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Healthy lifestyle for the few


Bandolier 78 reported on the US nurses study, which showed that nurses who had a good diet, BMI of below 25, who took a reasonable amount of exercise, who drank alcohol moderately, and who did not smoke ran a risk of heart attack or stroke only about one fifth that of women who fulfilled only two of these five or fewer. The amazing thing was that of 120,000 women, only 3% (yep, 3 out of every 100) could say that they could pass all five of these not very difficult targets. If you took alcohol out, the figure rose to 7 out of every 100.

But these were nurses, so what was happening in the rest of the population? A new study [1] tells us, and the answer is a bit scary.


This was a random telephone survey of people in all of the USA, restricted to adults aged 18 to 74 years. All results are by self-reported answers to a questionnaire on various lifestyle and other questions. Four categories of healthy lifestyle were created:


Complete information was available on 154,000 people. Overall, 76% did not smoke, 40% had a healthy weight, 23% had a healthy diet, and 22% took regular exercise. Only a very few had three or more healthy lifestyles, with only 3% (yep, 3 out of every 100) having all four healthy lifestyles, most people having two or fewer out of four healthy lifestyles (Figure 1).

Figure 1: Percentage of US adult population with each of 0 to 4 healthy lifestyles

Healthy lifestyle adherence was associated with higher education, higher income, and better health. All four lifestyles tended to be more prevalent in people with excellent or very good self-reported general health, and lower in those with fair or poor health (Figure 2). The prevalence of all four healthy lifestyles was 5% in those with excellent general health, but only 1% in those with fair or poor health.

Figure 2: Healthy lifestyle adherence and self-reported health quality


These results are pretty much like those found in the US nurses study, and reported in Bandolier 78. Few people, at least in the USA, but probably elsewhere, follow overall good lifestyles. We may be winning on smoking, but there is a long way to go on weight, diet, and exercise. Yet having all of these healthy lifestyles, plus a glass of wine or two a day, can massively reduce heart disease and strokes, and probably cancer, bone disorders, arthritis, depression, erectile dysfunction, and a whole lot more.

There are real public health lessons here. Single-issue preaching may be a waste of time. It is healthy living across the board that needs to be stressed, else healthcare costs will rocket and the lives of very many people will be miserable. Perhaps we should be stressing how much more fun it is being healthy.


  1. MJ Reeves, AP Rafferty. Health lifestyle characteristics among adults in the United States, 2000. Archives of Internal Medicine 2005 165: 854-857.

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