Study shows improvements in diet quality and exercise trends but not healthy weight

Key takeaways:

• Trends in diet quality, physical activity and smoking habits improved from 1999 to March 2020, but weight and alcohol intake did not.
• An expert encouraged PCPs to give patients healthy lifestyle tips.

From 1999 to March 2020, adults in the United States saw improvements in several lifestyle factors but declines in others, highlighting the need for lifestyle improvement efforts with a focus on equity, according to researchers.

Zhilei Shan, MD, PhD, a professor of nutrition at Tongji Medical College, Huazhong University of Science and Technology, and colleagues conducted a serial cross-sectional study using data from 10 National Health and Nutrition Examination Survey cycles (nine 2-year cycles from 1999 to 2016 and one combined cycle from 2017 to March 2020) among adults aged at least 20 years. They recently published their findings in JAMA Network Open.

Healio spoke with Shan to learn more about the most important lifestyle trends among U.S. adults, health disparities, what primary care physicians should know and more.

Healio: Why did you decide to research this subject?

Shan: Lifestyle is a popular topic in recent years given that it is modifiable and associated with various noncommunicable diseases and mortality. However, trends in lifestyle among U.S. adults have not been described since 2010. The updated trends in lifestyle factors could provide important data for relevant stakeholders to understand the health status of the population and for policymakers to facilitate policymaking to improve population health.

Healio: Will you briefly describe your findings and their importance?

Shan: From 1999 to March 2020, U.S. adults experienced improvements in smoking habits, diet quality and physical activity levels, but with a decrease in healthy weight and no significant change in moderate or less alcohol consumption. A modest improvement in overall lifestyle was also observed but with worsening disparities by age group and persistent disparities by race and ethnicity and socioeconomic level. These findings suggest that efforts are still warranted to improve lifestyle in U.S. adults, with attention on equity.

Healio: Were there any trends you thought were the strongest or most notable?

Shan: The strongest trends were the improvement in smoking habits and a decrease in healthy weight. As for the most notable trend, the little improvement in healthy lifestyle among adults 65 years and older may be the one.

Healio: What were some of the health equity disparities you observed? Why are these important to note?

Shan: From the 1999 to 2000 to the 2017 to March 2020 cycles, a greater change in healthy lifestyle was observed among younger vs. older adults. The little improvement in overall lifestyle among old adults is worth concern because older adults are the fastest-growing group in the U.S. population.

Disparities by race and ethnicity, educational level and income level were persistent over time, with consistently lower prevalence among non-Hispanic Black adults and adults with low income and educational levels. Previous studies indicated that disparities in life expectancy based on race and ethnicity and socioeconomic status are widespread in U.S. adults. Robust disparity in healthy lifestyle by race and ethnicity and socioeconomic levels may partly explain the health inequalities.

Healio: What should PCPs take away from your study?

Shan: Because PCPs play an important role in the health of their patients, patients may still need suitable suggestions from the physicians to attain a healthy lifestyle. Suggestions to maintain healthy body weight may be extremely important given the unfavorable trend in body weight at a national level. In addition, more attention is needed for population groups with little improvement in overall lifestyle (adults aged 65 years and older) and low prevalence in healthy lifestyle (non-Hispanic Black adults and adults with low income and educational levels).

Healio: What should be done to improve U.S. adults’ adherence to healthy lifestyle behaviors?

Shan: PCPs could provide suggestions for their patients to attain a healthy lifestyle. Apart from the health care system, the communities and non-health care organizations are important to initiate campaigns to promote lifestyle. Overall lifestyle promotion policies are also needed to improve population health status.

Reference: