Less than 7% of adults in the U.S. have good cardiometabolic health. This is a terrible health crisis that needs to be fixed right away, says new research led by a team from the Friedman School of Nutrition Science and Policy at Tufts University and will be published in the Journal of the American College of Cardiology on July 12.
Researchers looked at Americans’ blood pressure, blood sugar, blood cholesterol, adiposity (being overweight or obese), and whether or not they had cardiovascular disease (heart attack, stroke, etc.). As of 2017–2018, they discovered that just 6.8% of American adults have all five components at their ideal levels. Among these five factors, trends for obesity and blood glucose dramatically deteriorated between 1999 and 2018. In 1999, 1 in 3 persons had ideal levels of adiposity (neither overweight or obesity); by 2018, that proportion has dropped to 1 in 4. Similarly, in 1999, around a third of adults did not have diabetes or prediabetes; in 2018, that proportion has dropped to just under four in ten.
These figures are startling. Less than 1 in 15 persons in the United States, one of the richest countries in the world, have optimal cardiometabolic health, which is extremely worrisome, said Meghan O’Hearn, a doctoral student at the Friedman School and the study’s lead author. “We need a complete overhaul of our healthcare system, food system, and built environment, because this is a crisis for everyone, not just one segment of the population,” the author said.
The study examined data from the 10 most recent cycles of the National Health and Nutrition Examination Survey, which included 55,000 adults aged 20 or older from 1999 to 2018. Instead of only looking at the presence or absence of disease, the research team concentrated on optimal, intermediate, and poor levels of cardiometabolic health and its constituent parts.
Large health disparities were also seen across the sexes, across age groups, among different racial and ethnic groups, and between those with varying levels of education. For instance, Mexican Americans had one-third the optimal levels compared to non-Hispanic White adults, and persons with less education were half as likely to have optimal cardiometabolic health compared to adults with more education. Additionally, while the percentage of individuals in non-Hispanic White America who had good cardiometabolic health slightly increased between 1999 and 2018, it decreased for adults who were Mexican Americans, other Hispanic, non-Hispanic Black, and people of other races.
“This is really problematic. Social determinants of health such as food and nutrition security, social and community context, economic stability, and structural racism put individuals of different education levels, races, and ethnicities at an increased risk of health issues,” according to Dariush Mozaffarian, dean of the Friedman School and senior author. “This highlights the other important work going on across the Friedman School and Tufts University to better understand and address the underlying causes of poor nutrition and health disparities in the U.S. and around the world.”
The study also evaluated “intermediate” levels of health, which included pre-diabetes, pre-hypertension, and overweight problems. These levels were not ideal but were also not terrible. According to O’Hearn, “a large portion of the population is at a critical inflection point. Identifying these individuals and addressing their health conditions and lifestyle early is critical to reducing growing healthcare burdens and health inequities.”
The terrible health of American adults has far-reaching effects. “Its impacts on national healthcare spending and the financial health of the entire economy are enormous,” O’Hearn added. “And these conditions are largely preventable. We have the public health and clinical interventions and policies to be able to address these problems.”
According to O’Hearn, researchers at the Friedman School are actively working on numerous such solutions, such as Food is Medicine interventions, which use healthy eating to help prevent and treat illness, financial incentives and subsidies to make nutritious food more accessible, consumer education on a healthy diet, and private sector involvement to promote a more equitable and healthy food system.
“There are a lot of different avenues through which this can be done,” O’Hearn added. “We need a multi-sectoral approach, and we need the political will and desire to do it.”
“This is a health crisis we’ve been facing for a while. Now there’s a growing economic, social and ethical imperative to give this problem significantly more attention than it has been getting.”
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