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Is obesity decreasing in the U.S.? Do women live longer than men? What are the U.S. Dietary Guidelines 2025? Does America have a healthy diet?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses recent findings on obesity trends in the U.S., upcoming 2025 U.S. Dietary Guidelines changes, the importance of a healthy diet and the need for health equity in dietary recommendations. Also covering Americans' healthspan lifespan gap and the implications of living longer with diseases. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea. This is going to be our last update with you until January 8. So let's get started. We have new information about obesity rates in the U.S. What do we need to know about that?
Garcia: Well, Todd, I think overall, it's good news. Findings published last Friday in the JAMA Health Forum showed that obesity dipped slightly in adults in the U.S. last year. And although it is a small decrease, it's really notable because it's the first time we've seen a decrease in these numbers in more than a decade. An author of the study said that the results were not uniform across demographic and geographic regions. And for example, the most significant decrease was seen in the South, particularly among women, and then adults age 66 to 75.
However, that certainly wasn't the case in every region. We also saw decreases among Black Americans, but increases among Asian Americans. According to the study authors, the decreases we are seeing may be due, at least in part, to the recent rise in GLP-1 weight loss drugs like Ozempic. It's notable, for example, that the South experienced the biggest decrease. And they also had the highest observed per capita uptake of GLP-1 weight loss drugs based on an analysis of insurance claims. Obviously, we're going to need more research before we can truly determine whether that is a connection or not.
Unger: Well, if that indeed turns out to be the case, that will be a very interesting tie to the decrease that you're seeing. Staying on the topic of weight loss drugs for a moment, there may soon be a new application for them. So what is that?
Garcia: Well, this is still early, but the CEO of Eli Lilly, which makes the weight loss treatment, Zepbound, has announced that the company will start studying its weight loss drugs as treatments for alcohol and drug addiction. Emerging research suggests that GLP-1 drugs like Zepbound not only reduce food cravings, but they also may suppress desires for other substances. Most of this to date has been anecdotal. And these therapies obviously have not yet specifically been tested for treatments for addiction. But this is certainly something that we'll continue to watch and report back on as we learn more.
Unger: Very interesting. Well, we'll stay tuned. Turning to another study released last week, we learned that Americans spend more time living with disease than the rest of the world. What does that mean, exactly? And is that a good or a bad finding?
Garcia: Well, I think technically, it's both. This study was published in JAMA last week. And it revealed that Americans live with diseases for an average of 12.4 years, which is longer than people in other countries. According to that study, mental and substance use disorders, as well as musculoskeletal diseases are the main contributors to the years lived with disability in the U.S. And what this study looked at is essentially what we call the healthspan-lifespan gap.
So your health span is how many years you live healthy. Your life span is how many years you live total. And the gap refers to how many years you live unhealthy, or with disease. So what we learned in this study is that the latest overall healthspan-lifespan gap in the U.S. marks an increase from 10.9 years in 2000 to 12.4 years in 2024, resulting in a 29% higher gap than the global mean. And then globally, the healthspan-lifespan gap has widened over the last 20 years, extending from 8.5 years back into 2000 to 9.6 years.
So a 13% increase. We're also seeing that women in the U.S. exhibited a 2.6-year higher healthspan-lifespan gap than men. According to the study's authors, the broad takeaway here is that while people may be living longer, they live a greater number of years burdened by disease.
Unger: I guess that gets back to the question we had before, which is whether that's good or bad, because we learned that it's not just disease burden, but as part of that, obviously, a lot of different things, including living with chronic pain. So tell us a little bit more about that aspect.
Garcia: Yeah, so it was reported by The Washington Post earlier this week, the CDC found that nearly a quarter of U.S. adults reported living with chronic pain in 2023. And according to the agency's reports, respondents said that they experienced chronic pain either most days, or every day. And nearly, 9% of adults had experienced high impact chronic pain in the previous three months, meaning that their pain frequently limited their life, or their work activities.
Unger: Ouch. That is very serious. And I'm curious if this particular thing affects all demographics equally, or do we see disparities there?
Garcia: Well, the report found that chronic pain and high-impact chronic pain increased with age, and that American, Indian and Alaska Native, non-Hispanic adults, were significantly more likely to have chronic pain than Asian non-Hispanic and Hispanic adults. Women were also more likely than men to suffer both chronic pain and high-impact chronic pain, as were those who were living in less urban areas.
I think we also can't forget that chronic pain like this, especially pain that restricts life or work activities, has other health impacts as well. For example, chronic pain is one of the most common reasons that adults seek medical care. It's associated with decreased quality of life, opioid misuse, increases in anxiety and depression, and unmet mental health needs as well. So this affects many issues. And it really needs more of a focus in the coming year.
Unger: And with that in mind, let's talk about the coming year. We're heading into the holidays now. And with New Year's right around the corner, people do start to think a little bit more about their health, especially New Year's resolutions, and things of that nature. As we know, so much of our health care can be influenced by what we eat. A group recently met to make recommendations for the 2025 U.S. dietary guidelines. Any surprises or big changes in there?
Garcia: Todd, I would say there were no real surprises. And as you mentioned, it was a panel of nutrition experts that was tasked with counseling the U.S. government about the 2025 edition of our dietary guidelines. And they published a report last week that was covered by many media outlets, including the Associated Press.
These guidelines were last updated in 2020. They're updated every five years. And these recommendations do now go to HHS and USDA, where officials will draft the final guidance, which is set for release next year. I think it's important for people to know that the public now has 60 days to comment on the guidance before these are finalized. And HHS and USDA officials will be holding a public meeting on January 16 to discuss these recommendations.
Unger: Wow, I'm really interested to see what those recommendations are. Can you give us kind of broad strokes background on, well, what we should be eating in the new year?
Garcia: Well, I think overall, the guidelines really reinforce what physicians and other experts have been saying for decades. A healthy diet for people aged two years and older is higher in vegetables, fruits, legumes, nuts, whole grains, fish and vegetable oils that are higher in unsaturated fat. And it's lower in red and processed meats, sugar, sweetened food and beverages, refined grains and saturated fat. It may include fat-free or low-fat dairy, and then foods that are lower in sodium.
They may also include plant-based foods. This was the first panel to really focus on the dietary needs of Americans through what they call a health equity lens. And AMA member, Dr. Fatima Cody Stanford, who's an obesity expert based at Mass General Hospital, was part of this group, and recently explained how the committee considered factors such as household income, race, ethnicity and culture, when recommending healthy diets. She said, this will help ensure that the guidance really reflects and includes various population groups.
Unger: So that's newly included. But there are a few other things that were notably left out. Tell us about those, and the rationale behind not including them in this report, or the guidelines in general.
Garcia: Well, these have been reported on quite a bit. One is ultra-processed foods. We continue to see headlines about how consuming these foods can impact our overall health, and even lead to certain diseases or conditions, including certain types of cancers. After reviewing the literature, the panel said that there's not enough evidence to tell people to avoid them completely. The second thing the group stayed away from was updating guidance on alcohol consumption. And instead, it's leaving that analysis to two outside reports that they are expecting to be released soon.
Unger: Very interesting. Well, given this, do you have any final thoughts on this, or other advice as we close out the year 2024?
Garcia: Well, I think no matter what is and isn't included in these guidelines, the advisory panel acknowledged that the larger issue here is that the diets of most Americans don't meet the current guidelines. More than half of all U.S. adults have one or more diet-related chronic health conditions. And we know that 18 million U.S. households face food insecurity, according to the report. This really circles back to what we've been talking about today. It's not only about living longer, but having those years be healthy.
I'd say the message is this. As we enter the holiday season, close out the year, it's a really good time for all of us to take stock, get your recommended vaccines to prevent illness, prevent others from getting sick, stay home if you don't feel well, prioritize sleep, get moving and make healthy food choices. We know that even small changes can have a really big impact.
Unger: Well, that's all good advice, as usual. And that wraps up this week's, and this year's, last episode with Andrea. Andrea, thanks so much for spending time with us in 2024. We look forward to speaking with you a lot more in 2025. And specifically, I will see you back here on January 8.
In the meantime, we wish you and everyone watching or listening a healthy and happy holiday. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. You can always find all our videos and podcasts that you can watch them over that holiday period. ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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