I am passionate about food and I value health. As a dietitian, I am interested in how the former impacts the latter. But I will sing from the rooftops
NUTRITION IS FAR FROM EVERYTHING WHEN IT COMES TO HEALTH.
In fact, our individual behavior is just one small piece of the bigger picture health puzzle. Yes, it’s empowering to know we have some sway over our health. However, research on the social determinants of health – the conditions in which people are born, grow, live, work and age – demonstrates that’s all it is, some.
The myth of personal responsibility is deeply embedded in our American “bootstraps” culture. This is the idea that we can achieve anything, including living disease-free and to very old age, as long as we’re willing to put in the hard work. Eat the right mix of foods, take the right cocktail of vitamins, hit the right number of steps and you’re sure to reach centenarian status. Given how scary getting sick or dying is, the idea that we can biohack our way to health and longevity is seductive.
And yet we all know someone who has lived 90 (mostly) disease-free years while enjoying daily bacon and egg breakfasts or with a long history of smoking, or who has died too young from a heart-related event despite regular strenuous exercise and a strict diet. Given the common narrative that our health is largely within our control, it’s difficult to make sense of these stories.
But our personal choices, especially those that have to do with nutrition and movement, are far from the sole determinant of our lives’ health course. While estimates vary slightly between studies, research on the social determinants of health shows that health outcomes are impacted by
- Our genetics and biology at somewhere around 20%
- Medical care at around 10%
- Social circumstances at ~25%
- Environmental factors at ~10%
- Individual behavior at ~35%
Each of these categories have different contributors as well. For instance, genetics and biology include the body structure and function we were born with in addition to our genes. Medical care includes our health literacy and access to quality health care. Social circumstances include our early childhood education and development, income level, social connectedness, race/ethnicity, gender identify and exposure to discrimination. Environmental factors include where we live and our exposure to allergens, pollution, and firearms. I hope you can see that A LOT of factors impact our health outside of our individual behavior.
Maybe some of you are thinking, “But individual behavior is the largest slice of the pie.” Yes, it is, but like the other major categories, individual behavior encompasses much more than nutrition and exercise. It includes our psychological assets like self-efficacy, and life satisfaction level; affects like stress and anxiety levels, drug and alcohol use, sleep patterns and other risk behaviors like gun safety, driving behavior and sexual activity.
These other factors beyond food and movement within the “individual behavior” category are often overlooked. In fact, most of us wear stress and busyness as badges of honor. We’re high functioning go-getters cramming in Barry’s Bootcamp after 6 hours of sleep and before a jam-packed 12-hour day fueled by cold-pressed juice! Needless to say, this is probably not a great formula for long term health but it tracks with the myth of personal responsibility and our “bootstraps” culture. Similarly, many of my clients come to me feeling really stressed about how they feed themselves or their families; the first thing I do is remind them that stressing about food in the name of health is counterproductive.
So, yes, nutrition matters. What we choose to eat plays a role but it should not come at the expense of the other stuff. That’s why our relationship to food – the why of what we eat – is just as important as the what or how. Having a healthy relationship with food supports other contributors to health like social connectedness, self-efficacy and life satisfaction; and reduces other negative contributors like anxiety or stress.
So the next time you read a headline about higher heart disease risk within a certain racial group, or that those of lower socioeconomic status have higher rates of Covid infection, hospitalization and death, question the assumption that it has much to do with individuals’ diet and exercise routines.
Health is incredibly complex and not just about personal choices around food and movement. This is the myth of personal responsibility. The social determinants of health – the conditions in which people are born, grow, live, work and age – play an outsize role and are largely out of our control. We need to remember to look at the big picture and not focus on extremes within our personal behavior at the expense of other determinants of health. When it comes to nutrition it’s about patterns, not specifics. Having a healthy relationship with food and your body is just as important as what you choose to eat. If that is something you are struggling with, I’m here to help.