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Only 7% of American Adults in Good Cardiometabolic Health: Report

Only 7% of American Adults in Good Cardiometabolic Health: Report

New research suggests Americans are in the midst of a serious health crisis

According to new and troubling research, less than 7% of the adult population in the United States has good cardiometabolic health. The study, led by a team from Tufts University’s Friedman School of Nutrition Science and Policy, claims to have discovered a “devastating health crisis requiring immediate action.” Tufts Medical Center researchers were also on the team.

The findings were published in the Journal of the American College of Cardiology on July 12.

The researchers assessed Americans on five health factors: blood pressure, blood sugar, blood cholesterol, adiposity (overweight and obesity), and the presence or absence of cardiovascular disease (heart attack, stroke, etc.) Their findings revealed that only 6.8 percent of adults in the United States had optimal levels of all five factors in 2017-2018. Obesity and blood glucose levels “worsened significantly” between 1999 and 2019.

In 1999, for example, 1 out of every 3 adults was not classified as overweight or obese. By 2018, only 1 in every 4 people had not been classified as overweight or obese. Similarly, 3 out of 5 five adults did not have diabetes or prediabetes in 1999, but less than 4 out of every 10 adults were diabetes or prediabetes-free in 2018.

“These numbers are striking. 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,” said Meghan O’Hearn, a doctoral candidate at the Friedman School and the study’s lead author. “We need a complete overhaul of our healthcare system, food system, and built environment, because this is a crisis for everyone, not just one segment of the population.”


The study examined a sample of approximately 55,000 people aged 20 or older from the ten most recent cycles of the National Health and Nutrition Examination Survey from 1999 to 2018. Rather than just the presence or absence of disease, the research team says it concentrated on optimal, intermediate, and poor levels of cardiometabolic health and its components. “We need to shift the conversation, because disease is not the only problem,” O’Hearn said. “We don’t just want to be free of disease. We want to achieve optimal health and well-being.”

The researchers also looked into health disparities based on gender, age, race, ethnicity, and level of education. They discovered that adults with less education were half as likely to have optimal cardiometabolic health compared to adults with more education. Researchers also found that Mexican Americans had one-third the optimal levels versus non-Hispanic White adults. And, while the percentage of non-Hispanic White Americans with good cardiometabolic health increased slightly between 1999 and 2018, it decreased for Mexican Americans, other Hispanics, non-Hispanic Blacks, and adults of other races.

“This is really problematic. Social determinants of health such as food and nutrition security, social and community context, economic stability, and structural racism put individuals of different education levels, races, and ethnicities at an increased risk of health issues,” said Dariush Mozaffarian, dean of the Friedman School and senior author. “This highlights the other important work going on across the Friedman School and Tufts University to better understand and address the underlying causes of poor nutrition and health disparities in the U.S. and around the world.”

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The study also looked at “intermediate” levels of health, which are defined as not being optimal but also not being poor. This included conditions like pre-diabetes, pre-hypertension, and being overweight. “A large portion of the population is at a critical inflection point,” O’Hearn said. “Identifying these individuals and addressing their health conditions and lifestyle early is critical to reducing growing healthcare burdens and health inequities.”

O’Hearn says that poor health has consequences when it comes to national healthcare spending and the economy. “These conditions are largely preventable. We have the public health and clinical interventions and policies to be able to address these problems,” O’Hearn said. 

There are solutions O’Hearn points out, like Food is Medicine interventions, incentives and subsidies to make healthy food more affordable, consumer education on a healthy diet, and private sector engagement. “There are a lot of different avenues through which this can be done,” O’Hearn said. “We need a multi-sectoral approach, and we need the political will and desire to do it.”

“This is a health crisis we’ve been facing for a while,” O’Hearn said. “Now there’s a growing economic, social and ethical imperative to give this problem significantly more attention than it has been getting.”

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