“It’s deeply problematic that in the United States, one of the wealthiest nations in the world, fewer than 1 in 15 adults have optimal cardiometabolic health,” says Meghan O’Hearn, a doctoral candidate at the Friedman School of Nutrition Science and Policy at Tufts University in Boston and lead author of the study, which was published in the July 12 issue of the Journal of the American College of Cardiology. Researchers also found “striking disparities” in cardiometabolic health by age, sex, education level, and race and ethnicity, she adds.
Fewer Americans Have Good Cardiometabolic Health Compared With 20 Years Ago
To examine the overall trends in cardiometabolic health, researchers used data from 55,081 adults who participated in National Health and Nutrition Examination Survey (NHANES) between the years 1999 to 2018. Five components of health were included to evaluate heart health: levels of blood pressure, blood sugar, blood cholesterol, adiposity (overweight and obesity), and presence or absence of cardiovascular disease (such as prior heart attack or stroke). To be considered in “good” cardiometabolic health, people had to have optimal levels of all five components, and only 6.8 percent of U.S. adults cleared that bar. “This represents a decline from 1999 figures, when it was estimated that 7.7 of U.S. adults were in good cardiometabolic health,” says O’Hearn. Other key findings included:
Of the five risk factors measured, overweight or obesity and blood glucose levels had declined the most in past 2 decades.In 1999, 1 out of 3 adults were at a healthy weight; that number decreased to 1 out of 4 by 2018. A person with a body mass index (BMI) from 25 to 29.9 is considered overweight, and a person with a BMI of over 30 is considered to have obesity. BMI is calculated based on a person’s weight and height; the same formula is used for both men and women.About 60 percent of adults didn’t have diabetes or prediabetes in 1999, and that declined to fewer than 40 percent in 2018. People with prediabetes have higher than normal blood sugar levels and are at an increased risk of eventually developing diabetes, according to the Centers for Disease Control and Prevention (CDC). Nearly 7 out 8 people with prediabetes in the United States haven’t been diagnosed.Blood pressure levels worsened a small amount during the study period, and cardiovascular disease has remained stable.On the positive side, there’s been a small reduction in the number of people with high cholesterol in 2017–2018 compared with 1999.
Adults with less education were half as likely to have good cardiometabolic health compared with adults with more education — 5 percent versus 10 percent.Mexican Americans had one-third the optimal levels of the risk factors versus non-Hispanic white adults, 3.2 percent versus 8.4 percent.In addition, while optimal cardiometabolic health increased in white Americans, it went down for Mexican Americans, other Hispanic, Black Americans, and adults of other races.
“These findings add to the growing body of research indicating that social determinants of health, such as food and nutrition security, social and community context, economic stability, and structural racism may put individuals of difference education levels, races, and ethnicities at an increased risk of health issues,” says O’Hearn.
Findings Suggest the Urgency of Reforming Our Food System
“Diet is one of the primary contributors to unhealthy weight gain and poor blood glucose levels, and diet quality in the U.S. is poor, and getting worse,” says O’Hearn. This is a crisis that impacts everyone — not just one segment of the population — and a complete overhaul of the healthcare and food system are needed to address it, she says. “These findings suggest the urgency of reforming our food system,” she says. What would that look like? O’Hearn suggests the following measures to improve the current situation:
Using “food is medicine” interventions, in which good nutrition is used help prevent and treat illnessEnhancing existing U.S. food policies with incentives and subsidies to make healthy food more affordableEducation for both medical providers and consumers around the importance of a healthy diet and physical activityEarly interventions for improving lifestyle choices among U.S. youthPrivate sector engagement to drive a healthier and more equitable food system
Finally, there needs to be more research efforts to understand the underlying causes of these conditions, drivers of health disparities, and the effectiveness of public health interventions and policies, says O’Hearn. “We know that we can, and must, have a healthier and more equitable food system.”
