Preventable risk factors cut 4 to 5 years off life span

Family physician Stephen Taylor, MD, had no adolescent patients with type 2 diabetes when he started his rural Vivian, La., practice 26 years ago. Now he treats children as young as 12 for the disease.

Rising obesity is one reason Dr. Taylor says there are more adolescents with type 2 diabetes. He works with patients to change their lifestyles and improve their health, but they often won't act.

"Lifestyle-related diseases have an immense effect on our overall morbidity and mortality. This is a huge problem, and we're going to have to begin to deal with it," Dr. Taylor said.

A recent study in PLoS Medicine notes that most chronic diseases, including diabetes, are caused by multiple risk factors. The study found that four preventable risk factors for chronic diseases -- adiposity, elevated blood glucose, hypertension and smoking rates -- reduce Americans' life expectancy by about 4.9 years for men and 4.1 years for women.

The findings come as obesity continues to plague the U.S., with 66% of adults either overweight or obese, according to the most recent data from the Centers for Disease Control and Prevention. A CDC report released in November 2009 said the rate of tobacco use had stalled among adults and youths after decades of decline.

A new study also shows that there is a high prevalence of chronic health problems among Americans.

Nearly half of U.S. adults have hypertension, hypercholesterolemia or diabetes, which are associated with cardiovascular disease, according to a study released in April by the CDC's National Center for Health Statistics.

About 13% of adults have two of the conditions, and 3% have all three chronic diseases. In 15% of adults, at least one condition was undiagnosed.

For the study, researchers examined data from the National Health and Nutrition Examination Survey from 1999 through 2006. Study co-author Rosemarie Hirsch, MD, MPH, said the prevalence of undiagnosed cases is concerning.

"The message is that almost half of U.S. adults have at least one of these three very common health conditions. We need to reinforce ... that this is something you need to be aware of," said Dr. Hirsch, chief of the analysis branch at the NCHS Division of Health and Nutrition Examination Surveys.

The federal government has introduced initiatives designed to make the nation healthier by reducing obesity and tobacco use, increasing physical activity and improving nutrition.

For example, new tobacco regulations developed by the Food and Drug Administration intend to curb access to and reduce the appeal of tobacco products to children and adolescents. The regulations take effect June 22.

The American Medical Association said it supports the move.

"The FDA rule ... sends a clear message to the tobacco industry -- you have no business marketing your deadly product to a new generation," AMA Board of Trustees member Mary Anne McCaffree, MD, a pediatrician, said in a statement.

Family physician Arnold Hopland, MD, estimates that a quarter of the patients at his Elizabethton, Tenn., practice use tobacco. He said the new FDA tobacco regulations will help, but the key is educating families about the dangers of tobacco use.

"I tell the parents, 'You have an obligation. You can't tell kids not to smoke and then smoke [a cigarette yourself]. You're teaching your children to kill themselves,' " he said.

Creating healthy environments

The Dept. of Health and Human Services in March awarded more than $372 million to 44 communities to support efforts to create healthier environments for residents. The funds will help increase the availability of healthy foods, improve access to safe places for physical activity and discourage tobacco use, among other things.

Meanwhile, the health reform law includes requirements that chain restaurants display the calorie content of food on menus, menu boards and drive-through displays. Similar labeling will be required on vending machines.

The AMA supports calorie-labeling policies and recommends that fast-food and chain restaurants also provide consumers with fat, saturated fat, trans fat and sodium content for each food item.

"Doctors and patients are fighting a very tough battle," said Lawrence Appel, MD, MPH, professor of medicine at Johns Hopkins University School of Medicine in Baltimore and professor of epidemiology and international health at the university's Bloomberg School of Public Health. "We need to really focus on implementing strategies ... that discourage people from making bad decisions that in the end reduce life expectancy and increase [health care] costs."

For the March PLoS Medicine study, researchers analyzed data from 2003 to 2005 on weight and height, smoking, and history of diagnosis with hypertension and diabetes. They combined this with 2005 data on deaths by underlying cause, age and sex. They found substantial disparities in exposure to the four risk factors that led to life expectancy gaps across various groups of Americans.

As of 2005, Asians had the highest life expectancy at 86.8 years for women and 82.3 years for men. Black men in the rural South and high-risk urban areas had the lowest life expectancy at 68.1 years.

Smoking prevalence was highest among Native Americans and low-income whites in Appalachia and the Mississippi Valley. Smoking rates were lowest among Asians.

Chronic health problems in local communities need to be identified before the nation's health as a whole can be improved, said Majid Ezzati, PhD, the study's senior author and associate professor of international health at Harvard School of Public Health.