Eat a balanced diet, exercise regularly, keep your body fat at a healthy percentage, and don’t smoke.

Those guidelines for overall health are simple enough, aren’t they?

They are the four general barometers that experts believe could help make us healthier – the basic guidelines that healthcare practitioners often give to millions of patients all over the world.

But are we following those guidelines?

I hate to (once again) be the bearer of bad news, but most of us are not.

In fact, only 2.7 percent of the adult population in the US are adhering to all four of those guidelines, according to a new study.

It’s a shame we aren’t doing better, because the four barometers are associated with a lower risk of cardiovascular disease as well as many other health problems, including cancer and type 2 diabetes.

Ellen Smit, senior author on the study and an associate professor in the OSU College of Public Health and Human Sciences, said the findings were not encouraging:

The behavior standards we were measuring for were pretty reasonable, not super high. We weren’t looking for marathon runners.

This is pretty low, to have so few people maintaining what we would consider a healthy lifestyle. This is sort of mind boggling. There’s clearly a lot of room for improvement.


Part of the value of this study, the researchers said, is that the results are based on a large study group, 4,745 people from the National Health and Nutrition Examination Survey. It also included several measured behaviors, rather than just relying on self-reported information.

Measurements of activity were done with an accelerometer, a device people wore to determine their actual level of movement, with a goal of 150 minutes of moderate-to-vigorous activity a week. Blood samples were done to verify a person was a non-smoker. Body fat was measured with sophisticated X-ray absorptiometry, not just a crude measurement based on weight and height (this means they didn’t use BMI, which is great news, since that method is seriously flawed). A healthy diet was defined in this study as being in about the top 40 percent of people who ate foods recommended by the USDA.

The lifestyle characteristics were then compared to “biomarkers” of cardiovascular health. Some are familiar, such as blood pressure, cholesterol, and glucose levels. Others are more sophisticated, such as C-reactive protein, fasting triglycerides, homocysteine, and other data that can provide evidence of cardiovascular disease risk.

Many people accomplished one or more of the four basic lifestyle goals, such as not smoking or being adequately active. But the researchers said the most striking finding was how few people accomplished all the goals.

Having three or four healthy lifestyle habits, compared to none, generally was associated with better cardiovascular risk biomarkers, such as lower serum cholesterol and homocysteine levels. Meeting at least one or two healthy lifestyle characteristics, compared to none, was also associated with better levels of some cardiovascular risk biomarkers.

The researchers reported other findings, including:

  • Although having more than one healthy lifestyle behavior is important, specific health characteristics may be most important for particular cardiovascular disease risk factors.
  • For healthy levels of HDL and total cholesterol, the strongest correlation was with normal body fat percentage.
  • A total of 71 percent of adults did not smoke, 38 percent ate a healthy diet, 10 percent had a normal body fat percentage, and 46 percent were sufficiently active.
  • Only 2.7 percent of all adults had all four healthy lifestyle characteristics, while 16 percent had three, 37 percent had two, 34 percent had one, and 11 percent had none.
  • Women were more likely to not smoke and eat a healthy diet, but less likely to be sufficiently active.
  • Mexican American adults were more likely to eat a healthy diet than non-Hispanic white or black adults.
  • Adults 60 years and older had fewer healthy characteristics than adults ages 20-39, yet were more likely to not smoke and consume a healthy diet, and less likely to be sufficiently active.


Notice that for healthy cholesterol levels, the strongest correlation was with normal body fat percentage. And, of the adults observed, 38 percent ate a healthy diet, 10 percent had a normal body fat percentage, and 46 percent were sufficiently active.

Do you see the connection there? Let’s examine that information a bit more deeply.

As mentioned earlier, BMI (body mass index) was not used in this research. It used to be a go-to measure for assessing overall health. Many experts have complained about this for years: the BMI is simply a height-to-weight ratio that doesn’t take body fat (too much is bad) or lean body mass (you want more of this) into consideration. A recent study found that using BMI to gauge health incorrectly labeled an estimated 74,936,678 adults in the US as either healthy or unhealthy!

Notice that this study did not refer to body weight either – body fat percentage was used instead the scale. Two weeks ago, another study found that a high body fat percentage is associated with increased mortality in both men and women. It is very important to note that even in THIN people, having a high percentage of body fat is linked with higher rates of death. The researchers found that having excess body fat and inadequate muscle mass is a double whammy in terms of adverse effects on health.

Like BMI, the scale is not an adequate measure of body composition. The scale only tells you your overall body weight – and there are many components involved there. Your body is composed of two kinds of mass – lean mass (bone, water, muscle, and tissues) and fat mass (the squishy stuff).

It is important to understand that body fat serves important functions in the body. Having too little body fat can lead to problems with normal, everyday functioning, and in women, it can lead to reproductive problems. Body fat helps protect internal organs, provides energy, and regulates hormones that perform various functions.

But having too much body fat can increase the risk of many serious diseases, including certain cancers, high blood pressure, type 2 diabetes, stroke, and heart disease.

From The American Council on Exercise, here are body fat percentage ranges for men and women based on different levels of fitness.

body fat chart

Here’s a visual aid to show you what people with different body fat percentages look like:

body fat photos

Now, let’s go back to one of the findings from that study:

Of the adults observed, 38 percent ate a healthy diet, 10 percent had a normal body fat percentage, and 46 percent were sufficiently active.

I want to take a moment here to make a very important point: you can NOT outrun a bad diet.

*Note: when I say “diet,” I mean “way of eating,” not diet as in “restrictive, boring, stressful weight-loss diet.”

If you are drinking soda and eating pizza and donuts on a regular basis, don’t fool yourself into thinking that a few gym visits or walks during the week are going to help you burn that off. Remember, even if you are of a normal weight, too much body fat is unhealthy. You can be “thin on the outside, but fat on the inside.”

While regular exercise is important for many reasons, don’t rely on it alone: a healthful diet will likely have a bigger positive impact on your body fat percentage (and overall health).

Unfortunately, we REALLY need to work on our diets. Another recent study found that “ultra-processed” foods make up more than half of all calories (60 percent) consumed in the US and almost all (90 percent) of our added sugar intake. Those “foods” are high in health-damaging ingredients and are low in beneficial ones like fiber, vitamins, minerals, and other nutrients (or contain no nutrients at all).


How are YOU doing on the four healthy lifestyle guidelines?

Here are some quick tips to help you with any areas you need to improve.

*Stock your kitchen with healthful foods that are quick and easy to make. Plan ahead and pack snacks to take with you so you don’t find yourself grabbing junk from the convenience store or vending machine.

*Ditch soda, juice, and other sugary drinks and added sugars from your diet. This single act can do wonders to improve overall health and prevent you from developing serious problems like type 2 diabetes and liver disease.

*Get moving. Experts recommend at least:

2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity every week (five 30-minute sessions is a good plan) AND muscle-strengthening activities (weight training/ strength/resistance training:  2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week AND muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).


An equivalent mix of moderate- and vigorous-intensity aerobic activity AND muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).

*If you would like to find out what your body fat percentage is, there are various ways to do that. Two very accurate methods are DEXA scans or hydrostatic weighing, but they are only conducted at certain fitness and research facilities. Or, you can purchase a bioelectrical impedance scale or skinfold calipers to measure your body fat at home (some gyms also offer those methods). This online calculator can help you estimate body fat, but it isn’t as accurate as the other methods mentioned above.

*A consistent combination of proper diet (ex: adequate protein, healthy fats, vegetables, some fruit) and exercise (strength/resistance training in particular) can help you reach a healthy body fat percentage.

*If you smoke, stop. This can help you become smoke-free: How to Quit Smoking: Kick the Habit in the Butt and Don’t Look Back

Remember, small steps can lead to big changes. Don’t try to overhaul your life overnight. Instead, focus on making small changes. Over time, they will add up to a big transformation.

 “Little by little, a little becomes a lot.” ~ Tanzanian proverb

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