January 5, 2021

Empowering families to be healthier and happier in 2021 and beyond

Our previous posts have highlighted the dramatic and recent changes in lifestyles in the US, most impactfully changes in our national diet, which have created an epidemic of obesity and chronic health conditions. This post explores the opportunity for us to have a national focus, led by emerging new healthcare innovators, on the family unit as a place to reset our lifestyle habits.

A family-based strategy would leverage the strong natural instincts of families to protect themselves. Successfully changing family behaviors will require that each family receive highly tailored information, motivation, behavior skills, and long-term support from their trusted, local healthcare team. Telehealth tools and digital health partnerships that have emerged and grown rapidly in 2020 can support such a scalable initiative. Widespread use of cellphones and digital technology by most families in the US provides an access point for healthcare teams to engage and support families over the long haul.

What do today’s American families need to know?

National data show that the health of the average American family looked very different just a few decades ago. The National Health and Nutrition Examination Survey (NHANES), for example, shows that since the 1960s, the average man has gained more than 30 lbs. and the average woman more than 27 (see Figure below right), mostly in added body fat. Other research on infants, children, and teens (see Figure below left) shows that obesity in these groups has tripled over that same time period. As noted in a previous post, this high level of body fat, sustained over years, is associated with dramatic, negative changes in human physiology and health.  

(Figure source: Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008)

(Figure source: Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008)

Excess calories are not only stored as fat under the skin (subcutaneous fat) but in the gut cavity, liver, pancreas, and muscles, where they provoke a more serious chronic immune response resulting in metabolic changes such as insulin resistance, hypertension, and out-of-range blood lipids (collectively known as metabolic syndrome), leading to cardiovascular disease, diabetes, and other conditions. These changes are happening not only to parents, but now their children. For example, US national survey data shows that 1 in 5 adolescents and 1 in 4 young adults are at risk of developing type 2 diabetes. Another study showed that at 22 years old, 72% of young adults with type 2 diabetes had already developed eye and kidney disease as a result of chronically elevated blood sugar and blood pressure levels related to lifestyle. These health problems were rare among youth of the same age living in earlier generations. Unfortunately, some ethnic and racial groups are even more heavily affected and future generations will suffer unless there is urgent national action.

The underlying problem: our biology is colliding with our modern culture and lifestyle habits

A major challenge is that what our society sees as “normal” from a modern US cultural perspective, is actually abnormal from a human biological system perspective. While the human body is exquisitely adapted biologically to the prior stresses of chronic food shortage, famine, physical hardship, injuries, infections, and other environmental dangers that have defined human history; the human body is not designed for today’s reality. Our modern, technologically advanced world is defined by an excess intake of poor quality, highly processed foods, and factory-made, sugar-sweetened drinks. The human body is also not designed for sedentary family living, but today’s families spend extended hours each day sitting while watching television or using cellphones and laptops for entertainment, communication, education, and work. Travel by car rather than by foot or bicycle, and labor-saving devices, have also contributed to the declines in families’ daily physical activity.

Families need a fresh perspective on their culture and habits

So how can families become more aware of these shifts in our culture? How can they become engaged in reducing their family’s risk of negative health impacts? A starting point is using emotionally powerful and engaging stories of other families to create curiosity about change – and then invite participation in a practical change plan for interested families. For example, the visually compelling book published in 2007, The Hungry Planet: What the World Eats by Peter Menzel and Faith D’Aluisio, uses pictures of families from different places around the world, offering insights into the enormous differences in their habits and diets. The book includes fascinating images and narratives of what 30 families ate over a one-week period. The three US families profiled in the book were the Caven family from California, the Revis family from North Carolina, and the Fernandezes from Texas. The Aymes family from Ecuador was also profiled. The images show that each family’s eating habits reflect local culture, customs, and food options that are powerful shapers of family behavior and health. The diet of the three families from the US consisted mostly of highly processed and packaged foods, meat, dairy, and sugar-sweetened drinks. These images contrast sharply with those of the family from Ecuador whose diet was comprised of healthy vegetables, fruits, whole grains, and legumes, with water and teas for drinks. In 2007, only 6% of males and 15% of females in Ecuador were obese – less than half the rate of obesity in the US.  

In 2020, the commercial pressure placed on families to eat and drink more in their daily life is highlighted by the statistic that a staggering $54.2 billion is spent on marketing by the food industry. Families are encouraged to incorporate eating and drinking into more of their treasured family celebrations. On Halloween (originally a celebration of ancestors and spiritual life), we now consume $4.6 billion in candy during a highly commercialized version of the holiday. Similarly, high volumes of seasonal candy now dominate Christmas and Easter (religious celebrations) and Valentine’s Day (meant to celebrate romantic love).

Families are also eating and drinking more during leisure activities such as going to the movies, where food and drink concessions are more profitable than the movie tickets. Largely unhealthy food and drinks are now sold in places where they never were before – in the form of candy, drinks, and snack displays at checkout lanes of retail hardware and office supply stores. And mostly unhealthy foods and drinks are featured throughout airports, highway rest stops, and gas stations, and retail pharmacies have become mini markets. Vending machines and food delivery services are much more common today than in the 1960s when obesity rates were lower. Simultaneously, fast food and family restaurant portion sizes have grown dramatically in size. Fast foods help busy families feed themselves, but the meals and drinks can be calorie dense and easy to overeat. Sugar-sweetened drinks have proliferated and account for 30%-60% of added sugars in the diet of children, adolescents, and adults. In fact, most sugars consumed are hidden in unexpected places in today’s drinks and foods amounting to 22 teaspoons of added sugar a day, most hidden in processed and prepared foods to increase consumer demand and product shelf life.

These changes to the food options available to families in the US have powerfully shaped families’ behaviors. So, what can we do to raise awareness of these patterns and prompt families to be curious enough to ask: “What can our family do differently?” or “Who can help us create a family plan to improve our habits?”

Here are some basic principles for building an effective national family lifestyle program:

  • As a foundation, as part of routine care, primary care should raise the awareness of families about the dramatic changes in our lifestyle and culture (see our prior posts) and how this impacts family health and financial security. Programs should use engaging stories and messages to help families make connections between lifestyle habits and family quality of life and health.
  • Take an approach to communicating with families that is positive and supportive, avoiding criticism or judgement.
  • Leverage families’ growing use and familiarity with digital technology to engage them with new  health technology, such as remote monitoring, wearables, and digital weight scales, and patient portals.
  • Offer practical and scalable virtual family programs that are enjoyable and inclusive. Make them flexible enough to meet the needs of different extended or nuclear family configurations. 
  • Focus on healthy eating habits as the first pillar of a healthy family. The other 5 pillars of lifestyle medicine – physical activity, stress, sleep, drug/alcohol use, and social support – can follow.
  • Help families see patterns in their “typical day” and diet using photos and surveys to help them start to modify their home environment and family habits around shopping, cooking meals, and drinks. Help families become aware of their attitudes, beliefs, strengths, and roadblocks to change. These insights should be included in the family’s lifestyle plan and electronic health records to compliment and enrich the traditional biomedical information and analytics.
  • Track family behavior change and health outcomes and provide feedback and coaching.
  • Provide strategies for modifying the home environment so that healthy choices become the “easy default” and highly processed foods and drinks are either not present or take more effort to access. Create a plan for family members to navigate high-risk situations when they move outside the home and to make smarter decisions.
  • Teach the essential behavior skills for living a healthy lifestyle in our modern society, such as how to modify a family’s favorite meals to make them healthier; how to find and cook new healthier meals; how to read food labels and understand portion sizes; how to reduce meat and dairy intake by switching animal protein and fats for plant sources; how to cook more at home and eat meals together regularly (for the health benefits and the quality family time); how to navigate and select better options at restaurants, from takeout menus, and at social events; and how to select healthier alternatives to regular sodas and juices.
  • Help families celebrate their favorite holidays and events with less focus on foods, drinks, and candy, including learning about the original meaning and purpose behind those celebrations.
  • Connect families interested in lifestyle change with one another through digital communities.
  • Adjust programs to fit families’ culture, traditions, and values.
  • Consider social determinants of health, inequities in access to programs and healthy food sources, and other resource barriers that may create roadblocks for families who are otherwise interested in taking positive steps to improve their health.

The opportunity for US healthcare pioneers

Who could deliver these family-focused lifestyle programs? It is encouraging that many dynamic new entrants are coming into our healthcare system that could potentially create scalable, prevention programs for the 128 million families in the US – based on telehealth technologies and value-based healthcare business models. These innovators are part of a disruptive new wave, and include:

While there will be risks associated with investing in family programs that have a culture and behavior-change-based approach, there are also powerful incentives as the cost of healthcare in the United States is high and successful innovators that engage families in healthier living and begin to lower healthcare costs will be rewarded by the marketplace. At Silver Fern, we have invested in developing a prevention-based program that can support these players in comprehensively assessing the behavior and psychosocial factors that have been shown to impact 60% of personal health outcomes. The Healthy Lifestyle and Disease Prevention Program applies our evidence-based techniques for identifying patients’ individual barriers, goals, and treatment preferences across these areas and provides suggested areas for working with that individual to develop the knowledge, motivation, and behavior skills that can improve their health and the health of their family.

These five innovator groups are essentially competitors to our mainstream, primary care system and the traditional physician-leadership model. So, will US physicians successfully adapt or lose influence over time? Either way, family-based programs using scalable lifestyle medicine and behavior-change strategies can be an effective, prevention-focused model for stakeholders who want to help families live healthier lives. The challenge will be for all healthcare stakeholders to shift their talents to prevention.