Sky

    There really is cheap food out there.
    A bag of frozen veggies at most stores is .99 cents.
    An apple is also cheaper. So are most canned veggies.
    I’m not falling for the junk food is cheaper excuse.

    • Peter Scheffler

      Yes, there are some inexpensive healthy foods, but many of them do not have enough calories to keep you from feeling hungry. Plus, being stressed can make you want the sweet, fatty, and salty comfort foods even more. It’s often not simply a matter of telling someone what they should do. You may need to take time to understand their life, help them develop personal strategies, and remain supportive until those strategies have become habits. Plus, people in those insecure situations may find their lives changing so often that it is very difficult to develop consistent habits.

    • Wendy

      The basic tone of criticism is part of the social ills we live with; a little compassion for others’ struggles go a long way in ameliorating our neighbors’ disease, but also our own. Gratitude and compassion are healing to the very people who practice them. Any of us could be thrust into economic hardship so let’s cut each other some slack.

    • Tera Sandon

      I totally agree with you Sky. It’s all about the choices that you make. I know that the Cherries I purchased the other day were at a premium price, but the nutritional value benefits out weigh the amount spent on them. Instead of consuming other high calorie snacks at night, I choose a high protien content food to pair with the cherries. My favorite is cottage cheese with a sprinkle of sunflower seeds. This is great way to keep blood sugar levels in check through the night. Which in turn helps to lower Cortisol (the stress hormone) that helps to lose weight. These foods are not expensive, one simply needs to make the choice that will benefit them most.

  13. Isabel

    oh please be cognizant of the fact that most people work for a corporate system that makes people have no sense of job security and force people to work for 10-15 hrs/daily at a computer, sometimes 7 days a week- -while ‘claiming’ health advocacy and fitness centers. Yet when you take time to work out or sleep, you are frowned upon for missing meetings in global or bi-coastal times (5a to 8p minimum open domestic call hours. I have friends who have to take calls at 3am from China!) Sure, we could all live in section 8 housing and not have to work as hard, but also be subject to crime ridden, low education neighborhoods. We could live inner city closer to jobs and have more pollution. We could ask for less hours and get fired. Thanks. Try by changing the system. I don’t even get lunch breaks because they schedule meetings during lunch time. I have to commute ~1hr each way (MORE sitting) and give up sleep in order to get only 1/10th of the weekly exercise I so LOVED at one point in my life. But I can’t afford the gym or safe outdoors area unless I make the minimum income I do now. I can’t afford vegetables unless I have this salary (which then I end up throwing away most because of working too many hours and not getting to prepare.) I cannot even afford a balanced relationship in my life because of the amount of hours expected by companies by myself or my friend- so my house is a disaster per my standards but I don’ t want to hire a maid because then I have to worry I need to make more income in order to keep up. Excuse me- but nice article from someone who makes a ton of money and obviously has help at home or had help from family. I never did — they put me into debt by 14yrs. So far, I am lucky without too many health issues because of my earlier commitment to exercise and balance– and generally I am still in shape as a part-time athlete, but I can feel it going fast – and I can only hope I don’t end up with drastic health problems in my future. When you have people who write that actually had to struggle to get where they are at– then I will take it seriously. But when you have people who have no clue what the ‘real’ world forces upon the majority of the population–

  14. Nancy Wu

    A bag of beans is cheaper than a bag of cheapest cookies.
    A bag of beans is much healthier than a bag of any cookies.

    • Ann-Marie

      Very good point. Only problem is time needed to cook dried beans. Finding canned beans on sale is a big help. Beans also make great sandwich spread (with onion powder, garlic powder, Italian seasoning, etc.)

  15. jl

    Thanks for your heart felt article. I wanted to add that little is written about this topic and also weight gain due to stress. I’ve been thin all of my life and upon reaching premenopause, having part of a thyroid left (on Levothorox), having a child after age 46 , and mostly after having to stop most sports (was a runner most of my life) due to chondropathy of the knees, I’ve gained stomach fat (26 lbs overall). No matter that I eat well, healthy and have tried to find some sport to compensate (hate swimming so I’m on the Wii an hour a day running), Stress is the biggest factor in my struggle to lose weight,in particular stomach fat. More needs to be done to address such factors.

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