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Home » Harvard Health Blog » Healthy lifestyle: 5 keys to a longer life - Harvard
Health Blog
Healthy lifestyle: 5 keys to a longer life
POSTED JULY 05, 2018, 10:30 AM

Monique Tello, MD, MPH

Contributing Editor

How is it that the United States spends the most money on healthcare, and yet still
has the one of the lowest life expectancies of all developed nations? (To be
specific: $9,400 per capita, 79 years, and 31st.)
Maybe those of us in healthcare have been looking at it all wrong, for too long.
Healthy lifestyle and longevity
Researchers from the Harvard T.H. Chan School of Public Health conducted a massive
study of the impact of health habits on life expectancy, using data from the well-
known Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study
(HPFS). This means that they had data on a huge number of people over a very long
period of time. The NHS included over 78,000 women and followed them from 1980 to
2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This
is over 120,000 participants, 34 years of data for women, and 28 years of data for
men.
The researchers looked at NHS and HPFS data on diet, physical activity, body
weight, smoking, and alcohol consumption that had been collected from regularly
administered, validated questionnaires.
What is a healthy lifestyle, exactly?
These five areas were chosen because prior studies have shown them to have a large
impact on risk of premature death. Here is how these healthy habits were defined
and measured:
1. Healthy diet, which was calculated and rated based on the reported intake of
healthy foods like vegetables, fruits, nuts, whole grains, healthy fats, and omega-
3 fatty acids, and unhealthy foods like red and processed meats, sugar-sweetened
beverages, trans fat, and sodium.
2. Healthy physical activity level, which was measured as at least 30 minutes per
day of moderate to vigorous activity daily.
3. Healthy body weight, defined as a normal body mass index (BMI), which is
between 18.5 and 24.9.
4. Smoking, well, there is no healthy amount of smoking. “Healthy” here meant
never having smoked.
5. Moderate alcohol intake, which was measured as between 5 and 15 grams per day
for women, and 5 to 30 grams per day for men. Generally, one drink contains about
14 grams of pure alcohol. That’s 12 ounces of regular beer, 5 ounces of wine, or
1.5 ounces of distilled spirits.
Researchers also looked at data on age, ethnicity, and medication use, as well as
comparison data from the National Health and Nutrition Examination Surveys and the
Centers for Disease Control and Prevention’s Wide-Ranging Online Data for
Epidemiologic Research.
Does a healthy lifestyle make a difference?
As it turns out, healthy habits make a big difference. According to this analysis,
people who met criteria for all five habits enjoyed significantly, impressively
longer lives than those who had none: 14 years for women and 12 years for men (if
they had these habits at age 50). People who had none of these habits were far more
likely to die prematurely from cancer or cardiovascular disease.
Study investigators also calculated life expectancy by how many of these five
healthy habits people had. Just one healthy habit (and it didn’t matter which one)
… just one… extended life expectancy by two years in men and women. Not
surprisingly, the more healthy habits people had, the longer their lifespan. This
is one of those situations where I wish I could reprint their graphs for you,
because they’re so cool. (But if you’re very curious, the article is available
online, and the graphs are on page 7. Check out Graph B, “Estimated life expectancy
at age 50 according to the number of low-risk factors.”)
This is huge. And, it confirms prior similar research — a lot of prior similar
research. A 2017 study using data from the Health and Retirement Study found that
people 50 and older who were normal weight, had never smoked, and drank alcohol in
moderation lived on average seven years longer. A 2012 mega-analysis of 15
international studies that included over 500,000 participants found that over half
of premature deaths were due to unhealthy lifestyle factors such as poor diet,
inactivity, obesity, excessive alcohol intake, and smoking. And the list of
supporting research goes on.
So what’s our (big) problem?
As the authors of this study point out, in the US we tend to spend outlandishly on
developing fancy drugs and other treatments for diseases, rather than on trying to
prevent them. This is a big problem.
Experts have suggested that the best way to help people make healthy diet and
lifestyle change is at the large-scale, population level, through public health
efforts and policy changes. (Kind of like motorcycle helmets and seat belt
legislation…) We have made a little progress with tobacco and trans-fat
legislation.
There’s a lot of pushback from big industry on that, of course. If we have
guidelines and laws helping us to live healthier, big companies aren’t going to
sell as much fast food, chips, and soda. And for companies hell-bent on making
money at the cost of human life, well, that makes them very angry.
Follow me on Twitter @drmoniquetello
Sources
Impact of healthy lifestyle factors on life expectancies in the US population.
Circulation, April 2018.
National Institute on Alcohol Abuse and Alcoholism, What is a standard drink?
The population health benefits of a healthy lifestyle: Life expectancy increased
and onset of disability delayed. Health Affairs, August 2017.
The combined effects of healthy lifestyle behaviors on all-cause mortality: a
systematic review and meta-analysis. Preventive Medicine, September 2012.
Changing minds about changing behavior. Lancet, January 2018.
The US Food and Drug Administration (FDA) Final Determination regarding Partially
Hydrogenated Oils (trans fat)
The US Food and Drug Administration (FDA) Family Smoking Prevention and Tobacco
Control Act- An Overview
Related Information: Healthy Eating: A guide to the new nutrition
 Print
Related Posts:
Eating better: 3 keys to healthy grocery shopping
Time spent in “green” places linked with longer life…
6 keys to finding a high-quality addiction treatment center
The missing rewards that motivate healthy lifestyle changes
A healthy lifestyle may help you sidestep Alzheimer’s

COMMENTS
46
TOPICS
Health | Prevention
Comments:
1 POSTED SEPTEMBER 3RD, 2018 AT 4:16 AM asssad diets or straight to the
fridge…
2 To have a better life style one
3 POSTED AUGUST 10TH, 2018 AT 9:42 AM DanaGreat article and insight.
Education is key when it comes to a healthy lifestyle. I am curious as to why
stress management was not looked at? Numerous research studies have shown stress to
be a factor in heart disease, reducing life expectancy. Also, hydration is
important and often overlooked. So many factors are involved when it comes to our
health.
4 POSTED AUGUST 1ST, 2018 AT 5:41 AM Ian LewisJen – strongly support your
individual freedom perspective, and with this freedom is its connection to
responsibility – of individuals, corporations, state, et al.
◦ POSTED AUGUST 3RD, 2018 AT 1:16 PM Monique Tello, MD, MPHAnd I support
your “with freedom comes responsibilities” perspective, Ian, Thank you!
5 POSTED JULY 24TH, 2018 AT 7:20 AM Joshua MIllerExcellent article. But i
think we can also add Yoga in the top priorities. Yoga is considered as one of the
best thing that can reverse the aging effects significantly at home. There are
several poses that can boost the blood circulation and provide the essential
nutrition to various cells. I have found an article entitled ” 21 Yoga Poses for
Anti Aging – Yoga Turns the Clock Back”
◦ POSTED AUGUST 3RD, 2018 AT 1:17 PM Monique Tello, MD, MPHYoga is
fantastic for many reasons. Thanks, Joshua.
6 POSTED JULY 20TH, 2018 AT 4:34 PM Monique Tello, MD, MPHThanks
Frances, Yes, this is part of the healthy lifestyle generally!
7 POSTED JULY 20TH, 2018 AT 4:34 PM Monique Tello, MD, MPHYes, There is
evidence to suggest that artificial sweeteners are unhealthy in many ways, and they
definitely are not associated with weight loss.
8 POSTED JULY 20TH, 2018 AT 4:33 PM Monique Tello, MD, MPHDear S, I
agree that a high-quality diet and healthy lifestyle are more important than weight
as a number. But if a person is suffering from a disease that can respond well to
weight loss, then it only makes sense to include healthy weight loss as part of the
plan. This can be done safely, without fad diets.
9 POSTED JULY 20TH, 2018 AT 4:29 PM Monique Tello, MD, MPHBob, that was
well-stated. Yes, it’s hard to look at the numbers, but even harder to look at my
patient with multiple serious chronic illnesses and disability due to poor diet and
lifestyle, which could have been prevented. Time for us all to wisen up.
10 POSTED JULY 20TH, 2018 AT 4:26 PM Monique Tello, MD, MPHSorry, Jen,
for wanting to help you to live the healthiest, happiest, longest life you possibly
can! Promoting the healthiest options for people is what doctoring is all about.
11 POSTED JULY 20TH, 2018 AT 4:24 PM Monique Tello, MD, MPHCarolyn, agree
completely, a plant-based Mediterranean style diet is the best diet for health.
That includes some whole grains, ideally in intact form (such as farro, quinoa, and
brown rice), some healthy proteins and fats (legumes, nuts, seeds, fish, chicken),
and mostly fruits and veggies. Refined grains, like white flour and sugar, and
everything made from them (bread, pastas, backed goods, cereals, et cetera) are the
real culprit.
12 POSTED JULY 16TH, 2018 AT 1:01 PM Monique Tello, MD, MPHHi, No. Our
bodies handle intact whole grains very differently from processed whole grains, and
handles those very differently than refined grains. Check out the HSPH Nutrition
Source website on this: https://www.hsph.harvard.edu/nutritionsource/what-should-
you-eat/whole-grains/
13 POSTED JULY 16TH, 2018 AT 12:58 PM Monique Tello, MD, MPHYes, regular
intake of one drink or fewer per day of alcohol can increase the risk of cancer in
certain individuals, slightly.
14 The summary statement from one of the main research summaries on this
is:
15 “Clearly, the greatest cancer risks are concentrated in the heavy and
moderate drinker categories. Nevertheless, some cancer risk persists even at low
levels of consumption. A meta-analysis that focused solely on cancer risks
associated with drinking one drink or fewer per day observed that this level of
alcohol consumption was still associated with some elevated risk for squamous cell
carcinoma of the esophagus, oropharyngeal cancer, and breast cancer, but no
discernable associations were seen for cancers of the colorectum, larynx, and
liver. On the basis of the lesser overall cancer risk at the lower end of the dose-
response continuum, the World Cancer Research Fund/AICR made the following
recommendation: ‘If alcoholic drinks are consumed, limit consumption to two drinks
a day for men and one drink a day for women.'” You can check out the entire article
here: http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155
16 POSTED JULY 16TH, 2018 AT 12:50 PM Monique Tello, MD, MPHGood for you!
It may be a combination of factors.
17 POSTED JULY 16TH, 2018 AT 12:49 PM Monique Tello, MD, MPHYou are
welcome!
18 POSTED JULY 16TH, 2018 AT 12:49 PM Monique Tello, MD, MPHThanks Peter,
Yes, prevention is key, and I think the tide is turning on that. I will tell you
that as a physician, I recommend to people that they get their fiber from a health
diet rather than supplements, preferably.
19 POSTED JULY 16TH, 2018 AT 12:48 PM Monique Tello, MD, MPHThanks so
much and agree with all of your suggestions.
20 POSTED JULY 16TH, 2018 AT 12:47 PM Monique Tello, MD, MPHHi Walter,
Yes, there are no less than a gazillion research studies linking tobacco and cancer
with fairly accurate quantification of the risks. Check out the Cancer.gov website
(part of the National Institutes of Health) link below for some referenced
information:
21 https://www.cancer.gov/about-cancer/causes-
prevention/risk/tobacco/cessation-fact-sheet
22 POSTED JULY 16TH, 2018 AT 12:42 PM Monique Tello, MD, MPHHi Carl, I
can’t speak for these industries, but I can imagine which type of innovation would
be ore highly profitable over the long term.
23 POSTED JULY 16TH, 2018 AT 12:41 PM Monique Tello, MD, MPHThanks Jim, I
agree, prescribers really had no financial incentive. There was a huge push to
prescribe these based on erroneous ideas about the risks and benefits, many of
which were promoted by the pharmaceuticals industry, who had very clear (and large)
financial incentives.
24 POSTED JULY 16TH, 2018 AT 12:39 PM Monique Tello, MD, MPHHi Tom, Yes,
as reported: “Study investigators also calculated life expectancy by how many of
these five healthy habits people had. Just one healthy habit (and it didn’t matter
which one) … just one… extended life expectancy by two years in men and women. Not
surprisingly, the more healthy habits people had, the longer their lifespan.” All
of these results were statistically significant. There is a link to the actual
study at the bottom of the post, it’s very clearly written, take a look.
25 POSTED JULY 16TH, 2018 AT 12:37 PM Monique Tello, MD, MPHThanks
NutritionWHIT, appreciated! MT
26 POSTED JULY 16TH, 2018 AT 12:37 PM Monique Tello, MD, MPHThanks,
Peter, really appreciated! MT
27 POSTED JULY 16TH, 2018 AT 12:36 PM Monique Tello, MD, MPHI agree with
you that there is big industry interest in maintaining the current unhealthy
Western lifestyle, Azure. I also agree that certain pharmaceuticals manufacturers
profited off of the popularity of opioids. Not sure how you can state the same of
the prescribers, as I can’t see how there could have been a direct (or even
indirect) financial incentive.
28 POSTED JULY 12TH, 2018 AT 6:22 PM CarolynI agree with David (9th July
comment) with regard to diet. Whole grains can indeed have the effect of spiking
blood sugar (whole grain bread as just one example) and creating gut inflammation,
and therefore low-grade, sub-acute inflammation in general. This is the biggest
contributor to chronic disease that we are facing, long-term inflammation. The
standard food pyramid is, in my opinion, all wrong. I believe we should eat a more
Mediterranean diet, and minimise the grain-based carbohydrates, and the sugars.
Then we are considerably further down the track towards a healthy diet that
promotes longevity. Of course, all of the other factors mentioned are important as
well, but what we put into our mouths is probably the most important, given the
skyrocketing rates of obesity first world countries are facing, and now even asian
countries as well, who are well and truly catching up.
29 POSTED JULY 10TH, 2018 AT 7:23 PM JenVery clear informative article. My
only problem is her support a broad scale public policy that would tell people what
to eat. We are not a communist country. The United States is a republic – a
constitutional republic where people believe that they can govern themselves. The
notion that government should tell me what to eat is the absolute tyranny and tells
me that this doctor needs to have a lesson in civics as well the pitfalls of
scientism. I suspect she is thinking in terms of cost of care which is a
utilitarian Marxist approach to human life. I don’t know what happened to this
generation that they are so ignorant when it comes to Liberty and freedom versus
government encroachment and parenting.
30 POSTED JULY 10TH, 2018 AT 10:52 AM BobA very good read. I think you hit
the nail on the head and perhaps a few people’s fingers with your comments. USA has
about 5% of the world’s population yet issues about 50% of all medical
prescriptions worldwide. Common sense would tell us that the more people are well
the less the need for public health, medicines and health facilities. An inverse
relationship exists which implies an impressive health bill an indication of
sickness not wellness. Public health can only be realistically addressed by
governments acting in the public’s interest. The amount of money paid to political
parties by lobbyists is very tiny compared to the money paid by the health budget
and tax payer. Corporations need a cultural shift and to be aware of the growing
dissatisfaction by health advocates trying to protect the general public.
31 POSTED JULY 10TH, 2018 AT 1:23 AM SNot everyone can be in the “healthy
body weight”. each person has their own set point of weight. Some research shows
that what is called “overwieght” BMI is also OK. For an Obese Nation like the US,
setting the “normal” BMI as a goal is too much, and sends many people to dangerous
fad diets or straight to the fridge…
32 To have a better life style one should not focus on results like BMI,
but on the changes and the way to get them.
33 POSTED JULY 9TH, 2018 AT 9:58 PM Laxman GaddamwarAnother factor often
overlooked is the rampant use of artificial flavours synthesised in laboratories
and used to fool people with respect to the natural flavours derived from fresh
fruits and vegetables.
34 This fools the human olfactory system to devour more and probably is at
the heart of addictive eating patterns of unhealthy fast food.
35 POSTED JULY 9TH, 2018 AT 7:17 PM Frances Affandy0To which i would add
Good Night’s Sleep and Being Useful everyday
36 POSTED JULY 9TH, 2018 AT 6:18 PM JerryWhat role does nationality or
culture play? For example Norwegian ancestry versus Irish ancestry or Japanese
ancestry
37 POSTED JULY 9TH, 2018 AT 3:24 PM DavidI see you tout “whole grains”
over “processed foods” – don’t these have very similar blood sugar GI impacts and
thus spike blood sugar and inflammation?
38 POSTED JULY 9TH, 2018 AT 2:02 PM Brian C WhitakerUnder “moderate
alcohol intake” it doesn’t say if zero is bad or good (it’s outside the stated
range).
39 POSTED JULY 9TH, 2018 AT 1:50 PM Jon BlairWhat about the the recent
research that shows that even moderate drinking – such as one glass of beer or wine
per day – increases the risk of cancer?Is this research significant?
40 POSTED JULY 9TH, 2018 AT 1:47 PM AnnNewsflash from an 88 year old
female who looks 74 ! No one
41 believes my age, as I am mentally alert as well as physically well
42 For my age. I have no idea why I am so fortunate. Could it be
43 Genetic? Or life style ? Or perhaps nutrition? I even drive at night !
44 POSTED JULY 9TH, 2018 AT 1:28 PM Waris kaziThanks so much for this
article.
45 POSTED JULY 9TH, 2018 AT 1:20 PM PeterI got a degree in Health
Education in 1978 because it seemed obvious to me that “soon” lots of money and
health resources would go toward preventive health care. 40 years later, that still
hasn’t happened, as the article points out!
46 I feel good that during my life, I have been able to help with
preventive health care in a different way. I was able to help sell millions of
bottles of dietary fiber supplements, which do have a significant preventive health
benefit for people who use them.
47 POSTED JULY 9TH, 2018 AT 1:11 PM TCYes, spend money on prevention to
reduce money on treatment in the first place. And, can you legislate portion sizes?
It’s no secret that restaurants in America pride themselves on huge portions of
food and people scratch their heads at the insane obesity levels in America. The
American thinking of bigger and more is always better is just sending people to an
earlier grave and only big business seems to care more about protecting it’s right
vs politicians caring about the health of a nation. It’s not just the US though,
obviously. It’s a worldwide problem in many countries. America just seems to be the
front-runner. Well, that’s not something to be proud of as ‘title holder’.
48 POSTED JULY 9TH, 2018 AT 1:06 PM Walter FerineVery valuable . Is there
a study of the affects of smoking based on the number of years an individual had
smoked and the number of years that the individual had not smoked?
49 POSTED JULY 9TH, 2018 AT 12:57 PM CarlDoes that mean drug companies are
interested in finding cures or only therapies. Which is more profitable? I will let
you answer that question!
50 POSTED JULY 9TH, 2018 AT 12:54 PM Jim BrownMost of the opioids come
into the U.S. and are made in and shipped from China. They are ordered via the
internet. The opiod crisis isn’t just from physicians prescribing these drugs.
51 POSTED JULY 9TH, 2018 AT 12:45 PM TomThe article reports the lifespan
difference between those with all 5 habits versus none (14 years for women and 12
years for men). This sounds impressive, but what’s the difference between those at
the middle (3 good habits) versus those with all 5? How many years and is it even
statistically significant? Articles like these should focus on not only the most
dramatic headline number, but also the more realistic gains achievable by average
people making smaller improvements in their lifestyles.
52 POSTED JULY 9TH, 2018 AT 9:54 AM NutritionWHITThank you for putting
together this blog post. Very clear and concise information. Detailed statistics
ect. And yet not to long lol. Cheers,
53 -NutritionWhit
54 POSTED JULY 6TH, 2018 AT 8:13 PM PeterI wondered upon your blog and
wanted to say that I have really enjoyed reading your blog posts. Any way I’ll be
subscribing to your feed and I hope you post again soon.
55 POSTED JULY 6TH, 2018 AT 3:46 PM azureYou forgot the auto industry,
pesticide manufacturers, plastics manufacturers, BigPharma, and who knows what
other industry “sectors” that benefit from the mainstream US “lifestyle” including
addiction to a variety of substances. Greedy physicians bear some of the
responsibility as well, they’re the ones who have overprescribed opoids.
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