Only 2.7% of all adults had all 4 healthy lifestyle characteristics | Hacker News Reader

Only 2.7% of all adults had all 4 healthy lifestyle characteristics

mayoclinicproceedings.org

37 pointsBinaryIdiot60 comments

While I would bet that the general idea that few people lead healthy lifestyles is correct, the study is somewhat misleading, given how they measured the "healthy" amount of physical activity [0]:

"While attending the MEC, participants were instructed to wear an ActiGraph 7164 accelerometer (ActiGraph LLC) during all activities except water-based activities and while sleeping. The accelerometer measured the frequency, intensity, and duration of physical activity by generating an activity count proportional to the measured acceleration."

and dietary behavior [1]:

"Data from the Dietary Data Collection system were used to compute a Healthy Eating Index (HEI) score for each study participant. The HEI-2005 [2] was developed by the US Department of Agriculture as an indicator of dietary quality. The HEI has 12 components (total fruit; whole fruit; total vegetable; dark green, orange vegetable and legumes; total grain; whole grain; milk; meat and beans; oil; saturated fats; sodium; and calories from solid fats, alcoholic beverages, and added sugars), with each component individually scored and a maximum total score of 100. A higher score reflects closer adherence to the dietary guidelines for Americans."

I would guess the number is not higher than the 5-10% range, but 2,7% seems too low. Let's say you swim 5x a week and follow a ketogenic/low-carb diet, the study would have you classified as unhealthy. The HEI-2005 [2] is already outdated (revised in 2010) and it is probably not the "optimal" diet either.

[0] http://www.mayoclinicproceedings.org/article/S0025-6196(16)0...

[1] http://www.mayoclinicproceedings.org/article/S0025-6196(16)0...

[2] http://epi.grants.cancer.gov/hei/2005/

>the study is somewhat misleading, given how they measured the "healthy"

How is it "misleading" when they clearly explain the definition of their measures?

I'd go with "inaccurate" then.

What if they said they were measuring how many of test subjects where human and then explicitly say the measure humans as having above 1 meter tail.

Now they can, without being misleading at all, claim there were no humans in the last us census.

Your definition of measurement must be representative of the category you claim to be measuring.

It is misleading to say there are no humans in the American census when your measurement for human is non-representive just like it is misleading to say that hardly any Americans are healthy when you're measurement fails to capture most healthy subjects.

A ketogenic diet is unhealthy

You think you can just state that, uncontroversially, with no sources to back up your claim?

I don't have an opinion either way, but there's a lot of science that contradicts your statement:

https://www.reddit.com/r/ketoscience

There is literally no 100% healthy diet. Water takes minerals from your body with sweat and pee, water is unhealthy. Unhealthy is 90% of food and "diets" that were created in last a few decades, every other known for longer (hundreds of years) diet, keto or paleo has its disadvantages and advantages, but it's much better then fast food, frozen pizza or ready to microwave stuff.

True, fortunately there are initiatives such as http://nusi.org/

Ketogenic diets MIGHT be (but almost certainly aren't) unhealthy.

Eating the amount of sugars that most Americans do is absolutely unhealthy.

I know that I feel a billion times better when I reduce my carb intake, even not to ketogenic levels. Further, doing a ketogenic diet for about a year got me down to a weight low enough that I could exercise more regularly and effectively, with fewer injuries. Never mind the emotional health changes associated with not being an obese 20 year old.

I started when I was 17 and spent a week in one of the top children's hospitals in the country for unrelated things — all the doctors there were very approving of what I was doing.

It's not a might, it absolutely is for some. I'm one of them.

I tried keto for close to a year and my blood sugar shot up to being pre-diabetic. Why was that? Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency[1]. It produces an enzyme that is involved in breaking down fat from food and stored body fat into energy. Because people lack this energy source, affected individuals must keep their blood sugar levels up by eating regularly to avoid acute episodes of lethargy, seizures and coma. The condition can lead to sudden death unless it is diagnosed and proper dietary interventions are followed.

So when you're keto, eating lots of fat and little carbohydrates, which doesn't keep your blood sugar up, you can get into trouble.

Is keto unhealthy for everyone? No. Is it healthy for everyone? Definitely not.

[1] https://en.wikipedia.org/wiki/Medium-chain_acyl-coenzyme_A_d...

Yikes that must not have been fun.

Sure, and it's good to be aware of, but I would still classify something that poses a risk to 0.025% of the population as "almost certainly safe." Anything could be harmful to 1 in every 4000-17,000 people.

Sorry that happened to you!

I normally eat a lot of sugar, but tried ketogenic diets a few times for several weeks.

Couldn't think clearly at all, felt much better when returned to my sugar-taking habits.

I really don't understand why suddenly all this sugar-bashing.

If you normally eat "a lot" of sugar, then you'd expect your withdrawal symptoms to be pretty severe and prolonged relative to people who eat normal (still excessive) amounts.

I had about 3 weeks of brain fog and crappy feeling, and then felt 120% better. It's quite literally a withdrawal that you're experiencing.

And because it's been linked to diabetes, obesity, dementia, tooth decay, etc? And we're only putting more and more of it into our food?

The only way you can get diabetes from excessive sugar is if you are genetically predisposed. And if not, then not.

Tooth decay is a problem, of course, but you just have to clean teeth more often. I know no valid links to dementia, except on sugar scare sites. And sugar is tasty, and quite natural for me. (I experimented what foods give me the most weight gain; pure sugar and sweets are not exactly bad, compared to, say, white rice).

I am a vegetarian, I gave up meat quite easily, without any withdrawals, and I felt benefits immediately, but living without sugar looks unimaginable for me. Perhaps it's withdrawal, but I didn't feel _any_ positive effect, none at all.

There is insufficient data for a meaningful answer.

The study's method by definition places an upper limit of 40% of the population meeting all 4 requirements:

"Using the average of the 2-day HEI scores, participants at or above the 60th percentile (ie, top 40%) of HEI scores in the population were categorized as adhering to the dietary guidelines for consuming a healthy diet."

Regardless of how healthily people do or don't eat, you only have the 'healthy-diet' characteristic if you're in the top 40%.

I'd be shocked if the 60th percentile American diet is healthy, for any reasonable definition.

If less than 10% of people have "normal" body fat in the study, is it really normal? Perhaps that should have been identified as healthy body fat.

Most people are simply too fat and eat too much. Coming from Europe, it often baffles me what Americans consider "normal".

Edit: not to say it also isn't a problem here/worldwide, it's been getting noticeably worse over time.

If healthy is atypical and unexpected in a population, then it isn't normal. I'm pedantically suggesting that healthy is currently the abnormal condition (and one that clearly needs remediation).

It's easier to change definition of "normal" than start working out, right?

If you read the comment again, he advocates using "healthy" instead of "normal".

Which is part I agree with, I said it's easier to convince population to change definition of "normal" and decrease standards, than make them do any kind of healthy stuff.

What I would like to find out is; What the survival rate / life expectancy is for those 2.7% vs the rest of the population?

My masseuse said during massage yesterday: "Relax! If you can't relax, that's not good for you."

That's not much help to get relaxed, you can imagine, but nor is the "you're doing it all wrong" in these studies. I bet that most of these people do realise that their lifestyle isn't all healthy, but improvement is difficult with all the noise around.

Which sports should you do, how often is optimal? Which diet is the best one? Is rice healthy at all? Ask any of these questions from two "health experts", and feel free leave the scene: they will still be debating the following day.

1. Don't smoke, it causes deadly diseases.

2. Don't be immobile and stationary all day.

3. Don't buy food that comes in a plastic wrap or a cardboard box. Make your own from primary ingredients (vegetables, meats, grains).

You are talking about details. This study, if taken at face value, suggests people are ignoring the obvious fundamentals.

You've somewhat contradicted yourself with #3. Many primary ingredients are sold in cardboard or plastic packaging.

Also, #3 requires enough wealth to have the time to spend on it.

Preparing somewhat healthy food takes a few hours a week. It's not so hard that you need to be particularly wealthy to do it.

You don't need to be particularly wealthy, but it does require you to allocate:

* Fridge & pantry space for ingredients. This is significantly easier if you are not splitting that space with 2 roommates.

* Time and Executive Function to keep track of what you need to shop for. This is significantly easier if you spend $5 on an app like Paprika. https://itunes.apple.com/us/app/paprika-recipe-manager-for/i...

* Money to spend on cooking tools. This is significantly easier if you have friend who also cook and can recommend things.

* Time and skill to spend organizing your kitchen so that you can work reasonably efficiently.

* Time and patience to spend doing a skill poorly because you are learning. This is made easier if you have a snack before you cook dinner because trying to do an unfamiliar multi-threaded task is harder when you are hungry.

* Money to spend on ordering food to be delivered when you fuck something up.

* Time to spend going to the grocery store more frequently for fresher ingredients. This is significantly easier if you own a car or are willing to pay higher rent to live near a grocery store.

* Time to spend actually doing both the cooking and cleaning.

All of this is doable on a software engineer salary, but it does require making a deliberate decision to allocate resources.

While I was studying I was living on 800 Euros a month. That's 20 Euro more than poverty level. I had a tiny apartment with a tiny fridge and no proper kitchen. Making rice or lentils, heating some frozen veggies in the microwave and frying some meat or opening a can of fish takes about 15 minutes and anybody can do it. You need a pot, a pan and a microwaveable bowl. Ikea has all of that for like 50 Euro.

> Many primary ingredients are sold in cardboard or plastic packaging.

Ok yes, a rhetorical failure on my part. The distinction was of "meals coming in wrapping" vs. making them out of primary ingredients.

I'm thinking butchered meat and fish from the counter, fresh produce by weight, grains by the weight. But yes, those same things can be sold in boxes and plastic.

But with #3, you don't have to make complicated meals - those indeed are a luxury. My bachelor rule of thumb was 3 "foodthings", 3 minutes, add spice to taste. Or 5 of each, if you splurge. Of course, with higher income, you can buy even higher quality primary ingredients, and the contrast to the cheapest basics are remarkable. But the difference is mostly limited to freshness, texture, taste - at the moment research doesn't suggest they are better from a fundamental nutrititional value standpoint.

4, and possibly the most important: Don't overeat, regardless of the ingredients.

Our bodies are designed to continue eating until we obtain the nutrients we need - which is why junk food is not satisfying and we eat more of it. Try and overeat a meal consisting of pumpkin seeds, spinach, quinoa and berries.

Even if you get the right balance of everything else, there is evidence that too much of certain sugars can impede the body's ability to manage this as can the presence of certain common chemicals in the modern diet (caffeine, some sweeteners and other additives).

It isn't just that the modern diet of many people fails to provide what the body is looking for, it also breaks the body's ability to manage things (in some cases due to not processing it properly, in others due simply to hunger signals being present unnecessarily) even if it is provided with what it wants.

I think the explanation for this is not that your body miraculously detects the nutrients you need, but rather if something tastes of fat/salt/sugar we will eat as much of it as humanly possible.

or try eating something that tastes good.

Sticking with primary ingredients pretty much guarantees that. While it's possible to go overboard with fatty meat, lots of nutritionally dense seeds/nuts or drinking lots of calories in milk and beer for instance (which is probably how rich lordlings got fat in the centuries preceding ready meals), most people would struggle to consistently overeat meat, vegetables and non-wheat carbs.

Improving your health is a very personal thing though. These sorts of studies tend to be about populations, not individuals. Even with external help, you'd have to work with them over some period to figure out what works for you.

You're just going to have to do your own leg work if you're serious about getting healthier.

Here's a simple quiz from "Public Health England" in the UK. It asks some questions and gives advice about what you can do to improve things.

https://www.nhs.uk/oneyou/hay

It's not perfect, and there's room for debate on some recommendations. But public health is not about being perfect. It's about iteration, sometimes across a population. Get a few more people being a bit more active. Get a few more people to stop smoking. Get a few more people to cut down their excessive alcohol consumption. Get better mental health built into communities.

For the individual the recommendations aren't baffling. Don't smoke; don't drink too much; get some exercise; eat better food; look after your mental health.

> Is rice healthy at all?

Sure. Rice is fine. Be very careful if you eat cooled rice, it's a significant source of food poisoning. And don't only eat rice, eat other stuff too. And watch what you eat with the rice.

It's shocking, especially considering that failing two of those tests initially requires deliberate effort (smoking and bodyfat), even if after this point reversal is far more complicated and difficult.

Another two, daily activity and healthy food, have also become "non-default" behaviour only in the past couple of decades. Consider that increases in free time (for activity) and the fact that eating a healthy diet has never been as easy or less costly than now.

Does anyone have similar data for other countries, cultures or regions?

Why do you say that eating healthy has never been less costly? Easy, maybe (the Internet makes information easier to find and global trade and larger super markets make it potentially easier to find), but I don't feel that healthy is less costly. Annecdata: I recall that vegetables and healthier breakfast cereals were cheaper than junk foods in the 80's. Now, due to mostly demand, it seems to have flipped. Add to that that the overall growth in the price of food had outpaced the the growth in household income over the last three decades (on mobile, hard to find a source), and I begin to understand how my mostly healthy groceries take up such a large percent of my income. And if we think of it in terms of healthy vs unhealthy foods and cost, I could save a lot of money by only feeding the family pasta or processed foods. Healthy foods costs more than unhealthy foods (excluding potential health issues).

I'm open to being wrong. This would be an interesting point to research as an economist. You're right in that in the past 50 years unhealthy food has become relatively cheaper compared to healthy food.

My thought was comparing the cost of a particular balance of nutritional value from now, to past centuries and millennia. Maybe it doesn't hold for the economic "golden years" in America from 1950-1970.

My completely arbitrary estimate is that total food costs as a percentage of total household consumption has plummeted from something like 40-50% to about 2-5%.

Of course, there are regional differences. At the moment, in the developing world getting enough protein is a challenge. For many historically meat was prohibitively expensive. But it wasn't so for people close to hunting or fishing industries.

Man, I wish I spent that little. My family is closer to 20% of household income spent on groceries, and I make good money, too.

Their requirement for exercise was over two and half hours / week of "moderate to vigorous physical activity" which I guess is running or similar.

I suspect that alone disqualified a good chunk of people.

IIRC a brisk walk (faster than natural walking pace, but certainly not a jog) qualifies as moderate exercise in many studies. If that is so here then 2.5 hours is not nearly as difficult to achieve as you might otherwise think. Caveat: I've not read the report so I don't know if they explicitly define what they mean by "moderate".

It's a shame really. 2.5hrs a week isn't a huge commitment, especially if you're able to work it into your day, e.g. commuting to work.

What are these characteristics?

From the article:

* Measurement of Physical Activity

* Measurement of Dietary Behavior/Healthy Eating Index

* Measurement of Smoking Status

* Measurement of Body Fat Percentage

I would say number 4 is a bit odd, since it depends on the other ones. But I guess it is easy to measure.

IMO this looks more like shaming the whole adult population.

Guess what - we're already under stress and shaming us even more will only cause more unhealthy behavior trying to eat away/smoke away/drink away that stress.

Just stop.

What incentive would the Mayo Clinic have to publish data that Americans are generally healthy?

They could take credit for it.

They could, but what newspaper is going to report that press release?

Newspapers, by definition, cover reports that are newsworthy. "People are all healthy" would be the more surprising headline for any paper today, so I would assume that would be picked up at least as well.

https://en.wikipedia.org/wiki/Negativity_bias

From their POV, does it matter? The clinic doesn't exist to get column inches as far as I can tell.

If they didn't want money, for better or for worse, they wouldn't ask for it: https://philanthropy.mayoclinic.org/donatemc

$4.27 billion, pretty good for a non-profit: http://www.forbes.com/lists/2010/14/charity-10_Mayo-Clinic_C...

I'm not saying they don't use the money to help people. I am saying that, in regard to this article on HN, it's the finding one would expect.

being healthy is hard so let's not talk about it, or just move the goal post of healthy?

That kind of talk is worse than no talk at all.

How do you make a child know himself? You surround him with mirrors. "This is what everyone else sees when you do what you do. This is who everyone thinks you are."

You cause him to be tested: this is the kind of person you are, you are good at this but not that. This other person is better than you at this, but not better than you at that. These are the limits by which you are defined.

If you don't do this to a child, you get a narcissist. If you do this on a large scale, you get.. well, America. (Paraphrasing the satirical blog thelastpsychiatrist.com)

Adults are not your children and also they don't owe anything to you.

You get who you get.

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