Chartbook on Healthy Living

Lifestyle Modification and Health

• Unhealthy behaviors place many Americans at risk for a variety of diseases.
• Lifestyle practices account for more than 40% of the differences in health among individuals.¹

Impact of Behaviors on Health

• A recent study² examined the effects of three healthy lifestyles on the risks of all-cause mortality and developing chronic conditions among adults in the United States:
  • Not smoking.
  • Engaging in at least 150 minutes of moderate or vigorous physical activity per week.
  • Eating a healthy diet (e.g., grains, fruits, vegetables).
• Compared with adults who did not engage in healthy behaviors, the risk for all-cause mortality was reduced by:
  • 56% among nonsmokers.
  • 47% among adults who were physically active.
  • 26% among adults who consumed a healthy diet.²
• The risk of death decreased as the number of healthy behaviors increased. For adults engaged in all three healthy behaviors, the risk of death was reduced by:
  • 82% for all causes.
  • 65% for cardiovascular disease.
  • 83% for cancer.
  • 90% for other causes.²

Lifestyle Modification Measures

• Adult current smokers with a checkup in the last 12 months who received advice to quit smoking.
• Adults with obesity who ever received advice from a health professional to exercise more.
• Adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week.
• Children ages 2-17 for whom a health provider gave advice about exercise.
• Adults with obesity who ever received advice from a health professional about eating fewer high-fat or high-cholesterol foods.
• Children ages 2-17 for whom a health provider gave advice within the past 2 years about healthy eating.

Prevention: Counseling To Quit Smoking

• Smoking harms nearly every bodily organ and causes or worsens many diseases.
• In the past 50 years, more than 20 million premature deaths have been attributable to smoking and exposure to secondhand smoke.³
• Smoking causes more than 87% of deaths from lung cancer and more than 79% of deaths from chronic obstructive pulmonary disease.³

Adult current smokers with a checkup in the last 12 months who received advice from a doctor to quit smoking, by race/ethnicity and health insurance (ages 18-64), 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: Civilian noninstitutionalized adult current smokers who had a checkup in the last 12 months.
Note: Estimates are age adjusted to the 2000 U.S. standard population using three age groups: 18-44, 45-64, and 65 and over. White and Black are non-Hispanic. Hispanic includes all races.

• Importance: Smoking is a modifiable risk factor, and health care providers can help encourage patients to change their behavior and quit smoking. The 2008 update of the Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence concludes that counseling and medication are both effective tools alone, but the combination of the two methods is more effective in increasing smoking cessation. For more information, visit http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html.
• Overall Rate: In 2013, the percentage of adult current smokers with a checkup in the last 12 months who received advice from a doctor to quit smoking was 66.5%.
• Trends:
  • From 2002 to 2013, the percentage of adult current smokers with a checkup in the last 12 months who received advice from a doctor to quit smoking increased overall (from 63.1% to 66.5%), for Hispanics (from 52.0% to 64.2%), and for Whites (from 64.8% to 68.1%). 
• Groups With Disparities:
  • In 2013, among adult current smokers ages 18-64 with a checkup, those with public health insurance (72.6%) were more likely than those with private health insurance (63.1%) to receive advice from a doctor to quit smoking.
  • In 2013, among adult current smokers ages 18-64 with a checkup, those who were uninsured (52.9%) were less likely than those with private insurance (63.1%) to receive advice from a doctor to quit smoking.
  • In all years except 2011, uninsured adult current smokers ages 18-64 with a checkup were less likely to receive advice to quit smoking compared with those with private insurance.
  • From 2002 to 2013, there was no statistically significant change in the disparity between uninsured and privately insured adult current smokers with a checkup in the last 12 months who received advice from a doctor to quit smoking. 

Prevention: Counseling for Adults About Exercise

• About one-third of adults (34.9%) are obese:
  • Obesity-related conditions are among the leading causes of preventable death, such as heart disease, stroke, type 2 diabetes, and some cancers.⁴
  • Physicians encounter many high-risk individuals, whom they can educate about personal risks and lifestyle changes that can help reduce weight and increase activity.⁵

Adults with obesity who ever received advice from a health provider to exercise more, by race/ethnicity and age, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: Civilian noninstitutionalized adults age 18 and over with obesity.
Note: Estimates are age adjusted to the 2000 U.S. standard population using three age groups: 18-44, 45-64, and 65 and over. Obesity is defined as a body mass index of 30 or higher. White and Black are non-Hispanic; Hispanic includes all races.

• Importance: Physician-based exercise and diet counseling is an important component of effective weight loss interventions. Such interventions have been shown to increase levels of physical activity among sedentary patients, resulting in a sustained favorable body weight and body composition.⁵
• Overall Rate: In 2013, the overall percentage of adults with obesity who had ever received advice from a health provider to exercise more was 63.5%.
• Trends: 
  • From 2002 to 2013, the percentage of obese adults who ever received advice from a health provider to exercise more increased overall (from 55.6% to 63.5%), for Hispanics (from 45.9% to 59.5%), and for Blacks (from 55.8% to 64.8%).
  • From 2002 to 2013, the percentage of obese adults who ever received advice from a health provider to exercise more increased for those ages 18-44 (from 46.5% to 55.5%).
• Groups With Disparities:
  • In 2013, obese Hispanic adults (59.5%) were less likely than White obese adults (64.5%)  to ever receive advice from a health provider to exercise more.
  • In 8 of 12 years, obese Hispanic adults were less likely than White obese adults to ever receive advice from a health provider to exercise more.
  • From 2002 to 2013, the disparity between Hispanic and White obese adults who ever received advice from a doctor to exercise more grew smaller but was still present.
  • In 2013, obese adults ages 45-64 (73.7%) and age 65 and over (70.6%) were more likely than those ages 18-44 (55.5%) to ever receive advice from a doctor to exercise more.
  • In all years, obese adults ages 45-64 and age 65 and over were more likely than those ages 18-44 to ever receive advice from a doctor to exercise more.

Lack of Exercise Among Adults With Obesity

Adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week, by race/ethnicity, income, education, and residence location, 2011-2013

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2011-2013.
Denominator: Civilian noninstitutionalized population age 18 and over with obesity.
Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 U.S. standard population using three age groups: 18-44, 45-64, and 65 and over. Obesity is defined as a body mass index of 30 or higher. White and Black are non-Hispanic; Hispanic includes all races.

• Importance: The 2008 Physical Activity Guidelines for Americans recommend that adults engage in at least 2 hours and 30 minutes a week of moderate-intensity physical activity or 1 hour and 15 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. For more information, visit http://health.gov/paguidelines/guidelines/.
• Overall Rate: In 2013, the overall percentage of adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week was 60.5%.
• Groups With Disparities: 
  • In 2013, there were no statistically significant differences by race/ethnicity, income, education, or residence location in the percentage of adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week.

Adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week, by health insurance (ages 18-64), sex, age, chronic conditions, perceived health status, and activity limitations, 2011-2013

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2011-2013.
Denominator: Civilian noninstitutionalized population age 18 and over with obesity.
Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 U.S. standard population using three age groups: 18-44, 45-64, and 65 and over. Obesity is defined as a body mass index of 30 or higher. Basic activity limitations include problems with mobility, self-care, domestic life, or activities that depend on sensory functioning. Complex activity limitations include limitations experienced in work or in community, social, and civic life.

• Groups With Disparities:
  • In 2013, there were no statistically significant differences by health insurance in the percentage of obese adults ages 18-64 who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week.
  • In 2011 and 2012, adults ages 18-64 with obesity with only public insurance were less likely to spend half an hour or more in vigorous physical activity at least five times a week compared with those with private insurance.
  • In 2013, the percentage of adults with obesity who did not spend half an hour or more in moderate or vigorous physical activity at least five times a week was higher for:
    • Females (66.5%) compared with males (54.0%).
    • Those ages 45-64 (62.7%) and age 65 and over (67.6%) compared with those ages 18-44 (56.9%).
    • Those with 4 or more chronic conditions (81.5%) compared with those with 0-1 chronic conditions (57.0%).
    • Those who perceived their health status to be fair or poor (72.1%) compared with those who perceived their health status to be excellent, very good, or good (57.6%).
    • Those with basic (72.6%) or complex activity limitations (76.8%) compared with those with neither limitation (56.6%).

Prevention: Counseling About Exercise for Children and Adolescents

• About 17% of children and adolescents ages 2-19 are overweight or obese.⁶
• Childhood is when people can establish healthy lifelong habits, and physicians can play an important role in encouraging healthy behaviors.
• The 2008 Physical Activity Guidelines for Americans recommend that children and adolescents engage in 1 hour or more of physical activity everyday.
• For more information, visit www.health.gov/paguidelines/guidelines/default.aspx.

Children ages 2-17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have, by race/ethnicity and income, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: U.S. civilian noninstitutionalized population ages 2-17.
Note: White and Black are non-Hispanic. Hispanic includes all races.

• Importance: Physicians can educate children and parents about the importance of regular exercise and healthy eating.
• Overall Rate: In 2013, the overall percentage of children ages 2-17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have was 41.4%.
• Trends:
  • From 2002 to 2013, the percentage of children ages 2-17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have increased overall (from 30.0% to 41.4%), for Hispanics (from 30.4% to 45.1%), for Blacks (from 30.5% to 42.0%), and for Whites (from 30.5% to 39.9%).
  • From 2002 to 2013, the percentage of children ages 2-17 whose health providers gave advice about exercise increased for children in all income groups (poor, from 27.5% to 39.4%; low income, from 26.7% to 40.4%; middle income, from 28.2% to 40.3%; and high income, from 36.4% to 44.8%).
• Group With Disparities:
  • In 2013, there were no statistically significant differences by race/ethnicity or income in the percentage of children ages 2-17 whose health providers gave advice about exercise.

Prevention: Counseling for Adults About Healthy Eating

• An important factor in maintaining a healthy body weight is changing eating habits to incorporate nutritious food and beverages.
• The U.S. Department of Agriculture created the Dietary Guidelines for Americans to help people understand the complexity of healthy eating for both children and adults.
• For more information, visit www.dietaryguidelines.gov.

Adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods, by race/ethnicity and chronic conditions, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: Civilian noninstitutionalized population age 18 and over with obesity.
Note: Estimates are age adjusted to the 2000 U.S. standard population using three age groups: 18-44, 45-64, and 65 and over. Obesity is defined as a body mass index of 30 or higher. White and Black are non-Hispanic; Hispanic includes all races.

• Importance: Physicians need to emphasize the importance of eating foods from all food groups and balancing energy intake and energy expenditure. Foods from all food groups include whole grains and fibers, lean proteins, complex carbohydrates, fruits and vegetables, and low-fat or fat-free milk and dairy products.
• Overall Rate: In 2013, the overall percentage of adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods was 51.3%.
• Trends:
  • From 2002 to 2013, the percentage of adults with obesity who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods increased for Hispanics (from 38.6% to 52.3% ).
  • From 2002 to 2013, the percentage of obese adults who ever received advice from a health provider about eating fewer high-fat or high-cholesterol foods decreased for those with 4 or more chronic conditions (from 87.8%  to 70.9%).
• Groups With Disparities:
  • In 2013, obese adults with 2-3 chronic conditions (68.1%) and those with 4 or more chronic conditions (70.9%) were more likely to receive counseling about healthy eating than those with 0-1 chronic conditions (43.7%).
  • In all years, obese adults with 2 or more chronic conditions were more likely to receive counseling about healthy eating than those with 0-1 chronic conditions.

Prevention: Counseling for Children About Healthy Eating

• Children and adolescents have become overweight from eating more calories than they burn.
• About 30% to 40% of daily calories children and adolescents consume are energy-dense, nutrient-poor foods and drinks.⁷
• Children and adolescents consume 35% to 40% of their daily energy in school, so schools need to provide diverse, nutrient-based foods and drinks.⁷
• The Dietary Guidelines for Americans encourage children and adolescents to maintain a calorie-balanced diet to support normal growth and development without gaining excess weight.
• For more information, visit www.dietaryguidelines.gov.

Children ages 2-17 for whom a health provider ever gave advice within the past 2 years about healthy eating, by race/ethnicity and age, 2002-2013

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Denominator: U.S. civilian noninstitutionalized population ages 2-17.
Note: White and Black are non-Hispanic. Hispanic includes all races.

• Importance: It is important to advise parents and guardians to provide balanced diets at home. Eating patterns that are established early in childhood are often adopted later in life, making early interventions important.
• Overall Rate:  In 2013, the overall percentage of children ages 2-17 for whom a health provider gave advice within the past 2 years about healthy eating was 58.3%.
• Trends:
  • From 2002 to 2013, the percentage of children ages 2-17 for whom a health provider gave advice within the past 2 years about healthy eating improved overall (from 46.9% to 58.3%), for Hispanics (from 45.5% to 61.6%), for Blacks (from 49.3% to 58.5%), and for Whites (from 47.2% to 56.3%).
  • From 2002 to 2013, the percentage of children for whom a health provider gave advice about health eating increased for those ages 2-5 (57% to 67.2%) and for those ages 6-17 (43.7% to 55.4%).
• Groups With Disparities:
  • In 2013, Hispanic children (61.6%) were more likely than White children (56.3%) to receive advice from a health provider about healthy eating.
  • In 2013, children ages 6-17 (55.4%) were less likely than children ages 2-5 (67.2%) to receive advice about healthy eating.

References

1. Satcher D, Higginbotham EJ. The public health approach to eliminating disparities in health. Am J Public Health 2008;98(9 Suppl):S8-11. PMID: 18687626. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518593/. Accessed March 23, 2016.
2. Ford E, Bergmann M, Boeing H, et al. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med 2012 Jul;55(1):23-7. Epub 2012 Apr 29. PMID: 22564893. http://www.sciencedirect.com/science/article/pii/S0091743512001582. Accessed March 23, 2016.
3. Office on Smoking and Health. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html. Accessed March 23, 2016.
4. Adult Obesity Facts. Atlanta, GA: Centers for Disease Control and Prevention; 2014. http://www.cdc.gov/obesity/data/adult.html. Accessed March 23, 2016.
5. Lin JS, O’Connor E, Whitlock EP, et al. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2010 Dec 7;153(11):736-50. PMID: 21135297. http://annals.org/article.aspx?articleid=746527. Accessed June 26, 2015.
6. Childhood Obesity Facts. Atlanta, GA: Centers for Disease Control & Prevention; 2014. http://www.cdc.gov/obesity/data/childhood.html. Accessed March 23, 2016.
7. American Academy of Pediatrics, Council on School Health; Committee on Nutrition. Policy Statement. Snacks, sweetened beverages, added sugars, and schools. Pediatrics 2015;135(3):575-83. http://pediatrics.aappublications.org/content/135/3/575.long. Accessed March 23, 2016.

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