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Impact of Lifestyle on Health

Categories: Healthy Lifestyle

About this sample

Words: 766 |

Published: Jan 29, 2019

Words: 766 | Pages: 2 | 4 min read

Works Cited

Farhud, D. D. (2015). Impact of lifestyle on health. Iranian journal of public health, 44(11), 1442–1444.
World Health Organization. (2014). Noncommunicable diseases: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Gopinath, B., Hardy, L. L., Baur, L. A., Burlutsky, G., & Mitchell, P. (2011). Physical activity and sedentary behaviors and health-related quality of life in adolescents. Pediatrics, 128(6), e1493–e1500.
Knutson, K. L. (2010). Sleep duration and cardiometabolic risk: A review of the epidemiologic evidence. Best Practice & Research Clinical Endocrinology & Metabolism, 24(5), 731–743.
Richter, D., & Berger, K. (2016). Postmodern Health: Critical Perspectives and Issues. Routledge.
World Health Organization. (2021). Tobacco. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tobacco
McEwen, B. S., & Gianaros, P. J. (2010). Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Annals of the New York Academy of Sciences, 1186(1), 190–222.
Yazdani, S., Yaghoubi, A., & Mirzaei, M. (2017). Sleep quality and its relationship with lifestyle indices in patients with type 2 diabetes. The Scientific World Journal, 2017, 9805342.
Kandiah, J., Yake, M., & Jones, J. (2014). The relationship between dietary quality, serum vitamin D and depressive symptoms in an urban clinic. Journal of the American College of Nutrition, 33(6), 481–486.
Thompson, W. G., Foster, R. C., Eide, D. S., Levine, J. A., & Fealey, R. D. (2008). Sleep duration and body composition in a nationally representative sample of adults. Sleep, 31(9), 1317–1326.

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7 Positive Lifestyle Factors That Promote Good Health

How to Live Long and Well

You can't change your genes, or even much of the environment around you, but there are lifestyle choices you can make to boost your health. Being informed and intentional about diet, activity, sleep, and smoking can reduce your health risks and potentially add years to your life.

This article looks at seven lifestyle factors that are backed by the best evidence when it comes to your health over the long run. It shows you why they matter and how to begin making positive changes.

Getting the Right Amount of Sleep

Eva-Katalin / E+ / Getty Images

Getting the right amount of sleep, and doing so regularly, is first on the list. It's often missed because people focus on diet and exercise, but the link between sleep and life expectancy is supported by research.

What surprises some people is that the relationship is a U-shaped curve. This means that too little and too much sleep can affect your health. In one study, sleeping for a long duration (defined as more than 10 hours a night) was associated with psychiatric diseases and higher body mass index BMI.

Another study found that sleeping nine or more hours a night had an increased incidence of stroke of 23% compared to those sleeping seven to eight hours a night. Those who slept over nine hours and napped for 90 minutes or more had an 85% increased stroke risk.

A 2021 study of 1.1 million people in Europe and the United States found that 25% of people slept less than what is recommended for their ages. More than half of all teens don't get enough sleep. Adults do better but have more insomnia and poor sleep quality.

A good night's sleep is important to recharge both the body and mind. It helps the body repair cells and get rid of wastes. It also is important in making memories, and sleep deprivation leads to forgetfulness.

Even if you intend to sleep well, health issues can disrupt your plan. Sleep apnea , for example, can greatly increase health risks.

Sleep apnea affects millions of people, but it's believed that many cases are being missed. Part of the reason is that symptoms like snoring, or waking up gasping for air, don't happen in every case. Sleep apnea can present with a number of surprising signs and symptoms , such as teeth grinding and depression.

If you have any concerns, talk to your healthcare provider about a sleep study . There are treatments, like CPAP , that lower risk and improve quality of life. Changes in your sleep patterns can signal other health issues too, so see your healthcare provider for a checkup if anything changes.

Eating Well-Balanced Meals

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A healthy diet gives you energy and lowers your risk for heart disease, diabetes, cancer, and other diseases. Some of these conditions have proven links to food and nutrition, as is the case with red meat and colorectal cancer.

Taking steps toward a lifelong change in diet will help more than jumping on the latest fad diet does. You may have heard author Michael Pollan's signature phrase: "Eat food. Not too much. Mostly plants." Of those plants, choose a rainbow of colors to make sure you get all the nutrients you need.

One place to begin is with the well-regarded Mediterranean diet. It's rich in many of the healthiest foods and naturally limits less healthy choices. The more you follow the Mediterranean diet, the lower your risk of a host of diseases.

A 2018 review looked at over 12 million people and the risk of over a dozen chronic diseases. The researchers found that people who chose a Mediterranean diet lowered their risk of heart disease, stroke, cancer, and other diseases.

The Mediterranean diet includes a lot of fruits and vegetables, whole grains, "good" oils, and plenty of herbs and spices. It doesn't recommend highly processed foods, refined grains, or added sugar.

Making Time for Physical Activity

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Thirty minutes a day of physical activity protects heart health. It also lowers the amount of bone loss as you age, and with it the risk of osteoporosis . It's so important that a 2021 study of colon cancer survivors found that living in a "green" community that is friendly for exercise reduced the risk of death.

A 2017 review in Lancet found that people participating in moderate physical activity every day had a lower risk of heart disease and overall mortality, no matter what their income level.

Best of all, physical activity is a low-cost way to boost your health and even save you money. Sometimes your health may limit your exercise options, but you can keep moving by washing your windows, mowing your lawn, sweeping a sidewalk, and other basic tasks.

Once you are past age 65, you may benefit by adding balance and flexibility exercises, but keep moving too. Whether you dance, garden, swim, or go biking, choose moderate-intensity exercise that you know you'll enjoy.

Keeping a Healthy Body Weight

Shelly Strazis / UpperCut Images / Getty Images

Obesity is associated with a shorter lifespan and a higher risk of many diseases. The good news is that just being somewhat overweight does not reduce your longevity. In fact, for those over age 65, it's better to be on the high side of normal than the low side.

A 2018 study looked at body mass index (BMI) and mortality over a period of 24 years. A BMI considered between 19 and 24 is considered "normal" or healthy. For those who were in the range classified as obesity, a BMI of 30 to 35 meant a 27% increase in mortality. A BMI of 35 to 40 was linked to a 93% increase.

Among those with a BMI in the overweight range (BMI 25 to 30), mortality was only higher among those who smoked. People with a BMI on the high side of normal (BMI 24, for example) had the lowest death risks.

BMI is a dated, flawed measure. It does not take into account factors such as body composition , ethnicity, sex, race, and age. Even though it is a biased measure , BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

There isn't any real magic when it comes to keeping a healthy weight. Eating a nutritious diet and exercising daily are the true secrets for most people. If you're struggling, talk with your healthcare provider. But keep in mind that fad diets don't work, and your greatest hope for success lies in making long-term changes.

Avoiding Smoking or Chewing Tobacco

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Smoking accounts for some 480,000 deaths per year in the United States alone. Added to this are another 16 million people who are alive but coping with a smoking-related illness . If you want the chance to live well for however long you live, don't smoke or chew tobacco.

The list of diseases and cancers linked to smoking is long. If you're finding it hard to quit, and you think illness comes only later in life, it may help to think of more short-term goals. Perhaps it's too expensive, or indoor smoking bans limit your social outings.

Or maybe the midlife concerns will help you! Smoking speeds up wrinkling of the skin. There's also a link between smoking and erectile dysfunction in men. Quitting, or avoiding tobacco in the first place, will save lives but protect its quality too.

Limiting or Avoiding Alcohol

Dean Mitchell / E+ / Getty Images

Despite the hype over red wine and longevity , alcohol should be used only in moderation, and for many people, not at all. Red wine has been found to offer some protective health effects, but there are other ways to get these benefits.

Red wine is rich in flavonoids, particularly the nutrient resveratrol . Resveratrol, however, is also found in red grapes themselves, in red grape juice, and even peanuts.

Moderate alcohol consumption (one drink per day for women, two for men) may lower heart disease risk. Yet a link between alcohol and breast cancer suggests that even this amount should be used with caution.

Women who have three drinks per week have a 15% higher risk of breast cancer and the risk goes up another 10% for every additional drink they have each day.

It is important to note that alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. Group 1 is the highest-risk group, which also includes asbestos, radiation, and tobacco. Alcohol causes at least seven types of cancer. The more alcohol you drink, the higher your cancer risk.

Higher levels of alcohol can lead to health and other problems, including a greater risk for:

High blood pressure
Heart disease
Some cancers

Moderate intake of alcohol may be part of a healthy lifestyle in special moments, as long as you have no personal or family problems with alcohol abuse. As long as everyone understands the risks, there are times you may drink a toast to your good health!

Managing Mental Health

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, act, and relate to others.

Managing mental health includes factors such as managing stress and maintaining social connections. Research shows that people who report being happier live as much as four to 10 years longer than less happy people.

One way to increase happiness is to manage stress. Although we can't eliminate stress entirely, there are some ways to limit it:

Take time to unwind , such as doing deep breathing exercises, yoga, meditation, taking a bath, or reading a book. Schedule regular times for these and other healthy activities.
Take breaks from watching, reading, or listening to news and social media.
Practice gratitude by reminding yourself daily of things you are grateful for. Be specific. Write them down at night, or replay them in your mind.
Focus on the positive by identifying and challenging your negative and unhelpful thoughts.
Find a hobby. Research shows activities like gardening, singing, playing a musical instrument, and other hobbies are linked to living longer, healthier lives Hobbies may reduce stress and provide mental stimulation.

Research also shows that staying socially connected positively impacts health and longevity. Getting together regularly with friends or family members can provide emotional support and pleasure. Other ways to foster connection may include:

Connecting with community or faith-based groups
Volunteering with others
Joining a local group, such as a hiking club, knitting group, or other interest group

For a long, healthy life, the seven key lifestyle behaviors include getting enough sleep, eating a healthy diet, being physically active, maintaining a healthy body weight, not smoking, limiting alcohol, and managing mental health.

These factors may seem like a part of the common-sense advice, but there's a reason for that. They're all backed by data, and new medical research continues to point in the same healthy direction.

Frequently Asked Questions

To help strengthen your bones, try the following tips:

Eat foods that are good sources of calcium and vitamin D.
Get 30 minutes of exercise a day, especially weight-bearing and strength-building activities like walking, dancing, climbing stairs, and lifting weights.
Avoid smoking.
Prevent falls. Exercise may help you improve your balance. Also, remember to check for tripping hazards in your home.

Making healthy lifestyle choices can reduce your risk of high blood pressure, heart attack, and stroke. In a study of 55,000 people, those who made healthy lifestyle choices such as avoiding smoking, eating healthy, and exercising lowered their heart disease risk by about 50%.

The World Cancer Research Fund says at least 18% of cancers in the United States are related to preventable risk factors, including obesity, lack of exercise, poor nutrition, and drinking alcohol.

American College of Cardiology. Getting good sleep could add years to your life .

Léger D, Beck F, Richard JB, Sauvet F, Faraut B. The risks of sleeping “too much.” Survey of a national representative sample of 24671 adults (INPES health barometer) . PLOS ONE . 2014;9(9):e106950. doi:10.1371/journal.pone.0106950

Zhou L, Yu K, Yang L, et al. Sleep duration, midday napping, and sleep quality and incident stroke: the Dongfeng-Tongji cohort . Neurology . 2019;94(4):e345-e356. doi:10.1212/WNL.0000000000008739

Kocevska D, Lysen TS, Dotinga A, et al. Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis . Nat Hum Behav . 2021;5(1):113-122. doi: 10.1038/s41562-020-00965-x

National Institute of Neurological Disorders and Stroke. Sleep apnea information page.

Gurjao C, Zhong R, Haruki K, et al. Discovery and features of an alkylating signature in colorectal cancer . Cancer Discov . candisc;2159-8290.CD-20-1656v2. doi: 10.1158/2159-8290.cd-20-1656

Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomized trials. Eur J Clin Nutr . 2018;72(1):30-43. doi:10.1038/ejcn.2017.58

Wiese D, Stroup AM, Maiti A, et al. Measuring neighborhood landscapes: associations between a neighborhood’s landscape characteristics and colon cancer survival . IJERPH . 2021;18(9):4728. doi: 10.3390/ijerph18094728

Lear, S., Hu, W., Rangarajan, S. et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study . Lancet. 2017. 390(10113):2643-2654. doi:10.1016/S0140-6736(17)31634-3

Xu H, Cupples LA, Stokes A, Liu CT. Association of obesity with mortality over 24 years of weight history: findings from the Framingham Heart Study. JAMA Netw Open . 2018;1(7):e184587. doi:10.1001/jamanetworkopen.2018.4587

Centers for Disease Control and Prevention. Tobacco-related mortality .

Centers for Disease Control and Prevention. Health effects of smoking .

Breastcancer.org. Drinking alcohol.

World Health Organization. No level of alcohol consumption is safe for our health .

Centers for Disease Control and Prevention. Alcohol and cancer .

Centers for Disease Control and Prevention. Alcohol use and your health .

National Institute of Mental Health. Caring for your mental health .

Diener E, Chan MY. Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity . Social Science Research Network; 2013.

Evans GF, Soliman EZ. Happier countries, longer lives: an ecological study on the relationship between subjective sense of well-being and life expectancy . Glob Health Promot. 2019 Jun;26(2):36-40. doi: 10.1177/1757975917714035

Soga M, Gaston KJ, Yamaura Y. Gardening is beneficial for health: A meta-analysis . Prev Med Rep. 2016 Nov 14;5:92-99. doi: 10.1016/j.pmedr.2016.11.007

McCrary JM, Altenmüller E, Kretschmer C, et al. Association of music interventions with health-related quality of life: a systematic review and meta-analysis . JAMA Netw Open. 2022;5(3):e223236. doi: 10.1001/jamanetworkopen.2022.3236

Tomioka K, Kurumatani N, Hosoi H. Relationship of Having Hobbies and a Purpose in Life With Mortality, Activities of Daily Living, and Instrumental Activities of Daily Living Among Community-Dwelling Elderly Adults . J Epidemiol. 2016 Jul 5;26(7):361-70. doi: 10.2188/jea.JE20150153

Holt-Lunstad J. Why Social Relationships Are Important for Physical Health: A Systems Approach to Understanding and Modifying Risk and Protection . Annu Rev Psychol. 2018 Jan 4;69:437-458. doi: 10.1146/annurev-psych-122216-011902

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Bone health for life: Health information basics for you and your family .

Harvard Health Publishing. Lifestyle changes to lower heart disease risk .

American Cancer Society. Diet and physical activity: What's the cancer connection?

Chaput J-P, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep . 2018;10:421-430.

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By Kirsti A. Dyer MD, MS, FT Kirsti A. Dyer, MD, MS, FT, is a board-certified expert in grief and bereavement, and an associate adjunct professor in hospice and palliative studies.

Essay on Effects Of Modern Lifestyle On Health

Students are often asked to write an essay on Effects Of Modern Lifestyle On Health in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Effects Of Modern Lifestyle On Health

Introduction.

Modern lifestyle has brought many changes to our lives. It’s made things easier and faster, but it’s also had a big impact on our health. We’re less active, eat more processed food, and spend a lot of time in front of screens. This has led to a rise in health problems like obesity, heart disease, and mental health issues.

Physical Health Impact

One of the main health issues caused by the modern lifestyle is physical inactivity. Many of us spend hours sitting at desks or in front of TVs. This lack of movement can lead to weight gain and other health problems like diabetes and heart disease.

Diet and Health

Our diet has also changed a lot. We eat more processed foods that are high in sugar and fat. This can lead to obesity and other health problems. Plus, these foods often lack the nutrients we need to stay healthy. This can lead to deficiencies that can cause other health issues.

Mental Health Concerns

The modern lifestyle can also affect our mental health. The constant use of technology can lead to feelings of isolation and anxiety. Plus, the pressure to be always ‘on’ and available can lead to stress and burnout.

In conclusion, while the modern lifestyle has many benefits, it also has a significant impact on our health. It’s important for us to find a balance, to stay active, eat a balanced diet, and take time to disconnect from technology.

250 Words Essay on Effects Of Modern Lifestyle On Health

Modern life is full of comfort but it also brings along different health problems. Today’s lifestyle is very different from the way people lived in the past. Most people these days lead sedentary lives due to their work, and this has a huge impact on their health.

Unhealthy Eating Habits

One of the major effects of modern lifestyle on health is seen in eating habits. People tend to eat more fast food and processed foods because they are easy to prepare and consume. These foods are often high in sugar, salt, and unhealthy fats, leading to problems like obesity, heart disease, and diabetes.

Lack of Physical Activity

Modern lifestyle often involves less physical activity. Many people spend hours sitting at desks or in front of screens. This lack of movement can lead to weight gain, weak muscles, and poor posture. It can also increase the risk of various health issues like heart disease and diabetes.

Stress and Mental Health

Modern life can be very stressful. The pressure to succeed, long work hours, and less time for relaxation can lead to mental health problems. Stress can cause headaches, sleep problems, and even more serious conditions like depression and anxiety.

In conclusion, the modern lifestyle can have a negative effect on our health. It’s important to make healthy choices, like eating nutritious food, exercising regularly, and managing stress. By doing so, we can lead a healthier and happier life. It is important to remember that our health is our wealth and we should take care of it.

500 Words Essay on Effects Of Modern Lifestyle On Health

Modern lifestyle has brought many changes to our lives. These changes have made our lives easier in many ways. We have new technologies, new ways of working, and new ways of spending our free time. But, these changes also have a big impact on our health. In this essay, we will talk about how our modern lifestyle affects our health.

Physical Health

One of the biggest effects of modern lifestyle on health is on our physical health. In the past, people used to do a lot of physical work. They used to walk or cycle to work, do household chores by hand, and play outdoor games for fun. But now, we spend a lot of time sitting. We sit at our desks at work, sit in front of the TV at home, and even sit while traveling in cars or buses. This lack of physical activity can lead to health problems like obesity, heart disease, and diabetes.

Mental Health

Our modern lifestyle also affects our mental health. We live in a fast-paced world where we are always busy. We have to meet deadlines at work, manage our homes, and take care of our families. All this stress can lead to mental health problems like anxiety and depression. We also spend a lot of time on our phones and computers, which can make us feel isolated and lonely.

The food we eat is another area where our modern lifestyle affects our health. Fast food and processed food have become a big part of our diet. These foods are easy to get and save us time, but they are not good for our health. They are high in sugar, salt, and unhealthy fats, which can lead to health problems like high blood pressure, cholesterol, and diabetes.

Finally, our modern lifestyle affects our sleep. We stay up late watching TV or using our phones and wake up early for work or school. This lack of sleep can lead to health problems like tiredness, lack of concentration, and even serious conditions like heart disease and stroke.

In conclusion, our modern lifestyle has many effects on our health. It can lead to physical health problems like obesity and heart disease, mental health problems like anxiety and depression, poor nutrition, and lack of sleep. It is important for us to be aware of these effects and try to make changes to our lifestyle for better health. For example, we can try to be more active, eat healthier foods, manage our stress, and get enough sleep. By making these changes, we can enjoy the benefits of our modern lifestyle without harming our health.

That’s it! I hope the essay helped you.

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Essay on Healthy Lifestyle

The top secret of being physically fit is adopting a healthy lifestyle. A healthy lifestyle includes regular exercise, a healthy diet, taking good care of self, healthy sleep habits, and having a physically active daily routine. Lifestyle is the most prevailing factor that affects one’s fitness level. A person leading a sedentary lifestyle has a low fitness level whereas living a healthier life not only makes a person fit but also extends life. Good health has a direct impact on our personality. A person with a good and healthy lifestyle is generally more confident, self-assured, sociable, and energetic.

A good and healthy lifestyle allows one to relish and savor all the pleasures in life without any complications. Even all the wealth is less valuable when compared to sound health. Having all the luxuries in the world does not fulfill its purpose when one is continuously ill, depressed, or suffering from a significant health complication. A healthy person has a clear and calm perception of everything without prejudice. His actions and decisions are more practical and logical and are hence more successful in life.

A good habit is a key factor for a healthy lifestyle. To maintain a stable body and mind, one needs to inculcate good habits. Waking up early in the morning, regularly exercising or a good morning walk helps to keep our body energetic and refresh our mind. Maintaining a balanced and nutritious diet throughout the day is vital for maintaining a good lifestyle. Too much indulgence in alcohol or smoking excessively is not at all appropriate for a healthy lifestyle.

Self-Discipline

Self-discipline is important for maintaining a good lifestyle. When we are self-disciplined then we are more organized and regular in maintaining good health. A disciplined life is a regulated life. A man without discipline is a ship without a rudder. Discipline needs self-control. One who cannot control himself can seldom control others. The level of discipline and perseverance largely determines a person’s success. Self-discipline is the act of disciplining one’s own feelings, desires, etc. especially with the intention of improving oneself. It strengthens our willpower. The stronger our will power the positive will be our decision. It enables us to conquer our own self.

Punctuality

Punctuality is the habit of doing things on time. It is the characteristic of every successful person and everyone must observe punctuality in order to win success in life. Punctuality is necessary for maintaining a healthy lifestyle. It should become a habit with us. A punctual person is able to fulfill all his responsibilities and hence is treated with respect in society. It is needed in every walk of life.

Diet is an important component for overall fitness and works best in combination with exercise. A balanced diet and exercise regularly help to maintain good health. It is necessary to reduce weight if one is overweight or obese, failing which one cannot be physically fit for long. For people with obesity, more exercise and a strict regime are necessary, preferably under guidance. There are many ways of making the diet healthier.

Use less sugar and salt while cooking food.

Use less oil while cooking. Avoid deep-frying as much as possible.

Eat more fruits daily. They provide more vitamins and minerals to our bodies.

Add sprouts of gram and moong dal to at least one meal in a day. Add fiber to your diet. Use whole grains instead of polished cereals. Eat lots of salad and yogurt.

Eat fermented food regularly. Fermented food contains many useful bacteria that help in the process of digestion.

Prevention of Lifestyle Diseases

By adopting a healthy lifestyle one can avoid lifestyle diseases. The following are some ways in which we can prevent lifestyle diseases.

Eat a balanced diet that contains important nutrients. One must include more fresh fruits and green vegetables in the diet. Refrain from eating junk food. Stay away from foods that contain large amounts of salt or sugar.

Exercise regularly. Spend more time outdoors and do activities such as walking, running, swimming, and cycling.

One must avoid overindulgence in alcohol, junk food, smoking, and addiction to drugs and medicines.

Avoid spending too much on modern gadgets like mobile phones, laptops, televisions, etc. Spend time on these gadgets for short intervals of time only.

Set a healthy sleeping routine for every day. Waking early in the morning and going to bed early at night should be a daily habit. Lead an active life.

Unhealthy Lifestyle

Bad food habits and an unhealthy lifestyle such as less or no physical activity may lead to several diseases like obesity, high blood pressure or hypertension, diabetes, anemia, and various heart diseases. An unhealthy lifestyle reduces productivity and creativity in a person. It also adversely affects moods and relationships. It leads to depression and anxiety in human beings.

Maintaining a healthy lifestyle not only makes a person confident and productive but also drives him to success. A person with a healthy lifestyle will enjoy both personal and social life.

FAQs on Healthy Lifestyle Essay

What Do You Understand about a Healthy Lifestyle?

A healthy lifestyle is a lifestyle that includes regular exercise, a healthy diet, taking good care of self, healthy sleep habits and having a physically active daily routine.

How is Punctuality Important for Maintaining a Healthy Lifestyle?

Punctuality is the habit of doing things on time. It is the characteristic of every successful person and everyone must observe punctuality in order to win success in life. It should become a habit with us. A punctual person is able to fulfil all his responsibilities and hence is treated with respect in society. It is needed in every walk of life.

What Happens When One Does Not Maintain a Healthy Lifestyle?

When one does not maintain a healthy lifestyle then several diseases like obesity, high blood pressure or hypertension, diabetes, anaemia and various heart diseases can occur. An unhealthy lifestyle reduces productivity and creativity in a person. It also adversely affects moods and relationships. It leads to depression and anxiety in human beings.

What are the Main Factors that Determine a Good and Healthy Lifestyle?

In order to maintain a good and healthy lifestyle, one must be self-disciplined, self-motivated, maintain punctuality and have good habits like waking early in the morning and maintain a regular fitness regime and a balanced and nutritious diet.

Is writing an essay hard?

Essay writing is a difficult task that needs a great deal of study, time, and focus. It's also an assignment that you can divide down into manageable chunks such as introduction, main content, and conclusion. Breaking down and focusing on each individually makes essay writing more pleasant. It's natural for students to be concerned about writing an essay. It's one of the most difficult tasks to do, especially for people who aren't confident in their writing abilities. While writing a decent essay is difficult, the secret to being proficient at it is reading a lot of books, conducting extensive research on essential topics, and practicing essay writing diligently.

Why is it important for one to aspire to have a healthy lifestyle?

A healthy lifestyle is an important way for reducing the occurrence and impact of health problems, as well as for recovery, coping with life stressors, and improving the overall quality of life. An increasing collection of scientific data suggests that our habits have a significant impact on our health. Everything we eat and drink, as well as how much exercise we get and whether we smoke or use drugs, has an impact on our health, not just in terms of life expectancy but also in terms of how long we may expect to live without developing chronic illness. A large proportion of fatalities are caused by conditions such as heart attacks, stroke, diabetes, joint disease, and mental illness. A healthy lifestyle can help to avoid or at least delay the onset of many health issues.

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What constitutes a healthy lifestyle?

Healthy life is built on the pillars of a good diet, frequent exercise, and appropriate sleep. A healthy lifestyle keeps people in excellent shape, it also gives you more energy throughout the day, and lowers your chance of developing many diet-related chronic diseases. Healthy living is considered a lifestyle choice that allows you to enjoy more elements of your life. Taking care of one's physical, emotional, and spiritual well-being is part of living a healthy lifestyle.

Good Nutrition, Eating Right and proper diet.

Getting Physically Fit, Beneficial Exercise and working out often.

Adequate rest and uninterrupted sleep.

Proper Stress Management.

Self-Supportive Attitudes.

Positive Thoughts are encouraged.

Positive Self-Image and body image.

Inner Calmness and peace.

Openness to Your Creativity and Self-care.

Trust in Your Inner Knowing and your gut feeling.

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What stage of change are you in?

Contemplation: are you thinking of making changes, preparation: have you made up your mind, action: have you started to make changes, maintenance: have you created a new routine, clinical trials.

Are you thinking about being more active? Have you been trying to cut back on less healthy foods? Are you starting to eat better and move more but having a hard time sticking with these changes?

Old habits die hard. Changing your habits is a process that involves several stages. Sometimes it takes a while before changes become new habits. And, you may face roadblocks along the way.

Adopting new, healthier habits may protect you from serious health problems like obesity and diabetes . New habits, like healthy eating and regular physical activity, may also help you manage your weight and have more energy. After a while, if you stick with these changes, they may become part of your daily routine.

An older couple biking in the countryside, wearing helmets.

The information below outlines four stages you may go through when changing your health habits or behavior. You will also find tips to help you improve your eating, physical activity habits, and overall health. The four stages of changing a health behavior are

contemplation
preparation
maintenance

Contemplation: “I’m thinking about it.”

In this first stage, you are thinking about change and becoming motivated to get started.

You might be in this stage if you

have been considering change but are not quite ready to start
believe that your health, energy level, or overall well-being will improve if you develop new habits
are not sure how you will overcome the roadblocks that may keep you from starting to change

Preparation: “I have made up my mind to take action.”

In this next stage, you are making plans and thinking of specific ideas that will work for you.

have decided that you are going to change and are ready to take action
have set some specific goals that you would like to meet
are getting ready to put your plan into action

Action: “I have started to make changes.”

In this third stage, you are acting on your plan and making the changes you set out to achieve.

have been making eating, physical activity, and other behavior changes in the last 6 months or so
are adjusting to how it feels to eat healthier, be more active, and make other changes such as getting more sleep or reducing screen time
have been trying to overcome things that sometimes block your success

Maintenance: “I have a new routine.”

In this final stage, you have become used to your changes and have kept them up for more than 6 months.

You might be in this stage if

your changes have become a normal part of your routine
you have found creative ways to stick with your routine
you have had slip-ups and setbacks but have been able to get past them and make progress

Did you find your stage of change? Read on for ideas about what you can do next.

Making the leap from thinking about change to taking action can be hard and may take time. Asking yourself about the pros (benefits) and cons (things that get in the way) of changing your habits may be helpful. How would life be better if you made some changes?

Think about how the benefits of healthy eating or regular physical activity might relate to your overall health. For example, suppose your blood glucose, also called blood sugar, is a bit high and you have a parent, brother, or sister who has type 2 diabetes . This means you also may develop type 2 diabetes. You may find that it is easier to be physically active and eat healthy knowing that it may help control blood glucose and protect you from a serious disease.

Woman with her hand on her chin thinking about making changes in her habits.

You may learn more about the benefits of changing your eating and physical activity habits from a health care professional. This knowledge may help you take action.

Look at the lists of pros and cons below. Find the items you believe are true for you. Think about factors that are important to you.

Healthy Eating

Physical activity.

If you are in the preparation stage, you are about to take action. To get started, look at your list of pros and cons. How can you make a plan and act on it?

The chart below lists common roadblocks you may face and possible solutions to overcome roadblocks as you begin to change your habits. Think about these things as you make your plan.

Once you have made up your mind to change your habits, make a plan and set goals for taking action. Here are some ideas for making your plan:

learn more about healthy eating and food portions
learn more about being physically active
healthy foods that you like or may need to eat more of—or more often
foods you love that you may need to eat less often
things you could do to be more physically active
fun activities you like and could do more often, such as dancing

After making your plan, start setting goals for putting your plan into action. Start with small changes. For example, “I’m going to walk for 10 minutes, three times a week.” What is the one step you can take right away?

You are making real changes to your lifestyle, which is fantastic! To stick with your new habits

review your plan
look at the goals you set and how well you are meeting them
overcome roadblocks by planning ahead for setbacks
reward yourself for your hard work

Track your progress

Tracking your progress helps you spot your strengths, find areas where you can improve, and stay on course. Record not only what you did, but how you felt while doing it—your feelings can play a role in making your new habits stick.
Recording your progress may help you stay focused and catch setbacks in meeting your goals. Remember that a setback does not mean you have failed. All of us experience setbacks. The key is to get back on track as soon as you can.
You can track your progress with online tools such as the NIH Body Weight Planner . The NIH Body Weight Planner lets you tailor your calorie and physical activity plans to reach your personal goals within a specific time period.

Overcome roadblocks

Remind yourself why you want to be healthier. Perhaps you want the energy to play with your nieces and nephews or to be able to carry your own grocery bags. Recall your reasons for making changes when slip-ups occur. Decide to take the first step to get back on track.
Problem-solve to “outsmart” roadblocks. For example, plan to walk indoors, such as at a mall, on days when bad weather keeps you from walking outside.
Ask a friend or family member for help when you need it, and always try to plan ahead. For example, if you know that you will not have time to be physically active after work, go walking with a coworker at lunch or start your day with an exercise video.

Reward yourself

After reaching a goal or milestone, allow for a nonfood reward such as new workout gear or a new workout device. Also consider posting a message on social media to share your success with friends and family.
Choose rewards carefully. Although you should be proud of your progress, keep in mind that a high-calorie treat or a day off from your activity routine are not the best rewards to keep you healthy.
Pat yourself on the back. When negative thoughts creep in, remind yourself how much good you are doing for your health by moving more and eating healthier.

Make your future a healthy one. Remember that eating healthy, getting regular physical activity, and other healthy habits are lifelong behaviors, not one-time events. Always keep an eye on your efforts and seek ways to deal with the planned and unplanned changes in life.

Now that healthy eating and regular physical activity are part of your routine, keep things interesting, avoid slip-ups, and find ways to cope with what life throws at you.

Add variety and stay motivated

Mix up your routine with new physical activities and goals, physical activity buddies, foods, recipes, and rewards.

Deal with unexpected setbacks

Plan ahead to avoid setbacks. For example, find other ways to be active in case of bad weather, injury, or other issues that arise. Think of ways to eat healthy when traveling or dining out, like packing healthy snacks while on the road or sharing an entrée with a friend in a restaurant.
If you do have a setback, don’t give up. Setbacks happen to everyone. Regroup and focus on meeting your goals again as soon as you can.

Challenge yourself!

Revisit your goals and think of ways to expand them. For example, if you are comfortable walking 5 days a week, consider adding strength training twice a week. If you have limited your saturated fat intake by eating less fried foods, try cutting back on added sugars, too. Small changes can lead to healthy habits worth keeping.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov .

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank: Dr. Carla Miller, Associate Professor, Ohio State University

Open access
Published: 25 June 2021

Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands

Esther T. van der Werf 1 , 2 ,
Martine Busch 2 , 3 ,
Miek C. Jong 4 , 5 &
H. J. Rogier Hoenders 2 , 6

BMC Public Health volume 21 , Article number: 1226 ( 2021 ) Cite this article

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During the Covid-19 pandemic the Dutch government implemented its so-called ‘intelligent lockdown’ in which people were urged to leave their homes as little as possible and work from home. This life changing event may have caused changes in lifestyle behaviour, an important factor in the onset and course of diseases. The overarching aim of this study is to determine life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands.

Life-style related changes were studied among a random representative sample of the adult population in the Netherlands using an online survey conducted from 22 to 27 May 2020. Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle related measures, anxiety, and need for support to maintain lifestyle changes.

1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively associated with the variables ‘Worried/Anxious getting COVID-19’ (OR: 1.56, 95% C.I. 1.26–1.93), ‘CAM use’ (OR: 2.04, 95% C.I. 1.38–3.02) and ‘stress in relation to financial situation’ (OR: 1.89, 95% C.I. 1.30–2.74). ‘Age’ (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), ‘stress in relation to health’ (OR: 2.52, 95% C.I. 1.64–3.86) and ‘stress in relation to the balance work and home’ (OR: 1.69, 95% C.I. 1.11–2.57) were found predicting the change into an unhealthier direction.

These findings suggest that the coronavirus crisis resulted in a healthier lifestyle in one part and, to a lesser extent, in an unhealthier lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioural change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19.

Peer Review reports

The rapid spread of COVID-19 to nearly all parts of the world has posed enormous health, economic, environmental and social challenges worldwide. In the absence of effective drugs or vaccines, social distancing, surgical masks, washing hands and other preventive measures are presented as the only ways to fight the (spread of the) virus. Lockdown is among one of the options suggested by WHO to reduce spread of the virus. Although underreported, preventative strategies such as a healthy lifestyle seem important alternative avenues to fight (the spread of) COVID-19. From a public health perspective, these strategies are very important to consider. Between February 2020 and 1st of June 2021 1.651.780 positive cases and 17,632 deaths has been registered in The Netherlands [ 1 ]. As a response to COVID-19, many countries are using a combination of containment and mitigation activities with the intention of delaying major surges of patients and levelling the demand for hospital beds, while protecting the most vulnerable from infection, including elderly people and those with comorbidities [ 2 ]. In the Netherlands, a so-called “intelligent lockdown” was enforced on 15th of March 2020, with easing of restrictions per 1st of July 2020 [ 3 ]. With the intelligent lockdown, the Dutch Government appealed to the responsibility and self-discipline of citizens to practice 1.5 m social distance, and to maintain home isolation when showing COVID-19-related symptoms. Over the course of several weeks in March and April 2020, additional measures were taken to restrict the further spread of the coronavirus in the Netherlands. These measures included closure of schools, restaurants, certain beaches and parks, and prohibition of spontaneous group gatherings in public spaces.

Due to this intelligent lockdown, a sudden and radical change occurred in the lives and habits of the Dutch population. Life experiences that may greatly influence an individual’s daily routine are referred to as life changing events [ 4 ], defined as “those occurrences, including social, psychological and environmental, which require an adjustment or effect a change in an individual’s pattern of living.” Life changing events may influence lifestyle behaviours for better or worse [ 5 , 6 ]. For instance, Engberg et al. showed that transition to university, having a child, remarriage and mass urban disasters were associated with decreased physical activity levels, while retirement was associated with increased physical activity [ 7 ]. Stressful life events have been correlated with excessive alcohol consumption and alcohol dependence and emotional eating [ 8 ].

Maintaining a healthy nutrition status and level of certain exercise is crucial, especially in a period when the immune system might need to fight back. In fact, subjects with (severe) obesity (BMI ≥ 30 kg/m2) are one of the groups with a higher risk for COVID-19 complications [ 9 , 10 ]. Therefore, losing weight may be one of the strategies to lower the risk of severe illness from COVID-19. Worldwide, authorities and healthcare professional’s recommendations on how to stay healthy during the COVID-19 pandemic, besides taking appropriate hygiene measures, are related to healthy life-style measures such as assuring sufficient sleep, eat plenty of fresh fruits and vegetables, reduce stress and social isolation and stay active [ 11 , 12 ].

The COVID-19 pandemic might motivate people to make healthier choices and adopt a healthier lifestyle. Conversely, COVID-19 control measures such as social distancing and compulsory home isolation can be expected to increase sedentary behaviour and might cause an unhealthy eating and sleeping pattern. For example, the interruption of the daily (work) routine caused by the staying at home (which includes digital-education, working from home, and limitation of outdoors and in-gym physical activity) could result in boredom, which in turn is associated with a greater energy intake [ 13 ]. In addition, hearing or reading continuously about the COVID-19 pandemic and its possible impact from media can be stressful. Stress leads individuals toward overeating, especially ‘comfort foods’ or inactivity [ 14 ]. For future actions it is important to determine the lifestyle changes taken during this COVID-19 pandemic, and what support will be needed to (dis) continue this health behaviour in a post-COVID-19 era.

Previous studies show that Complementary and Alternative Medicine (CAM) users have on average a healthier lifestyle behaviour than non-CAM users, and overall a stronger focus on wellness [ 15 , 16 , 17 , 18 ]. In general, CAM is defined as a group of diverse medical and health care symptoms, practices and products that are not generally considered part of conventional medicine [ 19 ]. Nahin et al. found based on a survey among the US population that engaging in leisure-time physical activity, having consumed alcohol in one’s life but not being a current heavy drinker, and being a former smoker are independently associated with the use of CAM [ 16 ]. Interestingly, reported significantly better health status and healthier behaviours overall (higher rates of physical activity and lower rates of obesity) seems more prominent in adults using CAM for health promotion than those who use CAM as treatment [ 15 ]. The relation between CAM use and lifestyle needs further investigation in various populations.

The overarching aim of this reported study is to investigate life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands. Within this aim the following objectives has been framed: i) To determine life-style related changes (healtier/unhealthier) during the first wave of the COVID-19 pandemic; (ii) To identify the (sociodemographic) factors independently associated with changes into lifestyle (healthy/unhealthy); (iii) To explore possible differences in COVID-19-related lifestyle changes between CAM users and non-CAM users, and (iv) To determine the intention to continue lifestyle changes and the required support.

An international cross-sectional survey on CAM use and self-care strategies for prevention and treatment of COVID-19 related symptoms was carried out in Norway, Sweden and the Netherlands in spring 2020. The results of this international survey will be published elsewhere. This online survey consisted of a modified version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q) [ 20 ], and a country specific part on lifestyle for The Netherlands (it is the latter on which this paper reports). The modified I-CAM-Q consisted of four parts, and all parts related to CAM use during the past three COVID-19 pandemic months as did the Dutch part on lifestyle.

The modified I-CAM-Q included questions about visits to conventional and unconventional health care providers, self-management strategies such as use of natural remedies and self-help techniques such as mindfulness used within the last three months. The questions regarding specific therapies were adapted to The Netherlands ( supplementary material ).

The country specific part for the Netherlands included 26 questions divided into three sections on 1) current lifestyle related measures (alcohol use, smoking, daily consumption of certain foods, exercise, sleep, stress and meaning and purpose/spirituality), 2) lifestyle related changes since the COVID-19 outbreak and anxiety (section 1 and 2: 20 questions) and 3) intention to continue lifestyle changes and need for support (6 questions). For this study, we included six aspects of lifestyle with established effects on physical and mental health: nutrition, exercise, sleep, addiction, relaxation and meaning and purpose/spirituality.

In the Netherlands, an online survey was performed between May 22 and May 27, 2020 in collaboration with Ipsos Netherlands. An internal Ipsos tool (ISS) has been used to gather the respondents. The respondents registered into the IIS panel have shared their baseline information such as age,gender, region, and more specific information on education, income and work. From the panel of 45,000 Dutch residents, a representative sample (based on the baseline parameters) was invited to complete the questionnaire until 1000 responses were received (limit set due to costs). Individuals who were reached and refused participation ( n = 3607) were considered non-respondents, leading to a response rate of 22%. The final sample contained 1004 individuals.

Taking into account multiple response biases, the questionnaire was designed as followed: 1) answer options were randomized. Meaning every participant will see the same answer options, but in different order, preventing primacy bias (to decrease the amount of times one answer can be chosen which might lead to survey results being too unfairly weighted towards one option), and 2) questions were formulated in a neutral way when asked about education level, salary, age and gender to prevent prestige/stereotype bias as much as possible. Respondents received a personal link (password/username) to prevent filling in the questionnaire more than one time or any self-selection bias would happen.

Demographic characteristics collected were gender, age, municipality of residence and county, income, and level of education. Income was classified as high (Euro 75,000 >), middle (Euro 25,000 – 74,999) and low income (< Euro 24,999). Education was classified as higher education ((applied) university/ post-doctoral level), secondary education (middle and higher secondary education) and lower education (no school/primary school only/lower secondary education).

All data was anonymously collected and reported. The anonymous nature of the web-survey did not allow to trace in any way sensitive personal data. The study protocol was reviewed by the Medical Ethical Reviewing Committee of Wageningen University. They decided that this study did not fall within the remit of the Dutch Medical Research Involving Human Subjects Act (WMO), and therefore was exempt from further medical ethical review. Informed consent was obtained from all participants and all patients agreed their data to be used for scientific publication. GDPR guidelines were taken into account [ 21 ]. Once completed, each questionnaire was transmitted to the survey platform, and the final database was downloaded.

The current paper reports on the country specific part of the survey using data of the I-CAM-Q, only to categorize users and non-users of CAM. Here, CAM use is defined as all treatments and (self) care strategies that are used in addition or as an alternative to the usual (regular) care of e.g. general practitioner, specialist, dietician, physiotherapist or nurse in the past 3 months.

Statistical analyses

Descriptive statistics like measures of central tendencies, frequencies and proportions were used to evaluate the responses. Data are represented as number and/or percentage for categorical variables or mean and standard deviation for continuous variables. Pearson’s Chi-square test and ANOVA tests were performed to identify differences in socio-demographics (age, education level, household income), as well as to identify differences in lifestyle/lifestyle changes between users and non-users of CAM.

Univariable and multivariable logistic regression was used to identify the (sociodemographic) factors independently associated with changes in lifestyle (healthy/unhealthy). Outcomes on changes in lifestyle questions were dichotomized. Change in lifestyle due to corona crisis: answer categories: Yes, I live healthier, Yes, I live unhealthier and No. Multivariable models were derived through several iterations using backward stepwise logistic regression, including all variables that were statistically significant in the univariable analyses. The authors controlled for age, gender and education in these models.

Statistics were carried out using Statistical Package for Social Sciences (SPSS) v. 26.0. Results were statistically significant for p value < 0.05.

A total of 1013 individuals completed the online questionnaire, and, after validation of the data, 1004 respondents (age 18–88 years) were included in the study. As shown in Table 1 , most respondents were between 50 to 69 years of age (37.5%), and female respondents represented 50.7% of the population sample. Respondents were distributed across the 12 provinces, with 27.3% from the northern regions of the Netherlands, 27.6% from the central regions of the Netherlands and 45.1% from the southern regions of the Netherlands. Of all respondents, 46.5% resided in urban zones, 23.8% in sub-urban zones and 24.9% in rural/sub-rural zones. Married respondents living with or without children accounted for the majority of sample distribution, making up to 63.3% of responses followed by individuals living alone without children (24.8%). Half of the respondents (49.9%) had a higher education status and 49.7% of respondents was categorized to have a middle income.

Lifestyle changes during the COVID-19 pandemic

Although the majority of the surveyed population reported no significant change in their daily habits or intake of food/snacks since the COVID-19 outbreak in the Netherlands, we found substantial lifestyle changes in a considerable part of the population, both for the better and the worse (see Table 2 ). 14.0% of all respondents reported a decrease in sleeping hours, while 13.0% reported an increase. One fifth (20.0%) of the respondents reported to snack more than before the COVID-19 pandemic, and 7.7% snacked less. Intake of vegetables increased in 11.7% whereas it decreased in 1.7%.

Table 2 shows that the majority did not know whether their stress levels had changed in relation to ‘the balance between work and childcare’ and ‘care for their family’, respectively 57.8 and 62.1%. 52.3% of the respondents indicated no change in stress related to their own health, but nearly a quarter (22.2%) did perceive more health-related stress or future perspective related stress (27.7%).

As shown in Tables 3 , 80% of the respondents reported that in general they were happy with their current lifestyle. 12.2% of the total population reported an unhealthier lifestyle since the outbreak of the COVID-19 pandemic, whereas 19.3%, ( n = 194) indicated that the COVID-19 pandemic positively influenced their lifestyle (Table 3 ). The 194 respondents reported a healthier lifestyle due to a higher intake of fruit and vegetables (54.6%), exercise (63.4%), and relaxation (46.4%). Only a small proportion of the participants reported to live healthier due to a change in meaning of life aspects/spirituality (6.2%) (Table 3 ).

Remarkably, the number of respondents that thought that lifestyle changes can influence the natural history (symptoms) of COVID-19 once infected, was higher than the number of respondents that thought lifestyle changes can influence the risk of getting infected (Table 3 ). Nearly halve of respondents (48.2%) did not think that a change in their lifestyle could decrease their risk of getting infected by the corona virus (Table 3 ).

Factors independently associated with changes into lifestyle (healthy/unhealthy)

Table 4 shows the univariable statistically significant associated variables with a change to healthy- or unhealthy lifestyle that are entered into the multivariable analyses to come to the final models ( P < 0.05). Based on univariable analyses, no statistically significant associations with a change to a healthy lifestyle were found with regards to age, gender, residential region, smoking, alcohol use, stress in relation to work and stress in relation to future perspectives. With regard to a change to an unhealthy lifestyle no statistically significant associations were found for gender, income level, living region, smoking, alcohol use, use of CAM and anxiety for getting infected their selves with Covid-19.

The final multivariate models (Table 4 ) included 1004/1004 (100%) of the respondents of the survey. Three predictors were strongly associated with changing into a healthy lifestyle: Worried/Anxious getting infected with SARS-coV-2 (OR: 1.56, 95% C.I. 1.26–1.93), CAM use (OR: 2.04, 95% C.I. 1.38–3.02) and stress in relation to financial situation (OR: 1.89, 95% C.I. 1.30–2.74). Together these gave an AUROC of 0.66 (95% CI = 0.63 to 0.71). Similarly, three predictors were strongly associated with changing into an unhealthy lifestyle: Age (OR 18–25: 1.00, OR 25–40: 0.55, 95% C.I. 0.31–0.96, OR 40–55:0.50 95% C.I. 0.28–0.87 OR 55+: 0.1095% C.I. 0.10–0.33), stress in relation to health (OR: 2.52, 95% C.I. 1.64–3.86) and stress in relation to the balance work and home (OR: 1.69, 95% C.I. 1.11–2.57). Together these gave an AUROC of 0.56 (95% C.I. 0.50–0.62)).

Differences in COVID-19-related lifestyle changes between CAM users and non-CAM users

Our multivariable model shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic and is not statistically significant associated with a change to an unhealthy lifestyle. More than two third (68%) of the respondents indicated use of CAM in the past 3 months. 13.3% of all respondents consulted a CAM practitioner (medical doctor or other (non) healthcare professional specialized in CAM, 59.4% used (CAM) supplements (e.g. vitamins/minerals, herbs, and/or dietary supplements) and 30% indicated to make use of (CAM) self-help techniques ((e.g. breathing exercises, yoga) (Table 5 ).

No statistically significant differences were found between non-CAM and CAM users with regards to mean age, residential region, marital status, education and yearly income. Lifestyle related behaviour measures as smoking, alcohol use and daily exercise were similarly distributed between the two groups. The younger aged (age < 30) and the elderly (age 65+) did make less use of CAM then those aged between 31 and 64 years old, as did men (male non-CAM users: 61.7%).

As shown in Tables 5 , 87.7 and 84.0% of the CAM users and non-CAM users respectively reported that in general they were happy with their current lifestyle. The proportion CAM users that changed into a healthier lifestyle influenced by the COVID-19 pandemic is bigger than the proportion of non-CAM users.

More than one third of the CAM users indicated to think changes in lifestyle could change their risk of getting infected with SARS-coV2 (38.1%), and 46.3% did also think that changing their lifestyle could influence the course of the illness once infected, compared to 40.3% of the non-CAM users and 44.8% of all participants. CAM users were statistically significant less anxious/worried to get infected with COVID-19 than non-CAM users.

In general, CAM users perceived more often an increase in stress than non-CAM users. Rather large differences were found between more stress in the previous three months in relation to work (CAM users: 23.1%, Non-CAM users: 12.3%, P < 0.001), health (CAM users: 25.9%, Non-CAM users: 10.7%, P < 0.001), balance work/childcare (CAM users: 12.0%, Non-CAM users: 7.0%, P = 0.012)), financial situation (CAM users: 21.2%, Non-CAM users:10.7%, P < 0.001)) and future perspective (CAM users: 33.8, Non-CAM users:16.9%, P < 0.001)).

In the 3 months ahead of the survey, CAM users were more aware of their own diet habits than non-CAM users (CAM users: 18.8%, Non-CAM users: 9.1%, P < 0.05).

Intention to continue lifestyle changes and the required support

This study provides information that may be relevant to policy makers, health insurances and research funding organizations to guide future decisions on lifestyle and COVID-19.

Table 6 shows that in general, more than halve of the 194 respondents who reported a positive change in their lifestyle since the start of the COVID-19 pandemic indicated the wish to continue their changes through healthy food (56.2%) and exercise (54.6%). Of the pre-defined options: 1) healthy choices at work/school (food, drinks, exercise during breaks e.g., yoga, tai chi, mindfulness) 2) free choice and reimbursement of any treatment in relation to CAM and Lifestyle; 3) support from GP/Health centre/Community care; 4) online advice and support, and 5) affordable and easilyaccessible healthy food, 55.8% of respondents declared needing none of these.

However, affordable and easily accessible healthy food was perceived as helpful by one third of the respondents (34.7%), followed by healthy choices at work/school and free choice and reimbursement of CAM and lifestyle treatments with respectively 17.2 and 16.0%.

Statistically significant more CAM users reported a desire to continue more activities regarding meaning of life/ spirituality/ (CAM users: 27.4%, Non-CAM users: 10.8%, P = 0.03) in a post Covid-19 era.

This population-based study is a snapshot of the health related lifestyle changes of Dutch residents during the first wave of the COVID-19 pandemic which included nine weeks of Intelligent lockdown as declared by the Dutch Government. Our study seems to indicate that one fifth of the Dutch residents changed their lifestyle into a healthier one and that this was mainly due to healthier food habits, more exercise and more relaxation. More than half of these respondents reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Around 10% of the total study population, on the other hand, admitted to have started living unhealthier due to the corona crisis. 35% of respondents thought that a lifestyle change could change their risk of getting infected by the corona virus and nearly half of the total group thought this change could influence the course of the illness once infected.” Our study also shows that CAM use is an important predictor of changing to a healthier lifestyle during the first wave of the COVID-19 pandemic. The use of CAM and healthy lifestyle has been associated previously [ 15 , 16 , 17 , 18 ], and our results confirm this positive association.

Regardless of the time and context within one decides to eat better, exercise more, or be less stressed, it can be hard to make a lifestyle change, and even harder to make it a habit [ 22 ]. Life changing events might provide a unique opportunity to live healthier and to continue these changes [ 23 ]. Since the outbreak of the novel coronavirus disease (COVID-19) in China, the world is in the grip of a coronavirus pandemic, a unique crisis with disastrous health, societal and economic effects worldwide [ 24 ]. The Corona crisis is said to be the biggest crises since World War III in the Netherlands and is expected to change the way we think and live at individual and societal levels.

A large part of non-communicable diseases is caused by unhealthy behaviour [ 20 , 25 , 26 ]. Addressing modifiable risks such as tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol are among most effective interventions to keep people healthy and productive, reducing the individual, societal and economic impact and suffering caused by non-communicable diseases [ 20 , 25 , 26 ]. Nearly 20% of our respondents indicated that the COVID-19 pandemic positively influenced their lifestyle. This is a positive finding from a public health perspective, in which the importance of a healthier lifestyle to prevent chronic and non-communicable diseases is emphasized. A comparable percentage among a representative sample of the general population of Italy surveyed in the first months of 2020 was found to change to a healthier lifestyle. The survey in Italy further revealed that most of the Italian respondents declared not to have changed its habits (46.1%) (compared to 68% of our respondents), while 37.2% (compared to 12% of our respondents) felt to have made them worse [ 27 ]. This latter difference might be due to the difference in lockdown, with a stricter one in Italy.

Although healthy lifestyles offer a number of health benefits, non- adherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits [ 28 , 29 ]. It is therefore promising that of this representative sample of the Dutch population, more than half who changed into a healthier lifestyle indicates to be willing to maintain to these new habits. A US poll has found that as many as 80% of American adults will try to practice self-care more regularly once the COVID-19 pandemic is over [ 30 ]. The prospect of improving health and reducing illness through changes in living habits rather than through curative healthcare, is attractive from the perspective of public health and on economic grounds.

Our final multivariable model for changing into a healthy lifestyle showed positive associations with: (i) anxiety to get infected with SARs-coV-2; (ii) the use of CAM; and (iii) stress with regards to financial situation. Taylor et al. (2020) recently developed the COVID stress Scales (CSS) and identified five factors of stress and anxiety symptoms relating to the coronavirus in two large samples in Canada and the United States including ‘danger and contamination’ and ‘fears about economic consequences’. Two predictive factors (anxiety to get infected with SARs-coV-2 and stress with regards to financial situation) we found to be positively associated with a change into a healthy lifestyle. Previously, Anderson et al. showed that occurrence of life events and subsequent effects, can contribute to health promoted behaviour despite the potential worries, poor health and diseases which may also be associated with them [ 23 ].

Analyses of data from the National Health Interview Study (NHIS) found that CAM users were more likely to use exercise and less likely to be obese than those who did not use CAM [ 15 , 16 ]. Associations of CAM with exercise [ 15 , 16 , 31 , 32 ], higher vegetable intake [ 31 , 32 , 33 ], lower fat or lipid intake [ 31 , 32 , 33 ], and smoking cessation or decreased smoking [ 16 , 31 , 34 ] have been reported previously. These studies, like ours, show a commitment to overall wellbeing that spans both lifestyle and CAM use and hypothesise that CAM therapies may even be used as a gateway to healthy lifestyle. Concurrent use of the two modalities should be investigated further in various populations. Moreover, CAM users in our study indicated to favour support of policy driven decisions related to a healthy lifestyle, consequently, a focus on the Dutch CAM users could work as a gateway to a healthier lifestyle for the general population.

On the other hand, younger age and stress regarding health and the balance between work and family life were found to be positively associated (final multivariable model) with a change into an unhealthy lifestyle. Our data shows that especially younger age was a risk factor for a change into an unhealthier direction. The fact that the young generation seems to be more prone might be due to fact that the restrictions as home confinement during the pandemic has especially impacted their lives by home schooling, working from home and balancing work and childcare (parents) causing a long period of stress resulting into an unhealthier lifestyle. Heightened life stress has been linked to unhealthy eating [ 35 , 36 ] and stressed people are more likely to crave food high in energy, fats, and sugars [ 37 ]. Moreover, parenting is found to be stressful under normative circumstances but pandemic-related data indicate that COVID-19 has led to significant increases in the population’s general stress, a change felt even more acutely for parents than their non-parent counterparts [ 38 ]. The results obtained by our study are relevant if we consider that people with stress in relation to balancing work and family care have a 1.7 higher chance of changing into an unhealthy lifestyle than people not perceiving this specific stress.

Some strengths and limitations of this study need to be noted.

Our study has been strengthened by the fact that the survey was conducted during the first critical period of the epidemic in the Netherlands. Responses from over 1000 individuals were rapidly collected within a period of five days from a representative sample of the population. Another strength is that our sample size was sufficiently large for detecting correlations. A limitation of this study is the rather low response rate of 22% to the survey, increasing the risk of non-response bias. Furthermore, because of the urgency to rapidly assess lifestyle changes in a very critical period of the pandemic, the questionnaire was not first piloted among a smaller sample. Although the research team carefully developed and selected life-style related questions and thoroughly discussed comprehensiveness, flow and clarity of the survey, it is not known whether the questionnaire was fully understandable and acceptable for the target population. Another limitation includes the fact that the results are limited by a self-reported questionnaire. The assessment of lifestyle changes was based on individual recall methods, and not by direct measurement of dietary and sleeping pattern, smoking and alcohol consumption. Respondents may thus have either overestimated or underestimated their changes in behaviour. An obvious other limitation of a cross-sectional study design is that it does not allow causal inferences about relationships and thus limits any claim about the directionality of the results. Last, no data on comorbidities (e.g. diabetes, hypertension and obesity) were gathered for the purpose of this study, which might limit the results. Linking with GP data on comorbidities would strengthen future research [ 15 , 16 , 31 , 32 ].

The COVID-19 pandemic and following Intelligent lockdown provides an unique window of opportunity to improve lifestyle habits on a population level. This is not only important to combat COVID-19 but also the other pandemic; of obesity and other non-communicable lifestyle-related disease. For a part of the Dutch population, the Corona crisis has already brought a shift in thinking, working and lifestyle behaviour, another large part is now motivated to make such changes. From a public health perspective, it is important to use this unique situation optimally and immediately as this increased motivation is crucial to obtain sustainable lifestyle changes, but may disappear quickly once COVID-19 wanes off. Strategies may include investing in prevention and education (e.g. smoking, drugs, alcohol), health campaigns, lowering taxes on healthy foods and sponsorship of sport facilities. Further studies are warranted to see whether this behavioural change is maintained over time, and how (changing) lifestyle behaviour can affect the susceptibility for and the course of COVID-19. Finally, the results of this study are in line with others showing the potential synergistic relationship between CAM use and healthy lifestyle behaviours [ 15 , 16 , 31 , 32 ]. This relation could be targeted in future interventions to increase general wellbeing, symptom control, and clinical outcomes in at-risk populations and might be used as a potential translatable strategy to increase healthy lifestyle behaviours in general populations.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Complementary and Alternative Medicine

Confidence interval

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Acknowledgements

We would like to thank Barbara Wider Vellinga for her assistance with survey development.

This study was funded by co-funding of Triodos Foundation, Fred Foundation, Association of Homeopathy, Iona Foundation and the Artsen Vereniging Integrale Geneeskunde (AVIG)).

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National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway

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EvdW and MB designed the study. EvdW analysed the data and drafted the manuscript. RH,MB and MJ provided critical feedback for revisions. The authors read and approved the final manuscript.

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van der Werf, E.T., Busch, M., Jong, M.C. et al. Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands. BMC Public Health 21 , 1226 (2021). https://doi.org/10.1186/s12889-021-11264-z

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Healthy Lifestyle and Eating Essay

Healthy eating is the process of keeping the body clean, strong, and healthy at all times (Allen, 1926). Healthy living, on the other hand, means that one should be able to eat the right food, get enough exercise, and maintain cleanliness (James, 1907). Unfortunately, many people do not keep track of these requirements. Thus, they end up with serious health problems, which can be difficult to treat. Prevention of these problems can be accomplished through maintaining a healthy lifestyle. Such a lifestyle is achievable by eating the right food and adhering to all the requirements of healthy living.

The human body needs a balanced diet, which includes enough minerals, fats, vitamins, fiber, and carbohydrates (Albrecht, 1932). These substances are required by the body to facilitate the growth and functioning of body tissues. Low energy foods such as vegetables and fruits have small amounts of calories per unit volume of food. Therefore, it is advisable to eat this combination of foods in large volumes as it contains fewer calories, but has nutrients that are essential for optimal body functionality. Incidentally, one should take food that is free from unhealthy fats, but should ensure that whole grains and proteins go alongside fruits and vegetables.

Apart from choosing the best foods for the body, it is also advisable that people should maintain moderate quantities of food intake. For instance, it is prudent to eat less of unhealthy foods such as refined sugar and saturated fats and more of healthy foods such as vegetables and fruits. This pattern of eating has massive health benefits to its adherents. As such, people should strive to develop good eating habits that can sustain them throughout their lives.

Further, it is recommended that one should eat a heavy breakfast an hour after waking up. The breakfast needs to consist of carbohydrates, healthy fats, and proteins in balanced proportions. It should then be followed by light meals throughout the day. This requirement is important since breakfast helps to initiate the body’s metabolism. The light and healthy meals thereafter help maintain a high body energy level that keeps one active throughout the day (Allen, 1926). People should avoid eating late at night. Early dinners are advisable followed by an average of 15 hours of no food until breakfast time the next morning. Past studies show that this pattern helps regulate body weight (James, 1907).

People who are diagnosed with lifestyle diseases such as anemia, high blood pressure, and diabetes among others are advised to follow diets that are rich in fruits and vegetable content (Allen, 1926). Depending on the stage of illness, such people should strictly watch what they eat. For example, high blood pressure patients should cut down on sodium, which is mainly found in salt. They should also avoid foods that have high cholesterol and saturated fats since diets of this sort prompt a high risk of artery clogging. Consequently, it increases the risk of heart attacks and blood vessel diseases (Albrecht, 1932). Further, they need to control the amount of carbohydrates they take.

Carbohydrates should only account for 50% of their daily calories (Allen, 1926). Finally, they are discouraged from foods with a high phosphorous content since they may lead to bone diseases (Allen, 1926). Overweight people constitute another special needs group. They should reduce weight to be healthy. Consequently, they need at least 30 minutes of rigorous physical exercise everyday and a lean diet.

In conclusion, all these groups of people should increase their water intake. Water is essential in the human body since it facilitates the regulation of all body functions. As such, it enhances body health. In this regard, people should strive to take at least eight glasses per day. Apparently, healthy living calls for discipline and commitment. If people foster these two values in the lifestyles, the world will be full of healthy people.

Albrecht, Arthur E. (1932). About foods and markets : A teachers’ handbook and consumers’ guide . New York City, NY: Columbia University. Web.

Allen, Ida C. (1926). Your foods and you or the role of diet . Garden City, NY: Doubleday Page & Company. Web.

James F. (1907). How we are fed: A geographical reader . New York, NY: Macmillan. Web.

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Essay on Healthy Lifestyle for Students and Children

500+ Words Essay on Healthy Lifestyle

It is said that it is easy to learn and maintain bad habits but it is very difficult to switch them back. The issue of a healthy lifestyle is very serious but the people take it very lightly. Often, it is seen that the people take steps to improve their lifestyle but due to lack of determination quits in the midway.

Moreover, for a healthy lifestyle is it important that you take small and one-step at a time. Also, do not go overboard with it. Besides, this healthy lifestyle will help you in life in a lot of ways.

Habits That Keeps You Healthy

For keeping your body and mind healthy you have to follow certain rules that will help you achieve your goal. Besides, there are certain measures that will help you to stay healthy.

First of all, for being healthy you have to plan and follow a strict diet. This diet should contain all the essential minerals and vitamins required by the body. Also, eat only healthy food and avoid junk and heavily carbohydrate and fatty food.

In addition, wake up early in the morning because first of all, it’s a healthy habit. Secondly, waking up early means you can get ready for your work early, spend some quality time with your family. Besides, this decides time for your sleep and sleep early because it de-stresses body.

Doing exercise regularly makes your body more active and it also releases the pent-up stress from the muscles.

Avoid the mobile- the biggest drawback of this generation is that they are obsessed with their mobile phones. Moreover, these phones cause many physical and mental problem for them. So, to avoid the negative effects of mobile the usage volume of them should be reduced.

Connecting with positive minds because the more you indulge with these people then less you will go to the negative side.

Get the huge list of more than 500 Essay Topics and Ideas

The things that should be avoided for a healthy lifestyle

We knew that there are several bad habits that affect our healthy lifestyle. These habits can cause much harm to not only to the body but to the society too. In addition, these habits are also the cause of many evils of society. The major healthy lifestyle destroying habits are smoking, drinking, junk food, addiction , meal skipping, and overuse of pills.

All these activities severely damage body parts and organs which cannot be replaced easily. Besides, they not only cause physical damage but mental damage too.

Benefits of a Healthy Lifestyle

A healthy lifestyle has many benefits not only for the body but for the mind too. Also, if you follow a healthy lifestyle then you can reduce the risk of having cancer, heart disease, diabetes, obesity, and osteoporosis.

To sum it up, we can say that there are various benefits of living a healthy lifestyle. Also, a healthy lifestyle has many benefits to your social as well as personal life. Besides, it improves the relationships in the family. Most importantly, the person who lives a healthy lifestyle lives longer as compared to those who do not.

FAQs on Healthy Lifestyle

Q.1 Give some tips to live a healthy lifestyle. A.1 Some tips for staying healthy are eating a balanced diet, maintain weight, having enough sleep, sleep early and wake up early, use mobile lesser, etc.

Q.2 What is good health? A.2 Good health means freedom from sickness and diseases. It is a costly gift of nature to us for living a purposeful life. Also, good health means that we can do more work than our capacity without getting tired.

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Published: 29 September 2022

A healthy lifestyle is positively associated with mental health and well-being and core markers in ageing

Pauline Hautekiet ORCID: orcid.org/0000-0003-3805-3004 1 , 2 ,
Nelly D. Saenen 1 , 2 ,
Dries S. Martens 2 ,
Margot Debay 2 ,
Johan Van der Heyden 3 ,
Tim S. Nawrot 2 , 4 &
Eva M. De Clercq 1

BMC Medicine volume 20 , Article number: 328 ( 2022 ) Cite this article

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Studies often evaluate mental health and well-being in association with individual health behaviours although evaluating multiple health behaviours that co-occur in real life may reveal important insights into the overall association. Also, the underlying pathways of how lifestyle might affect our health are still under debate. Here, we studied the mediation of different health behaviours or lifestyle factors on mental health and its effect on core markers of ageing: telomere length (TL) and mitochondrial DNA content (mtDNAc).

In this study, 6054 adults from the 2018 Belgian Health Interview Survey (BHIS) were included. Mental health and well-being outcomes included psychological and severe psychological distress, vitality, life satisfaction, self-perceived health, depressive and generalised anxiety disorder and suicidal ideation. A lifestyle score integrating diet, physical activity, smoking status, alcohol consumption and BMI was created and validated. On a subset of 739 participants, leucocyte TL and mtDNAc were assessed using qPCR. Generalised linear mixed models were used while adjusting for a priori chosen covariates.

The average age (SD) of the study population was 49.9 (17.5) years, and 48.8% were men. A one-point increment in the lifestyle score was associated with lower odds (ranging from 0.56 to 0.74) for all studied mental health outcomes and with a 1.74% (95% CI: 0.11, 3.40%) longer TL and 4.07% (95% CI: 2.01, 6.17%) higher mtDNAc. Psychological distress and suicidal ideation were associated with a lower mtDNAc of − 4.62% (95% CI: − 8.85, − 0.20%) and − 7.83% (95% CI: − 14.77, − 0.34%), respectively. No associations were found between mental health and TL.

Conclusions

In this large-scale study, we showed the positive association between a healthy lifestyle and both biological ageing and different dimensions of mental health and well-being. We also indicated that living a healthy lifestyle contributes to more favourable biological ageing.

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According to the World Health Organization (WHO), a healthy lifestyle is defined as “a way of living that lowers the risk of being seriously ill or dying early” [ 1 ]. Public health authorities emphasise the importance of a healthy lifestyle, but despite this, many individuals worldwide still live an unhealthy lifestyle [ 2 ]. In Europe, 26% of adults smoke [ 3 ], nearly half (46%) never exercise [ 4 ], 8.4% drink alcohol on a daily basis [ 5 ] and over half (51%) are overweight [ 5 ]. These unhealthy behaviours have been associated with adverse health outcomes like cardiovascular diseases [ 6 , 7 , 8 ], respiratory diseases [ 9 ], musculoskeletal diseases [ 10 ] and, to a lesser extent, mental disorders [ 11 , 12 ].

Even though the association between lifestyle and health outcomes has been extensively investigated, biological mechanisms explaining these observed associations are not yet fully understood. One potential mechanism that can be suggested is biological ageing. Both telomere length (TL) and mitochondrial DNA content (mtDNAc) are known biomarkers of ageing. Telomeres are the end caps of chromosomes and consist of multiple TTAGGG sequence repeats. They protect chromosomes from degradation and shorten with every cell division because of the “end-replication problem” [ 13 ]. Mitochondria are crucial to the cell as they are responsible for apoptosis, the control of cytosolic calcium levels and cell signalling [ 14 ]. Living a healthy lifestyle can be linked with healthy ageing as both TL and mtDNAc have been associated with health behaviours like obesity [ 15 ], diet [ 16 ], smoking [ 17 ] and alcohol abuse [ 18 ]. Furthermore, as biomarkers of ageing, both TL and mtDNAc have been associated with age-related diseases like Parkinson’s disease [ 19 ], coronary heart disease [ 20 ], atherosclerosis [ 21 ] and early mortality [ 22 ]. Also, early mortality and higher risks for the aforementioned age-related diseases are observed in psychiatric illnesses, and it is suggested that advanced biological ageing underlies these observations [ 23 ].

Multiple studies evaluated individual health behaviours, but research on the combination of these health behaviours is limited. As they often co-occur and may cause synergistic effects, assessing them in combination with each other rather than independently might better reflect the real-life situation [ 24 , 25 ]. Therefore, in a general adult population, we combined five commonly studied health behaviours including diet, smoking status, alcohol consumption, BMI and physical activity into one healthy lifestyle score to evaluate its association with mental health and well-being and biological ageing. Furthermore, we evaluated the association between the markers of biological ageing and mental health and well-being. We hypothesise that individuals living a healthy lifestyle have a better mental health status, a longer TL and a higher mtDNAc and that these biomarkers are positively associated with mental health and well-being.

Study population

In 2018, 11611 Belgian residents participated in the 2018 Belgian Health Interview Survey (BHIS). The sampling frame of the BHIS was the Belgian National Register, and participants were selected based on a multistage stratified sampling design including a geographical stratification and a selection of municipalities within provinces, of households within municipalities and of respondents within households [ 26 ]. The study population for this cross-sectional study included 6054 BHIS participants (see flowchart in Additional file 1 : Fig. S1) [ 27 , 28 , 29 , 30 , 31 ]. Minors (< 18 years) and participants not eligible to complete the mental health modules (participants who participated through a proxy respondent, i.e. a person of confidence filled out the survey) were excluded ( n = 2172 and n = 846, respectively). Furthermore, of the 8593 eligible participants, those with missing information to create the mental health indicators, the lifestyle score or the covariates used in this study were excluded ( n = 1642, 788 and 109, respectively).

For the first time in 2018, a subset of 1184 BHIS participants contributed to the 2018 Belgian Health Examination Survey (BELHES). All BHIS participants were invited to participate except for minors (< 18 years), BHIS participants who participated through a proxy respondent and residents of the German Community of Belgium, the latter representing 1% of the Belgian population. Participants were recruited on a voluntary basis until the regional quotas were reached (450, 300 and 350 in respectively Flanders, Brussels Capital Region and Wallonia). These participants underwent a health examination, including anthropological measurements and completed an additional questionnaire. Also, blood and urine samples were collected. Of the 6054 included BHIS participants, 909 participated in the BELHES. Participants for whom we could not calculate both TL and mtDNAc were excluded ( n = 170). More specifically, participants were excluded because they did not provide a blood sample ( n = 91) or because they did not provide permission for DNA research ( n = 32). Twenty samples were excluded from DNA extraction because either total blood volume was too low ( n = 7), samples were clothed ( n = 1) or tubes were broken due to freezing conditions ( n = 12). Twenty-seven samples were excluded because they did not meet the biomarker quality control criteria (high technical variation in qPCR triplicates). This was not met for 3 TL samples, 20 mtDNAc samples and 4 samples for both biomarkers. For this subset, we ended up with a final number of 739 participants. Further in this paper, we refer to “the BHIS subset” for the BHIS participants ( n = 6054) and the “BELHES subset” for the BELHES participants ( n = 739).

As part of the BELHES, this project was approved by the Medical Ethics Committee of the University Hospital Ghent (registration number B670201834895). The project was carried out in line with the recommendations of the Belgian Privacy Commission. All participants have signed a consent form that was approved by the Medical Ethics Committee.

Health interview survey

The BHIS is a comprehensive survey which aims to gain insight into the health status of the Belgian population. The questions on the different dimensions of mental health and well-being were based on international standardised and validated questionnaires [ 32 ], and this resulted in eight mental health outcomes that were used in this study. Detailed information on each indicator score and its use is addressed in Additional file 1 : Table. S1. Firstly, the General Health Questionnaire (GHQ-12) provides the prevalence of psychological and severe psychological distress in the population [ 27 ]. On the total GHQ score, cut-off points of + 2 and + 4 were used to identify respectively psychological and severe psychological distress.

Secondly, we used two indicators for the positive dimensions of mental health: vitality and life satisfaction. Four questions of the short form health survey (SF-36) indicate the participant’s vital energy level [ 28 , 33 ]. We used a cut-off point to identify participants with an optimal vitality score, which is a score equal to or above one standard deviation above the mean, as used in previous studies [ 34 , 35 ]. Life satisfaction was measured by the Cantril Scale, which ranges from 0 to 10 [ 29 ]. A cut-off point of + 6 was used to indicate participants with high or medium life satisfaction versus low life satisfaction.

Thirdly, the question “How is your health in general? Is it very good, good, fair, bad or very bad?” was used to assess self-perceived health, also known as self-rated health. Based on WHO recommendations [ 36 ], the answer categories were dichotomised into “good to very good self-perceived health” and “very bad to fair self-perceived health”.

Fourthly, depressive and generalised anxiety disorders were defined using respectively the Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder Questionnaire (GAD-7). We identified individuals who suffer from major depressive syndrome or any other type of depressive syndrome according to the criteria of the PHQ-9 [ 37 ]. A cut-off point of + 10 on the total sum of the GAD-7 score was used to indicate generalised anxiety disorder [ 31 ]. Additionally, a dichotomous question on suicidal ideation was used: “Have you ever seriously thought of ending your life?”; “If yes, did you have such thoughts in the past 12 months?”. Finally, the BHIS also includes personal, socio-economic and lifestyle information. The standardised Cronbach’s alpha coefficients for the PHQ-9, GHQ-12, GAD-7 and questions on vitality of the SF-36 ranged between 0.80 and 0.90.

Healthy lifestyle score

We developed a healthy lifestyle score based on five different health behaviours: body mass index (BMI), smoking status, physical activity, alcohol consumption and diet (Table 1 ). These health behaviours were defined as much as possible according to the existing guidelines for healthy living issued by the Belgian Superior Health Council [ 38 ] and the World Health Organisation [ 39 , 40 , 41 ]. Firstly, BMI was calculated as a person’s self-reported weight in kilogrammes divided by the square of the person’s self-reported height in metres (kg/m 2 ). BMI was classified into four categories: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5–24.9 kg/m 2 ), overweight (BMI 25.0–29.9 kg/m 2 ) and obese (BMI ≥ 30.0 kg/m 2 ). Due to a J-shaped association of BMI with the overall mortality and multiple specific causes of death, obesity and underweight were both classified as least healthy [ 42 ]. BMI was scored as follows: obese and underweight = 0, overweight = 1 and normal weight = 2.

Secondly, smoking status was divided into four categories. Participants were categorised as regular smokers if they smoked a minimum of 4 days per week or if they quit smoking less than 1 month before participation (= 0). Occasional smokers were defined as smoking more than once per month up to 3 days per week (= 1). Participants were classified as former smokers if they quit smoking at least 1 month before the questionnaire or if they smoked less than once a month (= 2). The final category included people who never smoked (= 3).

Thirdly, physical activity was assessed by the question: “What describes best your leisure time activities during the last year?”. Four categories were established and scored as follows: sedentary activities (= 0), light activities less than 4 h/week (= 1), light activities more than 4 h/week or recreational sport less than 4 h/week (= 2) and recreational sport more than 4 h or intense training (= 3). Fourthly, information on the number of alcoholic drinks per week was used to categorise alcohol consumption. The different categories were set from high to low alcohol consumption: 22 drinks or more/week (= 0), 15–21 drinks/week (= 1), 8–14 drinks/week (= 2), 1–7 drinks/week (= 3)and less than 1 drink/week (= 4).

Finally, in line with the research by Benetou et al., a diet score was calculated using the frequency of consuming fruit, vegetables, snacks and sodas [ 43 ]. For fruit as well as vegetable consumption, the frequency was scored as follows: never (= 0), < 1/week (= 1), 1–3/week (= 2), 4–6/week (= 3) and ≥ 1/day (= 4). The frequency of consuming snacks and sodas was scored as follows: never (= 4), < 1/week (= 3), 1–3/week (= 2), 4–6/week (= 1) and ≥ 1/day (= 0). The diet score was then divided into tertiles, in line with the research by Benetou et al. [ 43 ]. A diet score of 0–9 points was classified as the least healthy behaviour (= 0). A diet score ranging from 10 to 12 made up the middle category (= 1), and a score from 13 to 16 was classified as the healthiest behaviour (= 2).

All five previously described health behaviours were combined into one healthy lifestyle score (Table 1 ). The sum of the scores obtained for each health behaviour indicated the absolute lifestyle score. To calculate the relative lifestyle score, each absolute scored health behaviour was given equal weight by recalculating its maximum absolute score to a relative score of 1. The relative lifestyle scores were then summed up to achieve a final continuous lifestyle score, ranging from 0 to 5, with a higher score representing a healthier lifestyle.

Telomere length and mitochondrial DNA content assay

Blood samples were collected during the BELHES and centrifuged for 15 min at 3000 rpm before storage at − 80 °C. After extracting the buffy coat from the blood sample, DNA was isolated using the QIAgen Mini Kit (Qiagen, N.V.V Venlo, The Netherlands). The purity and quantity of the sample were measured with a NanoDrop spectrophotometer (ND-2000; Thermo Fisher Scientific, Wilmington, DE, USA). DNA integrity was assessed by agarose gel electrophoresis. To ensure a uniform DNA input of 6 ng for each qPCR reaction, samples were diluted and checked using the Quant-iT™ PicoGreen® dsDNA Assay Kit (Life Technologies, Europe).

Relative TL and mtDNAc were measured in triplicate using a previously described quantitative real-time PCR (qPCR) assay with minor modifications [ 44 , 45 ]. All reactions were performed on a 7900HT Fast Real-Time PCR System (Applied Biosystems, Foster City, CA, USA) in a 384-well format. Used telomere, mtDNAc and single copy-gene reaction mixtures and PCR cycles are given in Additional file 1 : Text. S1. Reaction efficiency was assessed on each plate by using a 6-point serial dilution of pooled DNA. Efficiencies ranged from 90 to 100% for single-copy gene runs, 100 to 110% for telomere runs and 95 to 105% for mitochondrial DNA runs. Six inter-run calibrators (IRCs) were used to account for inter-run variability. Also, non-template controls were used in each run. Raw data were processed and normalised to the reference gene using the qBase plus software (Biogazelle, Zwijnaarde, Belgium), taking into account the run-to-run differences.

Leucocyte telomere length was expressed as the ratio of telomere copy number to single-copy gene number (T/S) relative to the mean T/S ratio of the entire study population. Leucocyte mtDNAc was expressed as the ratio of mtDNA copy number to single-copy gene number (M/S) relative to the mean M/S ratio of the entire study population. The reliability of our assay was assessed by calculating the interclass correlation coefficient (ICC) of the triplicate measures (T/S and M/S ratios and T, M and S separately) as proposed by the Telomere Research Network, using RStudio version 1.1.463 (RStudio PBC, Boston, MA, USA). The intra-plate ICCs of T/S ratios, TL runs, M/S ratios, mtDNAc runs and single-copy runs were respectively 0.804 ( p < 0.0001), 0.907 ( p < 0.0001), 0.815 ( p < 0.0001), 0.916 ( p < 0.0001) and 0.781 ( p < 0.0001). Based on the IRCs, the inter-plate ICC was 0.714 ( p < 0.0001) for TL and 0.762 ( p < 0.0001) for mtDNAc.

Statistical analysis

Statistical analyses were performed using the SAS software (version 9.4; SAS Institute Inc., Cary, NC, USA). We performed a log(10) transformation of the TL and mtDNAc data to reduce skewness and to better approximate a normal distribution. Three analyses were done: (1) In the BHIS subset ( n = 6054), we evaluated the association between the lifestyle score and the mental health and well-being outcomes (separately). These results are presented as the odds ratio (95% CI) of having a mental health condition or disorder for a one-point increment in the lifestyle score. (2) In the BELHES subset ( n = 739), we evaluated the association between the lifestyle score and both TL and mtDNAc (separately). These results are presented as the percentage difference in TL or mtDNAc (95% CI) for a one-point increment in the lifestyle score. (3) In the BELHES subset ( n = 739), we evaluated the association between the mental health and well-being outcomes and both TL and mtDNAc (separately). These results are presented as the percentage difference in TL or mtDNAc (95% CI) when having a mental health condition or disorder compared with the healthy group.

For all three analyses, we performed multivariable linear mixed models (GLIMMIX; unstructured covariance matrix) taking into account a priori selected covariates including age (continuous), sex (male, female), region (Flanders, Brussels Capital Region, Wallonia), highest educational level of the household (up to lower secondary, higher secondary, college or university), country of birth (Belgium, EU, non-EU) and household type (single, one parent with child, couple without child, couple with child, others). To capture the non-linear effect of age, we included a quadratic term when the result of the analysis showed that both the linear and quadratic terms had a p -value < 0.1. For the two analyses on TL and mtDNAc, we additionally adjusted for the date of participation in the BELHES. As multiple members of one household participated, we added household numbers in the random statement.

Bivariate analyses evaluating the associations between the characteristics and TL, mtDNAc, the lifestyle score or psychological distress as a parameter of mental health and well-being are evaluated based on the same model. The chi-squared tests (categorical data) and t -tests (continuous data) were used to evaluate the characteristics of included and excluded participants. The lifestyle score was validated by creating a ROC curve and calculating the area under the curve (AUC) of the adjusted association between the lifestyle score and self-perceived health. Adjustments were made for age, sex, region, highest educational level of the household, country of birth and household type.

In a sensitivity analysis, to evaluate the robustness of our findings, we additionally adjusted our main models separately for perceived quality of social support (poor, moderate, strong) and chronic disease (suffering from any chronic disease or condition: yes, no). The third model, evaluating the biomarkers with the mental health outcomes, was also additionally adjusted for the lifestyle score.

Population characteristics

The characteristics of the BHIS and BELHES subset are presented in Table 2 . In the BHIS subset, 48.8% of the participants were men. The average age (SD) was 49.9 (17.5) years, and most participants were born in Belgium (79.5%). The highest educational level in the household was most often college or university degree (53.3%), and the most common household composition was couple with child(ren) (37.7%). The proportion of participants in different regions of Belgium, i.e. Flanders, Brussels Capital Region and Wallonia, was respectively 41.1%, 23.3% and 35.6%. For the BELHES subset, we found similar results except for region and education. We noticed more participants from Flanders and more participants with a high educational level in the household. The mean (SD) relative TL and mtDNAc were respectively 1.04 (0.23) and 1.03 (0.24). TL and mtDNAc were positively correlated (Spearman’s correlation = 0.21, p < 0.0001).

We compared (1) the characteristics of the 6054 eligible BHIS participants that were included in the BHIS subset with the 2539 eligible participants that were excluded from the BHIS subset (Additional file 1 : Table S2) and (2) the 739 participants from the BHIS subset that were included in the BELHES subset with the 5315 participants that were excluded from the BELHES subset (Additional file 1 : Table S3). Except for sex and nationality in the latter, all other covariates showed differences between the included and excluded groups. On the other hand, population data from 2018 indicates that the average age (SD) of the adult Belgian population was 49.5 (18.9) with a distribution over Flanders, Brussels Capital Region and Wallonia of respectively 58.2%, 10.2% and 31.6% and that 48.7% were men. The distribution of our sample according to age and sex thus largely corresponds to the age and sex distribution of the adult Belgian population figures. The large difference in the regional distribution is due to the oversampling of the Brussels Capital Region in the BHIS.

Bivariate associations evaluating the characteristics with TL, mtDNAc, the lifestyle score or psychological distress as a parameter of mental health are presented in Additional file 1 : Table S4. Briefly, men had a − 6.41% (95% CI: − 9.10 to − 3.65%, p < 0.0001) shorter TL, a − 8.03% (95% CI: − 11.00 to − 4.96%, p < 0.0001) lower mtDNAc, lower odds of psychological distress (OR = 0.59, 95% CI: 0.53 to 0.66, p < 0.0001) and a lifestyle score of − 0.28 (95% CI: − 0.32 to − 0.24, p < 0.0001) points less compared with women. Furthermore, a 1-year increment in age was associated with a − 0.64% (− 0.73 to − 0.55%, p < 0.0001) shorter TL and a − 0.19% (95% CI: − 0.31 to − 0.08%, p = 0.00074) lower mtDNAc.

Mental health prevalence and lifestyle characteristics

Within the BHIS subset, 32.3% and 18.0% of the participants had respectively psychological and severe psychological distress. 86.7% had suboptimal vitality, 12.0% indicated low life satisfaction and 22.0% had very bad to fair self-perceived health. The prevalence of depressive and generalised anxiety disorders was respectively 9.0% and 10.8%, respectively. 4.4% of the participants indicated to have had suicidal thoughts in the past 12 months. Similar results were found for the BELHES subset (Table 3 ).

Within the BHIS subset, the average lifestyle score (SD) was 3.1 (0.9) (Table 4 ). A histogram of the lifestyle score is shown in Additional file 1 : Fig. S2. 16.6% were regular smokers, and 4.9% reported 22 alcoholic drinks per week or more. 29.7% reported that their main leisure time included mainly sedentary activities, and 18.6% were underweight or obese. 29.2% were classified as having an unhealthy diet score. The participants of the BELHES subset were slightly more active, but no other dissimilarities were found (Table 4 ). The ROC curve shows an area under the curve (AUC) of 0.74, indicating a 74% predictive accuracy for the lifestyle score as a self-perceived health predictor (Additional file 1 : Fig. S3).

Healthy lifestyle and mental health and well-being

Living a healthier lifestyle, indicated by having a higher lifestyle score, was associated with lower odds of all mental health and well-being outcomes (Table 5 ). After adjustment, a one-point increment in the lifestyle score was associated with lower odds of psychological (OR = 0.74, 95% CI: 0.69, 0.79) and severe psychological distress (OR = 0.69, 95% CI: 0.64, 0.75). Similarly, for the same increment, the odds of suboptimal vitality, low life satisfaction and very bad to fair self-perceived health were respectively 0.62 (95% CI: 0.56, 0.68), 0.62 (95% CI: 0.56, 0.68) and 0.56 (95% CI: 0.52, 0.61). Finally, the odds of having depressive disorder, generalised anxiety disorder or suicidal ideation were respectively 0.57 (95% CI: 0.51, 0.63), 0.63 (95% CI: 0.57, 0.69) and 0.63 (95% CI: 0.55, 0.72) for a one-point increment in the lifestyle score.

The biomarkers of ageing

After adjustment, living a healthy lifestyle was positively associated with both TL and mtDNAc (Table 6 ). A one-point increment in the lifestyle score was associated with a 1.74 (95% CI: 0.11, 3.40%, p = 0.037) higher TL and a 4.07 (95% CI: 2.01, 6.17%, p = 0.00012) higher mtDNAc.

People suffering from severe psychological distress had a − 4.62% (95% CI: − 8.85, − 0.20%, p = 0.041) lower mtDNAc compared with those who did not suffer from severe psychological distress. Similarly, people with suicidal ideation had a − 7.83% (95% CI: − 14.77, − 0.34%, p = 0.041) lower mtDNAc compared with those without suicidal ideation. No associations were found for the other mental health and well-being outcomes, and no associations were found between mental health and TL (Table 6 ).

Sensitivity analysis

Additional adjustment of the main analyses for perceived quality of social support, chronic disease or lifestyle score (in the association between the mental health outcomes and the biomarkers of ageing) did not strongly change the effect of our observations (Additional file 1 : Tables S5-S7). However, we noticed that most of the associations between severe psychological distress or suicidal ideation and mtDNAc showed marginally significant results.

In this study, we evaluated the associations between eight mental health and well-being outcomes, a healthy lifestyle score and 2 biomarkers of biological ageing: telomere length and mitochondrial DNA content. Having a healthy lifestyle was positively associated with all mental health and well-being indicators and the markers of biological ageing. Furthermore, having had suicidal ideation or suffering from severe psychological distress was associated with a lower mtDNAc. However, no association was found between mental health and TL.

In the first part of this research, we evaluated the association between lifestyle and mental health and well-being and showed that living a healthy lifestyle was positively associated with better mental health and well-being outcomes. Similar trends were found in previous studies for each of the health behaviours separately [ 11 , 12 , 46 , 47 , 48 ]. Although evaluating these health behaviours separately provides valuable information, assessing them in combination with each other rather than independently might better reflect the real-life situation as they often co-occur and may exert a synergistic effect on each other [ 24 , 25 , 49 ]. For example, 68% of the adults in England engaged in two or more unhealthy behaviours [ 25 ]. Especially, smoking status and alcohol consumption co-occurred, but half of the studies in the review by Noble et al. indicated clustering of all included health behaviours [ 24 ].

To date, the number of studies evaluating the combination of multiple health behaviours and mental health and well-being in adults is limited, and most of them use a different methodology to assess this association [ 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. Firstly, differences are found between the included health behaviours. Most studies included the four “SNAP” risk factors, i.e. smoking, poor nutrition, excess alcohol consumption and physical inactivity. Other health behaviours that were sometimes included were BMI/obesity, sleep duration/quality and psychological distress [ 50 , 53 , 54 , 56 ]. Secondly, differences are found in the scoring of the health behaviours and the use of the lifestyle score. Whereas in this study the health behaviours were scored categorically, studies often dichotomised the health behaviours and/or the final lifestyle score [ 50 , 52 , 53 , 56 ]. Also, two studies performed clustering [ 54 , 55 ]. Health behaviours can cluster together at both ends of the risk spectrum, but less is known about the middle categories. This is avoided by using the cluster method where participants are clustered based on similar behaviours. On the other hand, a lifestyle score can be of better use and more easily be interpreted when aiming to compare healthy versus unhealthy lifestyles, as was the case for this study.

Despite these different methods, all previously mentioned studies show similar results. Together with our findings, which also support these results, this provides clear evidence that an unhealthy lifestyle is associated with poor mental health and well-being outcomes. Important to notice is that, like our research, most studies in this field have a cross-sectional design and are therefore not able to assume causality. Therefore, mental health might be the cause or the consequence of an unhealthy lifestyle. Further prospective and longitudinal studies are warranted to confirm the direction of the association.

Healthy lifestyle and biomarkers of ageing

How lifestyle affects our health is not yet fully understood. One possible pathway is through oxidative stress and biological ageing. An unhealthy lifestyle has been associated with an increase in oxidative stress [ 57 , 58 , 59 ], and in turn, higher concentrations of oxidative stress are known to negatively affect TL and mtDNAc [ 60 ]. In this study, we showed that living a healthy lifestyle was associated with a longer TL and a higher mtDNAc. Our results showed a stronger association of lifestyle with mtDNAc compared with TL. TL is strongly determined by TL at birth [ 61 ]. On the other hand, mtDNAc might be more variable in shorter time periods. Although mtDNAc and TL were strongly correlated, this could explain why lifestyle is more strongly associated with mtDNAc. However, we can only speculate about this, and further research is necessary to confirm our results.

Similar as for the association with mental health, in previous studies, the biomarkers have been associated with health behaviours separately rather than combined [ 62 , 63 , 64 , 65 ]. To our knowledge, we are the first to evaluate the associations between a healthy lifestyle score and mtDNAc. Our results are in line with our expectations. As TL and mtDNAc are known to be correlated [ 60 ], we would expect similar trends for both biomarkers. In the case of TL, few studies included a combined lifestyle score in association with this biomarker. Consistent with our results, in a study population of 1661 men, the sum score of a healthier lifestyle was correlated with a longer TL [ 66 ]. Similar results were found by Sun et al. where a combination of healthy lifestyles in a female study population was associated with a longer TL compared with the least healthy group [ 67 ]. Also, improvement in lifestyle has been associated with TL maintenance in the elderly at risk for dementia [ 68 ], and a lifestyle intervention programme was positively associated with leucocyte telomere length in children and adolescents [ 69 ]. These results suggest that on a biological level, a healthy lifestyle is associated with healthy ageing. Within this context, a study on adults aged 60 and older showed that maintaining a normal weight, not smoking and performing regular physical activity were associated with slower development of disability and a reduction in mortality [ 70 ]. Similarly, midlife lifestyle factors like non-smoking, higher levels of physical activity, non-obesity and good social support have been associated with successful ageing, 22 years later [ 71 ].

Mental health and well-being and biomarkers of ageing

Finally, we evaluated the association between the biomarkers of ageing and the mental health and well-being outcomes. The hypothesis that biological ageing is associated with mental health has been supported by observations showing that chronically stressed or psychiatrically ill persons have a higher risk for age-related diseases like dementia, diabetes and hypertension [ 23 , 72 , 73 ]. Important to notice is that, like our research, the majority of studies on this topic have a cross-sectional design and therefore are unable to identify causality. Therefore, it is currently unknown whether psychological diseases accelerate biological ageing or whether biological ageing precedes the onset of these diseases [ 74 ].

Our results showed a lower mtDNAc for individuals with suicidal ideation or severe psychological distress but not for any of the other mental health outcomes. Evidence on the association between mtDNAc and mental health is inconsistent. Women above 60 years old with depression had a significantly lower mtDNAc compared with the control group [ 75 ]. Furthermore, individuals with a low mtDNAc had poorer outcomes in terms of self-rated health [ 76 ]. In contrast, Otsuka et al. showed a higher peripheral blood mtDNAc in suicide completers [ 77 ], and studies on major depressive syndrome [ 78 ] and self-rated health [ 79 ] showed the same trend. Finally, Vyas et al. showed no significant association between mtDNAc and depression status in mid-life and older adults [ 80 ]. These differences might be due to the differences in study population and methods. For example, the two studies indicating lower mtDNAc in association with poor mental health both had an elderly study population, and one study population consisted of psychiatrically ill patients. Next to that, differences were found in the type of samples, mtDNAc assays and questionnaires or diagnostics. The inconsistency of these studies and our results calls for further research on this association and for standardisation of methods within studies to enable clear comparisons.

As for TL, we did not find an association with any of the mental health and well-being outcomes. Previous studies in adults showed a lower TL in association with current but not remitted anxiety disorder [ 81 ], depressive [ 82 ] and major depressive disorder [ 73 , 83 ], childhood trauma [ 84 ] suicide [ 77 , 85 ], depressive symptoms in younger adults [ 86 ] and acculturative stress and postpartum depression in Latinx women [ 87 ]. Also, in a meta-analysis, psychiatric disorders overall were associated with a shorter leucocyte TL [ 88 ]. However, other studies failed to demonstrate an association between TL and mental health outcomes like major depressive disorder [ 89 ], late-life depression [ 90 ] and anxiety disorder [ 91 ]. Again, this could be due to a different method to assess the mental health outcomes, a different study design, uncontrolled confounding factors and the type of telomere assay. For example, a meta-analysis showed stronger associations with depression when using southern blot or FISH assay compared with qPCR to measure telomere length [ 92 ].

Strengths and limitations

An important strength of this study is the use of a validated lifestyle score that can easily be reproduced and used for other research on lifestyle. Secondly, we were able to use a large sample size for our analyses in the BHIS subset. Thirdly, by assessing multiple dimensions of mental health and well-being, we were able to give a comprehensive overview of the mental health status. To our knowledge, we are the first to evaluate the associations between a healthy lifestyle score and mtDNAc.

Our results should however be interpreted with consideration for some limitations. As mentioned before, the study has a cross-sectional design, and therefore, we cannot assume causality. Secondly, for the lifestyle score, we used self-reported data, which might not always represent the actual situation. For example, BMI values tend to be underestimated due to the overestimation of height and underestimation of weight [ 93 ], and also, smoking behaviour is often underestimated [ 94 ]. Also, equal weights were used for each of the health behaviours as no objective information was available on which weight should be given to a specific health behaviour. Thirdly, there is a distinct time lag between the completion of the BHIS questionnaire and the collection of the BELHES samples. The mean (SD) number of days is 52 (35). This is less than the period for suicidal ideation, assessed over the 12 previous months, but there might be a more limited overlap with the period for assessment of the other mental health variables, such as vitality and psychological distress, assessed over the last few weeks, and depressive and generalised anxiety disorders, assessed over the last 2 weeks. Fourthly, due to a non-response bias, the lowest socio-economic classes are less represented in our study population. This will not affect our dose–response associations but might affect the generalisability of our findings to the overall population. Finally, we do not have data on blood cell counts, which has been associated with mtDNAc [ 95 ].

In this large-scale study, we showed that living a healthy lifestyle was positively associated with mental health and well-being and, on a biological level, with a higher TL and mtDNAc, indicating healthy ageing. Furthermore, individuals with suicidal ideation or suffering from severe psychological distress had a lower mtDNAc. Our findings suggest that implementing strategies to incorporate healthy lifestyle changes in the public’s daily life could be beneficial for public health, and might offset the negative impact of environmental stressors. However, further studies are necessary to confirm our results and especially prospective and longitudinal studies are essential to determine causality of the associations.

Availability of data and materials

The dataset used for this study is available through a request to the Health Committee of the Data Protection Authority.

Abbreviations

Area under the curve

Body mass index

Confidence intervals

Generalised Anxiety Disorder Questionnaire

General Health Questionnaire

Inter-run calibrator

Mitochondrial DNA content

Patient Health Questionnaire

Relative operating characteristic curve

Short Form Health Survey

Telomere length

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Acknowledgements

We are grateful to all BHIS and BELHES participants for contributing to this study.

The HuBiHIS project is financed by Sciensano (PJ) N°: 1179–101. Dries Martens is a postdoctoral fellow of the Research Foundation—Flanders (FWO 12X9620N).

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Sciensano, Epidemiology and Public Health, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium

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PH drafted the paper. PH, NS, MD and ED set up the design of the study. NS, DM, JvdH, TN and ED reviewed and commented on the manuscript. All authors read and approved the final manuscript.

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TL, mtDNAc and single copy-gene reaction mixture and PCR cycling conditions. Table S1. The mental health indicators with their scores and uses. Table S2. Comparison of the characteristics of the 6,054 eligible BHIS participants that were included in the BHIS subset compared to the 1,838 eligible participants that were excluded from the BHIS subset. Table S3. Comparison of the characteristics of the 739 participants from the BHIS subset that were included in the BELHES subset compared to the 5,315 participants that were excluded from the BELHES subset. Table S4. Bivariate associations between the characteristics and telomere length (TL), mitochondrial DNA content (mtDNAc), the lifestyle score or psychological distress. Table S5. Results of the sensitivity analysis of the association between lifestyle and mental health. Table S6. Results of the sensitivity analysis of the association between lifestyle and the biomarkers of ageing. Table S7. Results of the sensitivity analysis of the association between mental health and the biomarkers of ageing. Fig. S1. Exclusion criteria. The BHIS subset consisted of 6,055 BHIS participants and the BELHES subset consisted of 739 BELHES participants. Fig. S2. Histogram of the lifestyle score. Fig. S3. Validation of the lifestyle score. ROC curve for the lifestyle score as a predictor for good to very good self-perceived health. The model was adjusted for age, sex, region, highest educational level in the household, household composition and country of birth.

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Hautekiet, P., Saenen, N.D., Martens, D.S. et al. A healthy lifestyle is positively associated with mental health and well-being and core markers in ageing. BMC Med 20 , 328 (2022). https://doi.org/10.1186/s12916-022-02524-9

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The Internet Has Made Health Anxiety Worse Than Ever

“Don’t google your cancer,” the oncology nurse said to me as she drew my blood ahead of my first round of chemotherapy. It was 2006 and I was 17 years old. I was very confused by the emphasis she put on this advice. Still, I took the print-out of “safe” web addresses she gave me home and pinned it on the noticeboard in the kitchen, where it stayed, ignored, as I slowly progressed through six months of cancer treatment.

I was confused because the opportunities for me to use the internet to research my recent diagnosis of Hodgkin’s Lymphoma, a kind of blood cancer, were minimal anyway. I didn’t own a smartphone or a laptop and my only access to the internet was in communal spaces: at school or via my family’s shared computer with its dial-up connection. The notion that I could use these public facilities to explore something as intensely private as my cancer didn’t even register as a possibility for me.

Read More: The Unique Hell of Getting Cancer as a Young Adult

Everything changed a year later when I learned that the treatment had not been effective and the cancer was back. Or it had never gone away in the first place, it was hard to tell. Standing petrified in my college dorm room, I found the lump in my neck myself and its malignant properties were quickly confirmed by scans and tests. The chance of this happening, I was told by my doctors, was less than 5%. I had been “unlucky.”

Now, I was no longer a regularly supervised schoolgirl and I owned my own computer. I was free to look up symptoms and side effects and death rates as much as I liked. The medical professionals were doing their best with my case, but naturally they couldn’t give me absolute certainty about what was going to happen. Desperately craving some concrete information about my future, I kept searching and searching until I literally scared myself sick. I would have to snap the laptop shut and lie down until this internet-induced nausea passed, worn out from a rigorous schedule of in-patient treatments and college classes.

With hindsight, I can now recognize this as an early sign of the hypochondria that would become such a feature of my life in my 20s The popular conception of hypochondria, or health anxiety as it is often termed in the modern medical lexicon, is that it is rooted in ignorance. Unable to know the full scientific story about this suspected lump or that twinge of pain either because of a lack of access to healthcare or fear of what a doctor might say, the anxious brain writes in a narrative to explain it—usually one that involves the worst possible scenario and a terminal illness.

This idea of the hypochondriac’s ignorance being “cured” with knowledge is a very old one. As I delved deeper into the fascinating yet convoluted history of this condition with my own searches, I became preoccupied with the so-called “glass men” of the middle ages, who experienced something called the glass delusion. Widely documented across Europe, these sufferers believed they were partly or wholly made of glass rather than human flesh, and the obsession with their fragile and breakable nature could come to dominate their whole life.

The 14th century French King Charles VI was a notable sufferer and in 1613 Cervantes published a whole novella about a “glass graduate” who experienced this. The treatment was simple: the “glass man” must be made to understand that he was not, in fact, made of glass. This was usually done by beating or squeezing him soundly until he acknowledged that he had not shattered into fragments. This proof, this extra knowledge of his resilience, would then cure him of the delusion.

But if hypochondria were truly cured by knowledge, advances in medicine would have made it a thing of the past. Yet anxiety disorders , including health anxiety, continue to be prevalent in countries with the most advanced healthcare systems. Hypochondria evolves and changes to keep pace with scientific knowledge. Where once people feared that they were made of glass or that an excess of black bile was making them melancholy, now they worry that they have brain tumours or long COVID-19. At every stage of medical progress, hypochondria is right there with us.

Read More: How to Tell If Your Health Concerns Are Normal—Or a Sign of Something More

Indeed, research shows that the prevalence of health anxiety is increasing among those who attend medical clinics—suggesting that more contact with medical knowledge is making our fears worse, rather than ridding us of them. This has been partly attributed to the rise of “cyberchondria,” in which anxieties about health escalate as a result of information found online. First used in the early 2000s, this word describes the pattern of excessive internet searching that I fell into after my cancer was declared cured, when my every twinge and sniff seemed to me to be a sign that the tumours were back.

I rationalized this behavior, as I think a lot of people with pre-existing conditions do, as simply being responsible or cautious about my health. Having already found a tumour once when my disease was supposed to be cured, I was hypervigilant against it happening again. Googling my every symptom and falling down a never-ending rabbit hole of research papers, online forums and wellness podcasts was just me being a good patient, I would tell myself.

It wasn’t excessive because I had such a complicated medical history. Doctors had told me to “keep an eye out” for possible symptoms and that was all I was doing. It took a lot of therapy and self-examination for me to realise that all of this extra information wasn’t affecting my medical outcomes positively at all: if anything, it was making me feel worse, not better.

Even with this awareness, it can be difficult to escape the clutches of cyberchondria. At times, it feels as though the whole internet is designed to magnify my fears. Typing “does headache mean…” into Google gives me, among others, the suggestions “miscarriage”, “concussion” and “brain tumour”, which are all rather more serious issues than the far more common and likely causes of “dehydration”, “stressed about work” and “lack of fresh air”.

The “escalation” mechanism that experts have identified as a tool in online political radicalisation operates in this field too. Just typing what feels like a mundane health query into a search engine can be the first step in a journey that leads to disinformation, self-diagnosis, and severe anxiety. Worse, there is evidence that the so-called “worried well”, with their health anxiety and their cyberchondria, can be up to 70% more likely to develop cardiac problems. All this worrying can make the worst happen, it would seem.

Knowing what I do now, I have immense respect for the foresight of my oncology nurse back in 2006. She said then that googling my cancer was a bad idea, and she was right, even though the true power of cyberchondria had not yet been unleashed by our constantly-online existence. The list of approved resources she gave me that day included only my healthcare provider’s website, a patient’s guide published by a cancer charity, a couple of online medical dictionaries and some academic publishers. This is what I restrict myself to today, even though sometimes my fingertips tingle with the desire to search more widely. I could click, and click, and click, until I am sick forever.

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Black Americans Have a Clear Vision for Reducing Racism but Little Hope It Will Happen

Many say key U.S. institutions should be rebuilt to ensure fair treatment

Table of contents.

Black Americans see little improvement in their lives despite increased national attention to racial issues
Few Black adults expect equality for Black people in the U.S.
Black adults say racism and police brutality are extremely big problems for Black people in the U.S.
Personal experiences with discrimination are widespread among Black Americans
Black adults see voting as the most effective strategy for moving toward equality in the U.S.
Some Black adults see Black businesses and communities as effective remedies for inequality
Black Americans say race matters little when choosing political allies
The legacy of slavery affects Black Americans today
Most Black adults agree the descendants of enslaved people should be repaid
The types of repayment Black adults think would be most helpful
Responsibility for reparations and the likelihood repayment will occur
Black adults say the criminal justice system needs to be completely rebuilt
Black adults say political, economic and health care systems need major changes to ensure fair treatment
Most Black adults say funding for police departments should stay the same or increase
Acknowledgments
Appendix: Supplemental tables
The American Trends Panel survey methodology

Photo showing visitors at the Martin Luther King Jr. Memorial in Washington, D.C. (Astrid Riecken/picture alliance via Getty Images)

Pew Research Center conducted this analysis to understand the nuances among Black people on issues of racial inequality and social change in the United States. This in-depth survey explores differences among Black Americans in their views on the social status of the Black population in the U.S.; their assessments of racial inequality; their visions for institutional and social change; and their outlook on the chances that these improvements will be made. The analysis is the latest in the Center’s series of in-depth surveys of public opinion among Black Americans (read the first, “ Faith Among Black Americans ” and “ Race Is Central to Identity for Black Americans and Affects How They Connect With Each Other ”).

The online survey of 3,912 Black U.S. adults was conducted Oct. 4-17, 2021. Black U.S. adults include those who are single-race, non-Hispanic Black Americans; multiracial non-Hispanic Black Americans; and adults who indicate they are Black and Hispanic. The survey includes 1,025 Black adults on Pew Research Center’s American Trends Panel (ATP) and 2,887 Black adults on Ipsos’ KnowledgePanel. Respondents on both panels are recruited through national, random sampling of residential addresses.

Recruiting panelists by phone or mail ensures that nearly all U.S. Black adults have a chance of selection. This gives us confidence that any sample can represent the whole population (see our Methods 101 explainer on random sampling). Here are the questions used for the survey of Black adults, along with its responses and methodology .

The terms “Black Americans,” “Black people” and “Black adults” are used interchangeably throughout this report to refer to U.S. adults who self-identify as Black, either alone or in combination with other races or Hispanic identity.

Throughout this report, “Black, non-Hispanic” respondents are those who identify as single-race Black and say they have no Hispanic background. “Black Hispanic” respondents are those who identify as Black and say they have Hispanic background. We use the terms “Black Hispanic” and “Hispanic Black” interchangeably. “Multiracial” respondents are those who indicate two or more racial backgrounds (one of which is Black) and say they are not Hispanic.

Respondents were asked a question about how important being Black was to how they think about themselves. In this report, we use the term “being Black” when referencing responses to this question.

In this report, “immigrant” refers to people who were not U.S. citizens at birth – in other words, those born outside the U.S., Puerto Rico or other U.S. territories to parents who were not U.S. citizens. We use the terms “immigrant,” “born abroad” and “foreign-born” interchangeably.

Throughout this report, “Democrats and Democratic leaners” and just “Democrats” both refer to respondents who identify politically with the Democratic Party or who are independent or some other party but lean toward the Democratic Party. “Republicans and Republican leaners” and just “Republicans” both refer to respondents who identify politically with the Republican Party or are independent or some other party but lean toward the Republican Party.

Respondents were asked a question about their voter registration status. In this report, respondents are considered registered to vote if they self-report being absolutely certain they are registered at their current address. Respondents are considered not registered to vote if they report not being registered or express uncertainty about their registration.

To create the upper-, middle- and lower-income tiers, respondents’ 2020 family incomes were adjusted for differences in purchasing power by geographic region and household size. Respondents were then placed into income tiers: “Middle income” is defined as two-thirds to double the median annual income for the entire survey sample. “Lower income” falls below that range, and “upper income” lies above it. For more information about how the income tiers were created, read the methodology .

Bar chart showing after George Floyd’s murder, half of Black Americans expected policy changes to address racial inequality, After George Floyd’s murder, half of Black Americans expected policy changes to address racial inequality

More than a year after the murder of George Floyd and the national protests, debate and political promises that ensued, 65% of Black Americans say the increased national attention on racial inequality has not led to changes that improved their lives. 1 And 44% say equality for Black people in the United States is not likely to be achieved, according to newly released findings from an October 2021 survey of Black Americans by Pew Research Center.

This is somewhat of a reversal in views from September 2020, when half of Black adults said the increased national focus on issues of race would lead to major policy changes to address racial inequality in the country and 56% expected changes that would make their lives better.

At the same time, many Black Americans are concerned about racial discrimination and its impact. Roughly eight-in-ten say they have personally experienced discrimination because of their race or ethnicity (79%), and most also say discrimination is the main reason many Black people cannot get ahead (68%).

Even so, Black Americans have a clear vision for how to achieve change when it comes to racial inequality. This includes support for significant reforms to or complete overhauls of several U.S. institutions to ensure fair treatment, particularly the criminal justice system; political engagement, primarily in the form of voting; support for Black businesses to advance Black communities; and reparations in the forms of educational, business and homeownership assistance. Yet alongside their assessments of inequality and ideas about progress exists pessimism about whether U.S. society and its institutions will change in ways that would reduce racism.

These findings emerge from an extensive Pew Research Center survey of 3,912 Black Americans conducted online Oct. 4-17, 2021. The survey explores how Black Americans assess their position in U.S. society and their ideas about social change. Overall, Black Americans are clear on what they think the problems are facing the country and how to remedy them. However, they are skeptical that meaningful changes will take place in their lifetime.

Black Americans see racism in our laws as a big problem and discrimination as a roadblock to progress

Bar chart showing about six-in-ten Black adults say racism and police brutality are extremely big problems for Black people in the U.S. today

Black adults were asked in the survey to assess the current nature of racism in the United States and whether structural or individual sources of this racism are a bigger problem for Black people. About half of Black adults (52%) say racism in our laws is a bigger problem than racism by individual people, while four-in-ten (43%) say acts of racism committed by individual people is the bigger problem. Only 3% of Black adults say that Black people do not experience discrimination in the U.S. today.

In assessing the magnitude of problems that they face, the majority of Black Americans say racism (63%), police brutality (60%) and economic inequality (54%) are extremely or very big problems for Black people living in the U.S. Slightly smaller shares say the same about the affordability of health care (47%), limitations on voting (46%), and the quality of K-12 schools (40%).

Aside from their critiques of U.S. institutions, Black adults also feel the impact of racial inequality personally. Most Black adults say they occasionally or frequently experience unfair treatment because of their race or ethnicity (79%), and two-thirds (68%) cite racial discrimination as the main reason many Black people cannot get ahead today.

Black Americans’ views on reducing racial inequality

Bar chart showing many Black adults say institutional overhauls are necessary to ensure fair treatment

Black Americans are clear on the challenges they face because of racism. They are also clear on the solutions. These range from overhauls of policing practices and the criminal justice system to civic engagement and reparations to descendants of people enslaved in the United States.

Changing U.S. institutions such as policing, courts and prison systems

About nine-in-ten Black adults say multiple aspects of the criminal justice system need some kind of change (minor, major or a complete overhaul) to ensure fair treatment, with nearly all saying so about policing (95%), the courts and judicial process (95%), and the prison system (94%).

Roughly half of Black adults say policing (49%), the courts and judicial process (48%), and the prison system (54%) need to be completely rebuilt for Black people to be treated fairly. Smaller shares say the same about the political system (42%), the economic system (37%) and the health care system (34%), according to the October survey.

While Black Americans are in favor of significant changes to policing, most want spending on police departments in their communities to stay the same (39%) or increase (35%). A little more than one-in-five (23%) think spending on police departments in their area should be decreased.

Black adults who favor decreases in police spending are most likely to name medical, mental health and social services (40%) as the top priority for those reappropriated funds. Smaller shares say K-12 schools (25%), roads, water systems and other infrastructure (12%), and reducing taxes (13%) should be the top priority.

Voting and ‘buying Black’ viewed as important strategies for Black community advancement

Black Americans also have clear views on the types of political and civic engagement they believe will move Black communities forward. About six-in-ten Black adults say voting (63%) and supporting Black businesses or “buying Black” (58%) are extremely or very effective strategies for moving Black people toward equality in the U.S. Smaller though still significant shares say the same about volunteering with organizations dedicated to Black equality (48%), protesting (42%) and contacting elected officials (40%).

Black adults were also asked about the effectiveness of Black economic and political independence in moving them toward equality. About four-in-ten (39%) say Black ownership of all businesses in Black neighborhoods would be an extremely or very effective strategy for moving toward racial equality, while roughly three-in-ten (31%) say the same about establishing a national Black political party. And about a quarter of Black adults (27%) say having Black neighborhoods governed entirely by Black elected officials would be extremely or very effective in moving Black people toward equality.

Most Black Americans support repayment for slavery

Discussions about atonement for slavery predate the founding of the United States. As early as 1672 , Quaker abolitionists advocated for enslaved people to be paid for their labor once they were free. And in recent years, some U.S. cities and institutions have implemented reparations policies to do just that.

Most Black Americans say the legacy of slavery affects the position of Black people in the U.S. either a great deal (55%) or a fair amount (30%), according to the survey. And roughly three-quarters (77%) say descendants of people enslaved in the U.S. should be repaid in some way.

Black adults who say descendants of the enslaved should be repaid support doing so in different ways. About eight-in-ten say repayment in the forms of educational scholarships (80%), financial assistance for starting or improving a business (77%), and financial assistance for buying or remodeling a home (76%) would be extremely or very helpful. A slightly smaller share (69%) say cash payments would be extremely or very helpful forms of repayment for the descendants of enslaved people.

Where the responsibility for repayment lies is also clear for Black Americans. Among those who say the descendants of enslaved people should be repaid, 81% say the U.S. federal government should have all or most of the responsibility for repayment. About three-quarters (76%) say businesses and banks that profited from slavery should bear all or most of the responsibility for repayment. And roughly six-in-ten say the same about colleges and universities that benefited from slavery (63%) and descendants of families who engaged in the slave trade (60%).

Black Americans are skeptical change will happen

Bar chart showing little hope among Black adults that changes to address racial inequality are likely

Even though Black Americans’ visions for social change are clear, very few expect them to be implemented. Overall, 44% of Black adults say equality for Black people in the U.S. is a little or not at all likely. A little over a third (38%) say it is somewhat likely and only 13% say it is extremely or very likely.

They also do not think specific institutions will change. Two-thirds of Black adults say changes to the prison system (67%) and the courts and judicial process (65%) that would ensure fair treatment for Black people are a little or not at all likely in their lifetime. About six-in-ten (58%) say the same about policing. Only about one-in-ten say changes to policing (13%), the courts and judicial process (12%), and the prison system (11%) are extremely or very likely.

This pessimism is not only about the criminal justice system. The majority of Black adults say the political (63%), economic (62%) and health care (51%) systems are also unlikely to change in their lifetime.

Black Americans’ vision for social change includes reparations. However, much like their pessimism about institutional change, very few think they will see reparations in their lifetime. Among Black adults who say the descendants of people enslaved in the U.S. should be repaid, 82% say reparations for slavery are unlikely to occur in their lifetime. About one-in-ten (11%) say repayment is somewhat likely, while only 7% say repayment is extremely or very likely to happen in their lifetime.

Black Democrats, Republicans differ on assessments of inequality and visions for social change

Bar chart showing Black adults differ by party in their views on racial discrimination and changes to policing

Party affiliation is one key point of difference among Black Americans in their assessments of racial inequality and their visions for social change. Black Republicans and Republican leaners are more likely than Black Democrats and Democratic leaners to focus on the acts of individuals. For example, when summarizing the nature of racism against Black people in the U.S., the majority of Black Republicans (59%) say racist acts committed by individual people is a bigger problem for Black people than racism in our laws. Black Democrats (41%) are less likely to hold this view.

Black Republicans (45%) are also more likely than Black Democrats (21%) to say that Black people who cannot get ahead in the U.S. are mostly responsible for their own condition. And while similar shares of Black Republicans (79%) and Democrats (80%) say they experience racial discrimination on a regular basis, Republicans (64%) are more likely than Democrats (36%) to say that most Black people who want to get ahead can make it if they are willing to work hard.

On the other hand, Black Democrats are more likely than Black Republicans to focus on the impact that racial inequality has on Black Americans. Seven-in-ten Black Democrats (73%) say racial discrimination is the main reason many Black people cannot get ahead in the U.S, while about four-in-ten Black Republicans (44%) say the same. And Black Democrats are more likely than Black Republicans to say racism (67% vs. 46%) and police brutality (65% vs. 44%) are extremely big problems for Black people today.

Black Democrats are also more critical of U.S. institutions than Black Republicans are. For example, Black Democrats are more likely than Black Republicans to say the prison system (57% vs. 35%), policing (52% vs. 29%) and the courts and judicial process (50% vs. 35%) should be completely rebuilt for Black people to be treated fairly.

While the share of Black Democrats who want to see large-scale changes to the criminal justice system exceeds that of Black Republicans, they share similar views on police funding. Four-in-ten each of Black Democrats and Black Republicans say funding for police departments in their communities should remain the same, while around a third of each partisan coalition (36% and 37%, respectively) says funding should increase. Only about one-in-four Black Democrats (24%) and one-in-five Black Republicans (21%) say funding for police departments in their communities should decrease.

Among the survey’s other findings:

Black adults differ by age in their views on political strategies. Black adults ages 65 and older (77%) are most likely to say voting is an extremely or very effective strategy for moving Black people toward equality. They are significantly more likely than Black adults ages 18 to 29 (48%) and 30 to 49 (60%) to say this. Black adults 65 and older (48%) are also more likely than those ages 30 to 49 (38%) and 50 to 64 (42%) to say protesting is an extremely or very effective strategy. Roughly four-in-ten Black adults ages 18 to 29 say this (44%).

Gender plays a role in how Black adults view policing. Though majorities of Black women (65%) and men (56%) say police brutality is an extremely big problem for Black people living in the U.S. today, Black women are more likely than Black men to hold this view. When it comes to criminal justice, Black women (56%) and men (51%) are about equally likely to share the view that the prison system should be completely rebuilt to ensure fair treatment of Black people. However, Black women (52%) are slightly more likely than Black men (45%) to say this about policing. On the matter of police funding, Black women (39%) are slightly more likely than Black men (31%) to say police funding in their communities should be increased. On the other hand, Black men are more likely than Black women to prefer that funding stay the same (44% vs. 36%). Smaller shares of both Black men (23%) and women (22%) would like to see police funding decreased.

Income impacts Black adults’ views on reparations. Roughly eight-in-ten Black adults with lower (78%), middle (77%) and upper incomes (79%) say the descendants of people enslaved in the U.S. should receive reparations. Among those who support reparations, Black adults with upper and middle incomes (both 84%) are more likely than those with lower incomes (75%) to say educational scholarships would be an extremely or very helpful form of repayment. However, of those who support reparations, Black adults with lower (72%) and middle incomes (68%) are more likely than those with higher incomes (57%) to say cash payments would be an extremely or very helpful form of repayment for slavery.

Black adults in the September 2020 survey only include those who say their race is Black alone and are non-Hispanic. The same is true only for the questions of improvements to Black people’s lives and equality in the United States in the October 2021 survey. Throughout the rest of this report, Black adults include those who say their race is Black alone and non-Hispanic; those who say their race is Black and at least one other race and non-Hispanic; or Black and Hispanic, unless otherwise noted. ↩

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EU Health Data Space: more efficient treatments and life-saving research

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Citizens will have access across the EU to an electronic health record containing prescriptions, imagery and lab tests
Anonymised health data to be shared for research e.g. into rare diseases
Strong privacy safeguards governing how and for what purpose sensitive data are shared

MEPs approved the creation of a European Health Data Space, improving citizens’ access to their personal health data and boosting secure sharing in the public interest.

On Wednesday, MEPs voted with 445 in favour and 142 against (39 abstentions) to approve the inter-institutional agreement on establishing a European Health Data Space. It will empower patients to access their health data in an electronic format, including from a different member state to the one in which they live, and allow health professionals to consult their patients’ files with their consent (so-called primary use), also from other EU countries. These electronic health records (EHR) would include patient summaries, electronic prescriptions, medical imagery and laboratory results.

The law will make it possible to transfer health data safely to health professionals in other EU countries (based on MyHealth@EU infrastructure), for example when citizens move to another state. It will be possible to download the health record free of charge.

Data-sharing for the common good with safeguards

Additionally, the Health Data Space would unleash the research potential of health data in an anonymised or pseudonymised format. Data including health records, clinical trials, pathogens, health claims and reimbursements, genetic data, public health registry information, wellness data and information on healthcare resources, expenditure and financing, could be processed for public interest purposes, including research, statistics and policy-making (so-called secondary use). Data could, for example, be used to find treatments for rare diseases, where small datasets and fragmentation currently prevent advances in treatments.

Secondary use will not be allowed for commercial purposes including advertising, assessing insurance requests or lending conditions or making job market decisions. Access decisions will be made by national data access bodies.

Robust privacy safeguards

The law ensures people will have a say in how their data are used and accessed. Patients will be able to refuse their health data being accessed by practitioners (except where this is necessary for protecting the vital interests of the data subject or another person) or processed for research purposes, apart from certain public-interest, policy-making or statistical purposes. Patients will also have to be informed each time their data are accessed, and will have the right to request corrections to incorrect data.

Tomislav Sokol (EPP, Croatia), Environment Committee co-rapporteur, said: "The Health Data Space can help us to leverage the data we have in a safe and secure manner, giving vital research into new treatments a major boost. It will prevent gaps in treatment by making sure health professional can access their patients’ records across borders. At the same time, opt-outs will ensure that patients have a say, and that the system is trustworthy. It will be a major step forward for digital healthcare in the EU."

Annalisa Tardino (ID, Italy), Civil Liberties Committee co-rapporteur, said: “The Health Data Space will boost everyone's access to healthcare. In future, doctors can be authorised to access their patients’ health records and laboratory results in other regions, or even other EU member states, saving money, resources and providing better cures. We also secured opt-outs to ensure that patients have a say in how their data are used. Although we would have preferred even stronger measures, we were able to find a position that can be accepted by a majority."

The provisional agreement still needs to be formally approved by the Council. Once published in the EU’s Official Journal, it will enter into force twenty days later. It will be applied two years after, with certain exceptions, including primary and secondary use of data categories, which will apply four to six years later, depending on the category..

By adopting the law, Parliament is responding to the demands of citizens put forward in the conclusions of the Conference of the Future of Europe. These include proposal 8(1), which explicitly recommended the creation of a health data space to facilitate exchanges, and proposals 35(7) and 35(8) on data and artificial intelligence.

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UnitedHealth says Change hackers stole health data on ‘substantial proportion of people in America’

The health tech giant handles health data for about half of all americans.

Health insurance giant UnitedHealth Group has confirmed that a ransomware attack on its health tech subsidiary Change Healthcare earlier this year resulted in a huge theft of Americans’ private healthcare data.

UnitedHealth said in a statement on Monday that a ransomware gang took files containing personal data and protected health information that it says may “cover a substantial proportion of people in America.”

The health insurance giant did not say how many Americans are affected but said the data review was “likely to take several months” before the company would begin notifying individuals that their information was stolen in the cyberattack.

Change Healthcare processes insurance and billing for hundreds of thousands of hospitals, pharmacies and medical practices across the U.S. healthcare sector; it has access to massive amounts of health information on about half of all Americans.

UnitedHealth said it had not yet seen evidence that doctors’ charts or full medical histories were exfiltrated from its systems.

The admission that hackers stole Americans’ health data comes a week after a new hacking group began publishing portions of the stolen data in an effort to extort a second ransom demand from the company.

The gang, which calls itself RansomHub, published several files on its dark web leak site containing personal information about patients across an array of documents, some of which included internal files related to Change Healthcare. RansomHub said it would sell the stolen data unless Change Healthcare paid a ransom.

In a statement provided to TechCrunch, UnitedHealth spokesperson Tyler Mason confirmed the company paid the cybercriminals. “A ransom was paid as part of the company’s commitment to do all it could to protect patient data from disclosure.” The company would not confirm the amount it paid.

RansomHub is the second gang to demand a ransom from Change Healthcare. The health tech giant reportedly paid $22 million to a Russia-based criminal gang called ALPHV in March, which then disappeared, stiffing the affiliate that carried out the data theft out of their portion of the ransom.

RansomHub claimed in its post alongside the published stolen data that “we have the data and not ALPHV.”

In its statement Monday, UnitedHealth acknowledged the publication of some of the files but stopped short of claiming ownership of the documents. “This is not an official breach notification,” UnitedHealth said.

The Wall Street Journal reported Monday that the criminal hacking affiliate of ALPHV broke into Change Healthcare’s network using stolen credentials for a system that allows remote access to its network. The hackers were in Change Healthcare’s network for more than a week before deploying ransomware, allowing the hackers to steal significant amounts of data from the company’s systems.

The cyberattack at Change Healthcare began on February 21 and resulted in ongoing widespread outages at pharmacies and hospitals across the United States. For weeks, physicians, pharmacies and hospitals could not verify patient benefits for dispensing medications, organizing inpatient care, or processing prior authorizations necessary for surgeries.

Much of the U.S. healthcare system ground to a halt, with healthcare providers facing financial pressure as backlogs grow and outages linger.

UnitedHealth reported last week that the ransomware attack has cost it more than $870 million in losses. The company reported it made $99.8 billion in revenue during the first three months of the year, faring better than what Wall Street analysts had expected.

UnitedHealth CEO Andrew Witty, who received close to $21 million in total compensation the full year of 2022, is set to testify to House lawmakers on May 1 .

Updated with comment from UnitedHealth.

Want to see an NHS doctor? Prepare to cough up your data first.

Sophia Bush Says Romance With Girlfriend Ashlyn Harris Feels 'Fated': All About Their Sweet Relationship

The One Tree Hill star and former USWNT player bonded over their respective divorces.

preview for Sophia Bush's Natural Beauty Tips

On April 25, the One Tree Hill star came out as queer in a Glamour personal essay, encouraging others to "do the brave thing." And, along the way, she opened up about her relationship with the former USWNT player.

The longtime pals ended up getting closer last year as both were going through divorce, Sophia wrote. Their friendship blossomed into something more, with Sophia writing that their first date felt like "a sparkly moment [that] maybe the universe had been conspiring for me."

"I am absolutely in awe of her relentless integrity," Sophia wrote of Ashlyn . "Seeing Ashlyn choose to not simply survive, but thrive, for her babies has been the most beautiful thing I’ve ever witnessed a friend do. And now I get to love her. How lucky am I?"

Here's everything you need to know about Sophia and Ashlyn's relationship.

They bonded over their respective divorces.

In the essay, Sophia explained while she was separating from her former husband in the summer of 2023, she relied on the support of the women in her life, including Ashlyn. The pair met at a Cannes conference in 2019, Sophia shared, and quickly became part of the same friend group, who were all navigating divorce. (Ashlyn filed for divorce from ex Ali Krieger in 2023.)

"I didn’t expect to find love in this support system," she said. "I don’t know how else to say it other than: I didn’t see it until I saw it. And I think it’s very easy not to see something that’s been in front of your face for a long time when you’d never looked at it as an option and you had never been looked at as an option. What I saw was a friend with her big, happy life. And now I know she thought the same thing about me."

Sophia asked Ashlyn out to dinner.

Sophia said it only became clear to her that she and Ashlyn could become romantic when their other friends began pointing it out. "It really took other people in our safe support bubble pointing out to me how we’d finish each other’s sentences or be deeply affected by the same things," she said. "When you’re so in the trenches of hardship—plus you have the added weight of having to go through it on a public stage—it can be hard to see anything but what’s right in front of you."

After "countless sessions of therapy" and "some prodding from loved ones," Sophia took a leap of faith and asked Ashlyn out to dinner.

“That meal was four and a half hours long and truly one of the most surreal experiences of my life thus far. In hindsight, maybe it all had to happen slowly and then suddenly all at once,” Sophia wrote. “Maybe it was all fated. Maybe it really is a version of invisible string theory. I don’t really know. But I do know that for a sparkly moment, I felt like maybe the universe had been conspiring for me. And that feeling that I have in my bones is one I’ll hold on to no matter where things go from here.”

Since their first date, the two have been spotted out on numerous occasions, including a Mariah Carey concert in November, Art Basel in December, and Elton John's Oscars party in March.

Sophia admires Ashlyn’s parenting.

Ashlyn shares two children her ex-wife, a daughter named Sloane and a son named Ocean. And the way Ashlyn dotes on her babies has made Sophia fall in love with her even more.

The relationship has even brought Sophia closer to her own mother, she wrote.

"The way she prioritizes and centers her kids, not only in her life but in the core of her being, is breathtaking to behold," she said. "Falling in love with her has sutured some of my own childhood wounds, and made me so much closer to my own mother."

Sophia has defended the relationship from online haters.

In the essay, Sophia directly calls out fans who have accused her of leaving her marriage because of "some hysterical rendezvous," rather than "having taken over a year to do the most soul-crushing work of my life."

She also defended the relationship from "blatant lies" and "accusations of being a homewrecker." (Shortly after Ashlyn and Ali's divorce went public in September 2023, it was reported that Sophia and Ashlyn were dating.)

"People looking in from the outside weren’t privy to just how much time it took, how many painful conversations were had," she wrote. "A lot of effort was made to be graceful with other people’s processing, their time and obligations, and their feelings. What felt like seconds after I started to see what was in front of me, the online rumor mill began to spit in the ugliest ways."

“It’s painful to be doing deep work and have it picked apart by clueless strangers," she continued. "Everyone that matters to me knows what’s true and what isn’t. But even still, there’s a part of me that’s a ferocious defender who wants to correct the record piece by piece. But my better self, with her earned patience, has to sit back and ask, What’s the f*cking point? For who? For internet trolls? No, thank you. I’ll spend my precious time doing things I love instead."

Sophia's parents are big fans of Ashlyn.

Ashlyn and Sophia now stronger than ever, with Sophia writing that it took her "41 years" to experience this kind of "real joy."

Sophia’s parents love the pairing, too. “I really love who I am, at this age and in this moment," she said. "I’m so lucky that my parents, having spent time with Ash over the holidays, said, ‘Well, this finally looks right.’”

So happy for these two!

Jacqueline Tempera is an award-winning writer and reporter living in New Jersey with her many pets. She is a business owner and a double Scorpio who loves all things astrology and reality television. She is passionate about body diversity and representation, mental health, and the fight to end sexual assault and harassment. To learn more about Jackie, follow her on Instagram @jacktemp or visit her website at jackietempera.com .

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Early trauma cuts life short for squirrels, and climate change could make matters worse

Life in the Yukon can be tough for young red squirrels.

Frigid winters, food scarcity, intense competition for territories and the threat of becoming prey to large predators like the Canada lynx are just some of the trials they face.

Early-life struggles and trauma can literally get under their skin, affecting long-term survival, said Lauren Petrullo, a University of Arizona assistant professor in the Department of Ecology and Evolutionary Biology. Scientists want to know what factors, if any, can buffer young squirrels against these threats.

Petrullo is part of the Kluane Red Squirrel Project, a multi-university long-term field project involving the University of Alberta, University of Michigan, University of Colorado Boulder and University of Saskatchewan. The project has tracked and studied thousands of wild North American red squirrels in the southwestern part of Canada's Yukon territory for over 30 years.

A new study -- which Petrullo led with David Delaney, a postdoctoral fellow at the University of Colorado Boulder -- finds that the more challenges young squirrels face in the year they are born, the shorter their adult lifespan.

Red squirrels who make it past their first year of life live about 3 1/2 years, on average, but early life adversity can cut life expectancy by at least 14%.

But there's a big caveat.

"The ecosystem red squirrels inhabit in this region is unique," Petrullo said. "Every three to seven years, their favorite food -- seed from cones of white spruce trees -- is produced in superabundance during what we call a food boom. We found that these booms, even though rare, can interrupt the biological embedding of early-life adversity. If a squirrel had a harsh first year of life, if they were lucky enough to experience a food boom in their second year of life, they lived just as long -- if not longer -- in spite of early-life adversity."

The team replicated a food boom by offering wild squirrels in the Yukon peanut butter as a supplemental food source. The peanut butter didn't have the same effect as the naturally occurring food boom did.

"This suggests that the buffering effect we see is not really just about an increase in available calories," Petrullo said. "It's probably about shifts in larger population-level dynamics, like competition."

What squirrels can teach us about humans

Petrullo and her colleagues are eager to tease out the mechanisms that link squirrels' early developmental conditions with later-life survival. What they learn could inform scientific understanding of human resilience, too.

"Our findings in red squirrels echo what we know about how early-life adversity can shorten adult lifespan in humans and other primates," Petrullo said. "Humans vary widely in how vulnerable or resilient they are to challenges faced during early development. Our study demonstrates that future environmental quality might be an important factor that can explain why some individuals appear to be more, or less, susceptible to the consequences of early-life adversity."

While it might be surprising that scientists can glean insights about human resilience from wild red squirrels, Petrullo pointed out that squirrels are rodents, and rodents are commonly used as models for humans in laboratory settings.

"Many lab experiments have limited relevance for broader dynamics between ecology and evolution, because it can be hard to really replicate the ecological challenges that animals have evolved to cope with in a lab setting," she said.

Wild red squirrels, on the other hand, allow for such investigations and are an especially useful study group for questions regarding the early-life environment, Petrullo said. Although growing up as a young squirrel in the Yukon can be difficult, with lots of things making early development challenging, there are also things that can go right.

"Some red squirrels have the luck of being born into gentler early environments, akin to being born with a silver spoon," Petrullo said. "Because of this, we've got this really nice individual variation in early-life environmental quality across a natural ecological environment."

This environment, however, is expected to experience a great deal of change as global temperatures continue to rise.

"As food boom patterns begin to change," Petrullo said, "the pathways that connect early-life experiences and lifespan may change as well, potentially offering important insight into how animals may adapt to increasingly challenging environments."

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Materials provided by University of Arizona . Note: Content may be edited for style and length.

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Red squirrel

Journal Reference :

Lauren Petrullo, David Delaney, Stan Boutin, Jeffrey E. Lane, Andrew G. McAdam, Ben Dantzer. A future food boom rescues the negative effects of early-life adversity on adult lifespan in a small mammal . Proceedings of the Royal Society B: Biological Sciences , 2024; 291 (2021) DOI: 10.1098/rspb.2023.2681

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Initiation and maintenance of lifestyle changes among participants in a healthy life centre: a qualitative study

Cille h. sevild.

1 Department of Public Health, University of Stavanger, Stavanger, Norway

2 Center for Health Promotion, Research Unit, Stavanger, Norway

Christopher P. Niemiec

3 Department of Psychology, University of Rochester, Rochester, USA

4 Centre for Learning Environment, University of Stavanger, Stavanger, Norway

Lars Edvin Bru

Sindre m. dyrstad, anne marie lunde husebø, associated data.

The data used in the current study are not publicly available, yet they can be made available (anonymized) by CHS upon reasonable request so long as permission for data storage is applicable.

Since the early 2000s, Healthy Life Centres have been established in Norway to promote physical and mental health. Yet to date, little is known about the efficacy of Healthy Life Centres in promoting health behaviour change and maintenance or the factors that underlie these processes. Accordingly, the aim of the current study was to examine the factors that participants in a Healthy Life Centre perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet.

Participants were purposely recruited from among adherers in a 12-month multi-method research project at a Healthy Life Centre. Individual, semi-structured interviews were conducted with 8 women and 6 men who were between the ages of 20 and 61 years old. Data were analysed using Systematic Text Condensation.

Three main themes were derived from this analysis. The first theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. The second theme focused on strategies for coping with the challenges and potential pitfalls that were associated with various unpleasant experiences and life events. The third theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes.

The current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants’ experiences. In line with self-determination theory, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritizations in order to balance healthy lifestyle behaviours with the routines of “daily life” while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways.

On average each year, 71% of all mortalities globally occur from non-communicable diseases (NCDs), and the risk of NCDs is increased by lifestyle behaviours such as physical inactivity and unhealthy diet [ 1 , 2 ]. Indeed, the percentage of individuals in high-income Western countries who do not meet their recommended level for physical activity is alarmingly high [ 3 , 4 ], and health-depleting diets are consumed around the world [ 5 ]. These risk factors for NCDs can be lowered through modification of lifestyle behaviours [ 2 ]. Yet these modifications are remarkably difficult to achieve, as previous research on maintenance of treatment gains around physical activity and diet is limited [ 6 ] and equivocal [ 7 ].

Since the early 2000s, the Norwegian Directorate of Health has recommended establishing Healthy Life Centres (HLCs) as a part of primary health care services in Norway. The main goal of the HLCs is to promote physical and mental health through structured, individual and group experiences that focus on physical activity and diet [ 8 ]. Yet to date, little is known about whether or not HLCs can successfully promote behaviour change and maintenance. For instance, one study revealed that participants in HLCs did not report an increased level of physical activity [ 9 ]. A second study, with a high rate of dropout, revealed that participants who adhered to the program reported an improvement in general health [ 10 ]. A third study revealed that participants in HLCs had a reduced risk of diabetes after 24 months [ 11 ]. Other studies that examined the initiation of health behaviour change found that emotional baggage and feeling “stuck” in old habits were barriers to change, that mental distress could lead participants to question the efficacy of HLCs [ 12 ], and that the feelings of shame and guilt could hinder participants’ taking responsibility for changing their lifestyle behaviours [ 13 ]. Taken together, these studies suggest that lifestyle change is a challenging process to initiate and maintain successfully.

Recently, a systematic review underscored the importance of five factors that help promote successful change and maintenance of new lifestyle behaviours, namely, having autonomous reasons for the health behaviour change, having skills to monitor and regulate the health behaviour change, making the new lifestyle behaviours habitual, having physical and psychological resources available, and having supportive environments available [ 14 ]. It is interesting to note, therefore, that numerous studies using self-determination theory (SDT) have shown that health behaviours that are initiated and regulated with autonomous motivation are more likely to be maintained over time [ 15 , 16 ]. From the perspective of SDT, the quality of motivation can be distinguished as either more controlled or more autonomous. Controlled motivation involves an experience of pressure or coercion to think, feel, or behave in a particular way, perhaps in order to comply with a health care provider’s request or to avoid shame and guilt for not living in a healthy way [ 15 ]. In contrast, autonomous motivation involves an experience of choicefulness, volition, and reflective endorsement of action, such that the individual understands the value of the new lifestyle behaviour and engagement in the behaviour is congruent with a broader set of values and beliefs that the individual endorses. Also, from the perspective of SDT, all individuals require support for satisfaction of the basic psychological needs for autonomy (an experience of self-determination), competence (an experience of effectance), and relatedness (an experience of close connection with others) in order to function in a healthy, integrated way. Importantly, satisfaction of these basic psychological needs is conducive to autonomous motivation, physical health, thriving, and psychological well-being [ 17 , 18 ].

Other theories and research outside of SDT have elaborated on the process of goal pursuit, and have underscored the importance of planning and executing actions that promote goal attainment as well as resolving cognitive, emotional, and behavioural challenges that impede success [ 19 , 20 ]. Lazarus [ 21 ], for instance, defined coping as the cognitive and behavioural efforts that are used to manage stressful events, and highlighted the importance of emotional coping skills for successful goal pursuit. Ferrer and Mendes [ 22 ] underscored the importance of affective states in health decisions, as health-promoting behaviours can be undermined by stress or poor emotion regulation. Altering cognitions to help regulate emotions has been shown to be beneficial in treating obesity [ 23 ], and maladaptive cognitions have been shown to be barriers to successful treatment [ 24 ]. Behavioural strategies, such as exercise, have been shown to be valuable for emotion regulation, too [ 25 – 27 ]. Lifestyle change is a complex and multifaceted process that requires successful regulation of various experiences and competing motives. Although HLCs might have the potential to promote optimal (or autonomous) motivation for physical activity and diet, and offer guidance on how to plan, execute, and cope with lifestyle changes, there is a gap in knowledge around how the initiation and maintenance of such changes are experienced by participants in HLCs over time. The initiation and maintenance of health behaviour change can be difficult for individuals to disentangle in retrospect, as they tend to experience one continuous process of lifestyle change. Accordingly, the aim of the current study was to examine the factors that participants in an HLC perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet.

Study design and setting

We conducted a qualitative study using individual, semi-structured interviews to examine participants’ experiences with health behaviour change after participating in an HLC to increase physical activity and improve quality of diet. This approach afforded an opportunity to explore the participants’ own experiences and perceptions [ 28 ] in order to create a broad, deep understanding of the factors that are relevant for initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet. The interviews were conducted at the end of a multi-method research project that lasted for 12 months in one HLC. The aim of this project was to examine perceptions of need support from the HLC as well as changes in autonomous motivation and perceived competence (constructs relevant to SDT); changes in physical activity and diet (health behaviours); and changes in visceral fat, lower body strength, and psychological distress (physical and mental health outcomes). Inclusion criteria for this project included being a Norwegian-speaking citizen who is at least 18 years old and consulting an HLC in order to improve physical activity and diet. Participants were excluded due to severe and disabling mental illness.

Individuals were able to attend the HLC either through self-referral or through referral by a general practitioner, health worker, or social worker. Individuals who attended the HLC were given choice of activities (to support autonomy) from a menu of options that enhance perceived competence for lifestyle change (to support competence), including lifestyle courses (weekly for 14 weeks), walking groups (continuously ongoing), food classes (weekly for 5 weeks), yoga (eight sessions), training groups (continuously ongoing), and discussion groups (five sessions). Also, individual face-to-face guidance was offered on goal setting and goal striving. All activities and guidance were provided by a team that was comprised of physiotherapists, dietitians, a social worker, a nurse, a peer, and a sports educator. The HLC employees were experienced in lifestyle counselling and trained to foster good team spirit in groups (to support relatedness). Participants were given free choice in selecting from the menu of options and could participate in the continuously ongoing groups as desired. In addition, participants were encouraged to engage in physical activities on their own.

Participants

Of the 120 individuals who were recruited for the 12-month research project, 50 participants completed the 12-month follow-up assessment. Potential participants were asked by their counsellors if they were willing to complete an individual, semi-structured interview, and recruitment ended with the completion of 14 interviews due to sufficient information power [ 29 ]. The counsellors did not record participants’ reasons for declining to take part in the interview, and several participants had yet to complete the 12-month follow-up assessment even after 14 interviews had been completed and information power was considered to be sufficient, which means that recruitment for the current study could have continued if data saturation was weak. Potential participants were recruited into the current study regardless of how successful they were with their lifestyle change. Table 1 presents sample characteristics.

Sample characteristics

a BMI category [ 30 ] was measured by Inbody 720 (Inbody 720, Body Composition Analyzer, Biospace Co. Ltd.)

b Measured by the Hopkins Symptom Checklist [ 31 ]

The Regional Committee for Medical and Health Research Ethics in Norway concluded that ethics approval was not necessary for this study, and the Data Protection Officer in the Municipality of Stavanger and the Norwegian Data Protection Authority granted permission for collecting and storing the data. All participants provided informed written consent after receiving information about the purpose and procedures of this study as well as how data would be handled in a secure way. All data were permitted to be stored for 10 years in a manner that is secure and protects privacy.

Data collection

The individual, semi-structured interviews were conducted “on site” by the first author, who had previous experience working in the field at the HLC. On average, interviews took 42 min to complete (range: 21 min to 100 min). Throughout each conversation, the interviewer aimed to be open, respectful, and non-judgemental in order to create an atmosphere of trust that would ensure that the participant felt cared for, and to enhance the quality of the interview [ 32 ]. Each interview followed a guide that was developed for the current study and designed to be open to various experiences and not based on theoretical assumptions. It was comprised of five parts. 1) “Introduction”, in which the purpose of the study was described, and anonymity was assured. 2) “Background”, in which participants were invited to discuss their motives, goals, and previous experiences around lifestyle change. 3) “Experiences from the Last Year”, in which participants were asked to discuss their experiences with physical activity and diet during the last year, including any change attempts and strategies for change, physical and mental health correlates, group and/or individual counselling, perceptions of competence and support, goal development and pursuit, and methods of assessment. 4) “Reflection Themes”, in which participants were invited to reflect on their perceptions of health, motivation, identity, and movement in and out of periods of managing lifestyle changes or not. 5) “Closing”, in which participants were asked to imagine that they had 2 min to share their experiences with lifestyle change with a beginner, and to do so aloud. Audio recordings of the interviews were transcribed verbatim and then checked for accuracy.

Data analysis

After each interview, the first author listened to the audio recording and reflected upon the themes contained therein. The co-authors contributed to the process of data analysis as follows: one read all of the material, two read half of the material, and two read large amounts of quotes. The co-authors contributed to the search for themes, to the sorting of data into themes and subthemes, to coding, and to linking themes with theory, if applicable. All co-authors agreed on the final version of the data analysis. The co-authors had unique backgrounds and perspectives relevant to themes and subthemes. Data analysis was performed using Systematic Text Condensation (STC) described by Malterud in 2012 [ 33 ], which is a systematic and valid method for the analysis of qualitative data. STC was used to analyse the meaning and content of data across the set of participants, which gave the possibility for abstraction beyond the interview narrative. Although the interviews were conducted at one time point and thus have limited capacity for exploring processes over time, this limitation was mitigated by the longitudinal design of the multi-method research project and participants’ retrospective recollections [ 28 , 33 ].

The analysis of qualitative data using STC proceeds through four phases. In Phase 1, the goal was to obtain an overview of the data and define preliminary themes—to “search for patterns in the chaos”, which included searching for patterns in the experiences based on demographic characteristics. In Phase 2, the preliminary themes were developed further into subthemes/codes by sorting meaning units (i.e., text fragments relevant to the research question) drawn from the preliminary themes. In Phase 3, the decontextualized meaning units were coded into subgroups regardless of the individual participants from whom the meaning units were derived. In Phase 4, main themes were synthesized to ensure that the results represented the original context in such a way that protected the validity and wholeness of the original context. Also in Phase 4, an analytic text was written that described the “story” told by the material and illuminated the text with meaning units [ 28 , 33 ].

During the individual, semi-structured interviews, participants reflected on their experiences around striving to increase their physical activity and consume a healthier diet in consultation with the HLC, as well as the cognitive, behavioural, and emotional skills that they perceived to be important for the initiation and maintenance of these lifestyle changes. The conclusions on the findings were made regardless of the participants’ demographic categories and resulted in three main themes, namely, 1) motivational basis for change, 2) coping for emotional balance, and 3) self-regulation skills. Table 2 presents examples of meaning units for the main themes and subthemes. In general, the participants considered a healthy lifestyle to be an important foundation for better health, and their progress toward lifestyle change tended to co-occur with an enhanced sense of well-being and thriving. Yet their pursuit of a healthy lifestyle was also described as an ongoing process with emerging challenges along the way. The presentation of results is supplemented with quotes from participants along with their interview number, gender, and age category.

Examples of meaning units for the main themes and subthemes

Main theme 1: motivational basis for change

The first main theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. This main theme encompasses two subthemes, namely, 1) controlled versus autonomous motives for healthy behaviour and 2) relational support.

Subtheme 1.1: controlled versus autonomous motives for healthy behaviour

Some participants made a health behaviour change in response to external pressure, such as a spouse, family member, friend, doctor, childhood recollection, or societal/media standard, which tended to be perceived as controlling. Some of these participants felt able to maintain their healthy lifestyle over time, yet the motivation for their lifestyle changes was not autonomous. As a result, maintenance of the new behaviours became difficult after the external pressure was removed.

But, my up-going spiral, in the period I stayed with my grandma, it was not really me pushing it upwards. I just “turned off” and did what I was told … so in retrospect, when I moved to live by myself it is natural that the spiral started to go down because I was not the one pushing it up … I cannot make that a standard since I got all the help to get the spiral moving up … I must learn myself how to do it. 5, M, 20-25

Other participants made a health behaviour change by doing things that they did not like, or by engaging in lifestyle behaviours that held no personal value or were experienced as unpleasant.

I have never enjoyed exercise. I think it is horrible … I never find it lovely or fun. 3, M, 50-55

Reflecting more autonomous reasons for healthy behaviour, most participants identified their health as an important motive behind the initiation of lifestyle changes. Indeed, the process of health behaviour change was fuelled by motives that were personally important and valuable for living a good life, rather than to achieve an appealing image. Participants felt satisfied as they developed a sense of congruence between their perceived identity and lifestyle commitments, which aided their maintenance of a healthy lifestyle.

I have spent a lot of time reflecting on whether I am a person who exercises or not … Maybe I have become a person who exercises? I believe I have, because I really enjoy it, I do it because I enjoy it. It makes me feel good, and I do it because it is fun doing it. 13, F, 45-50

This congruence between perceived identity and lifestyle commitments afforded participants a sense of confidence to set their own standards for success, rather than using external standards for their evaluation of success.

It is more important for me to be a person who stands up for myself, who is confident about my feelings, than to lose weight. (10, F, 30–35)

Indeed, such congruence promoted the emergence of a “new” identity that was fulfilling, satisfying, and vitalizing, and this energy could be used for the benefit of others and to promote the maintenance of lifestyle changes.

Slowly I am turning into a “Mr. Healthy” who has the energy to vacuum when I get home after a long day, who goes for walks and helps when needed … I am not just the “Fatty”—a little “Mr. Healthy” too. (14, M, 35–40)

Subtheme 1.2: relational support

Many participants found it necessary and valuable to seek out and utilize relational support from others, even though some struggled to find sustainable sources of such support. Participants identified their family, friends, work colleagues, group members at the HLC, and employees of the HLC as sources of relational support. Indeed, guidance from HLC staff was perceived as professional, knowledgeable, affirming, and effective at revealing internal struggles and increasing competence.

[The individual counselling] was very good … it was the first time I spoke to someone about my problems regarding weight and exercise. Ever. So, it was challenging because I found it hard to open up … I joined a class on emotions and eating when I realized that it was about an eating disorder, not just laziness or lack of knowledge. (10, F, 30–35)

Also, participants experienced their relationships with group members at the HLC to be helpful for raising awareness, staying focused, and feeling connected.

I joined a structure group … here the focus is on what you do and what you don’t do ... And the focus gets so big, it forces you to think about changes that work. So, the structure group helped me most. (9, M, 35–40)

Main theme 2: coping for emotional balance

The second main theme focused on strategies for coping with the challenges and potential pitfalls to lifestyle change that were associated with stress, poor self-image, sickness, injuries, problematic relationships, loneliness, depression, and negative life events. Behaviour change was perceived as a complex process that is affected by time, context, physical illness, and mood. It was, thus, necessary for participants to use coping strategies to achieve emotional balance. This main theme encompasses two subthemes, namely, 1) cognitive appraisals and 2) behavioural adjustments.

Subtheme 2.1: cognitive appraisals

Several participants described how they became aware of and changed their cognitive patterns in order to strengthen their health behaviour change, while others felt stuck in “old ways” of thinking. Often, it was necessary to acquire new cognitive techniques such as positive visualization, reducing catastrophic thinking, replacing self-blame with self-compassion, and altering a black-and-white (or dichotomous) thinking style.

I am in a totally different path than a year ago. I had a black-and-white mind set; if you eat chocolate one day, three weeks are ruined … I got a lot of help because I have struggled with the black-and-white mind set. (6, F, 20–25)

It was a common experience for participants to struggle with high expectations, and some participants dealt with this struggle by lowering their expectations in order to make their goals more attainable.

I have learned I just have to schedule. I am going to exercise on Wednesday, I am going to exercise on Sunday. And I have learned to go on no matter what. Like, you don’t have to examine, am I in too much pain to go? Am I too tired to go? You go. Then you can stop if you cannot manage and go home. But always go. Try. And most times it is OK. Usually you manage to complete that exercise. (1, F, 55–60)

Some participants used techniques such as mindful eating and focusing on food added rather than food removed in order to deal with experiences of deprivation due to changes in diet.

If you start changing by denying yourself things, then you will crack at the end. Try instead to add things instead of removing … I can eat carrots, I can eat broccoli, I can eat fish and salmon. And it has helped a lot … (10, F, 30–35)

Many participants experienced shame—an unpleasant feeling of not “meeting the standard” of others and/or society. Indeed, it was deeply satisfying for participants to liberate themselves from the experience of shame, which promoted their maintenance of a healthy lifestyle.

And I had a lot of barriers. I could not go to the swimming pool, I could not get undressed in front of others, I was afraid to sit on chairs … But the shower was filled with women of all sizes … And it was so nice, they were really all sizes and I found it fantastic … they were very relaxed. So, I felt relaxed at once when I got in, I did not mind, and went out to the pool … It all went so much better than I imagined, and it occurred to me that I might be rid of that enormous panic for those things. That I have won over it a long time ago, I just did not know, did not believe it. (13, F, 45–50)

Subtheme 2.2: behavioural adjustments

For some participants, the desire to escape from stressful life circumstances that were marked by multiple challenges, relational troubles, and feelings of depression and anxiety was overwhelming, which made it difficult to focus on lifestyle changes. Unfortunately, some participants tried to mute the intensity of these painful experiences with alcohol, tobacco, emotional eating, and/or gambling.

It is my “escape”, kind of … Gambling and food. Overeating … It is what I use to avoid thoughts … (5, M, 20–25)

Still, many participants who struggled with such pain made behavioural adjustments that were in line with more sustainable ways to cope, including seeking comfort in nature, socializing, reading, yoga, meditation, physical activities, and eating healthy snacks. Indeed, these alternative strategies were discovered by the participants themselves and/or through guidance from HLC personnel and other health services.

I still have the yoga. It does a lot for wellness. For the mind. Actually, I think it is the yoga that has given me most throughout the year. It is like there is a little gap to the intense feelings attached to food. Which makes me able to analyse it, if not in the moment at least in retrospect. (10, F, 30–35)

I find [exercise] joyful and the effects are good, both physically but not at least mentally … regarding depression. (11, M, 25–30)

Main theme 3: self-regulation skills

The third main theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes. This main theme encompasses three subthemes, namely, 1) goal setting, 2) creating space for new behaviours, and 3) monitoring satisfaction with outcomes.

Subtheme 3.1: goal setting

Although better health was an overarching goal, most participants also decided on and developed specific short-term goals related to lifestyle changes, rather than (for example) weight, during their time at the HLC. Indeed, many participants viewed weight as an outcome of health behaviour change.

I had eating supper as a main goal. And increased physical activity. Those two. I know if I can manage them, I will manage to change my lifestyle in the long run anyhow. 9, M, 35-40

Still, initially some participants viewed health behaviour change as having instrumental value for the overall goal of weight control, such that the reason to exercise and eat healthy was to control weight. Yet over the year of participation at the HLC lifestyle changes tended to be viewed as having inherent value.

Subtheme 3.2: creating space for new behaviours

In order to pursue their lifestyle changes, participants found it important to create space for new behaviours, which are time consuming and could affect relationships. For example, time spent exercising leaves less time for family, and acceptance of this fact was worthwhile.

It is an epiphany when you realize that your children understand that you must [spend time exercising], you need this. Like, you don’t have to feel bad. (1, F, 55–60)

Spend more time planning what to buy, and make sure to only have those healthy options … I spend time doing groceries, I spend time cooking, and I experience it does not take too much time. And the results are so good, the body feels better. (8, F, 60–65)

I see myself as the hindrance … Because I am really good at not implementing my plans, at least if I have made bad plans. (4, M, 30–35)

Subtheme 3.3: monitoring satisfaction with outcomes

Many participants expressed vigilance as an awareness of their routines and evaluation of their outcomes in order to assist with their progress.

Awareness of what I am doing has been very important for me. (7, F, 20–25)

Participants tended to experience joy and a sense of competence as they progressed toward the initiation and maintenance of lifestyle changes.

Exercise has given me a sense of mastery that has affected other areas … It is both that it works out OK and that I am not as paralyzed because I don’t think it will work out. (11, M, 25–30)

Participants experienced the assessments that occurred at the HLC (body composition and health related fitness) in a variety of ways. Many participants viewed these assessments as concrete measures of progress—or lack thereof—that was important information for goal striving. A few participants felt shame in light of these assessments, too.

I found the machine [that measured body composition] super. It measured progress when I did not measure it myself ... It was reassuring that what I do is not completely meaningless. (4, M, 30–35)

For some participants, their satisfaction with outcomes was a function of psychological wellness rather than weight-related changes.

No, I think it has turned out fine. I know that the results regarding the research havn't turned out that good. But if I were to be tested again in a year it would show quite big changes. (9, M, 35–40)

The aim of the current study was to examine the factors that participants in an HLC perceived to be relevant for the initiation and maintenance of lifestyle changes. The main findings underscored the importance of 1) a motivational basis for change, 2) coping for emotional balance, and 3) self-regulation skills for the successful pursuit of a healthy lifestyle. Below, we reflect on each of these main themes.

Motivational basis for change

Most participants in our study expressed a heightened sense of being “in charge” of their health behaviour change such that the motives for the lifestyle changes emanated from the self rather than from a source external to the self. Although some participants initiated their health behaviour change due to someone else’s desire or demand, over time such behaviours tended to be given up or their motives were internalized and experienced as more autonomous. This is particularly important because autonomous motivation for health behaviour change was not only satisfying but conducive to maintenance of lifestyle changes as well. Indeed, this finding is consistent with SDT [ 15 , 34 ]. Participants found it to be depleting and difficult to maintain health behaviour change when their motives for lifestyle changes were strongly linked to societal standards and/or social pressures. With such controlled motivation, participants tended to feel like a “puppet on a string”, which is unlikely to promote maintenance of lifestyle changes over time [ 15 , 34 ].

Specifically, with regard to consumption of a healthier diet, some research outside of SDT has revealed a comparable set of findings. Sarlio-Lahteenkorva [ 35 ], for instance, found that dietary self-regulation was difficult without adequate structured support, and Hindle and Carpenter [ 36 ] found that autonomous motivation for a healthy diet tended to co-occur with the maintenance of a healthy diet. As the desire to eat healthy was common for all participants in our study regardless of weight category, SDT can offer a broad perspective for understanding the motives behind healthy eating and disordered eating behaviours [ 37 ].

Likewise with regard to physical activity, the health-enhancing, stimulating, and pleasurable facets of exercise have been shown to promote maintenance of an active lifestyle [ 26 , 27 ]. Some of the participants in our study experienced a transition toward a new identity as “an exerciser” that aided their maintenance of a healthy lifestyle. Interestingly, Eynon and colleagues [ 38 ] found identity transformation to be conducive to maintenance of lifestyle changes among participants who received an exercise referral program, while others have reflected on the potential of identity elaboration to promote health [ 39 ]. Directly in line with our findings, Texeira and colleagues [ 40 ] reported that a motivational profile marked by a high level of autonomous motivation was helpful for maintenance of physical activity. Thus, it is important for health professionals to be aware of autonomous (versus controlled) motives in those with whom they work and promote competence to explore autonomous reasons for lifestyle changes [ 40 ], as such internalization can provide a solid foundation for sustained health behaviour change over time.

Most participants in our study expressed the importance of the social environment as a source of relational support, which they obtained from their family, friends, or work colleagues. Also, group members and employees at the HLC were perceived as supportive. Participants described the HLC as important for their health behaviour change because it supported their competence for lifestyle changes. SDT underscores the importance of relatedness, as individuals are more likely to adopt values and behaviours that are promoted by those they trust and to whom they feel connected [ 15 ]. It is unfortunate, therefore, that shame can hinder individuals’ seeking relational support, such as the participant who did not find groups outside of the HLC for the “fat and slow”, as it was expressed. Sagsveen and colleagues [ 41 ] found that relational continuity was important to individuals who utilize HLC services, which can be an experience that is challenging to guarantee in an ever-changing clinical practice. Nonetheless, it is important that clinical systems are developed to support the basic psychological needs of those who utilize HLC services. For instance, although some might prefer that HLC providers are knowledgeable “experts” [ 41 ], it is critical that the HLC providers are flexible in their guidance around the implementation of changes in participants’ lives. In line with SDT [ 42 ], we recommend that HLC providers work in partnership with their participants to inform and support autonomous decision making.

Coping for emotional balance

Several participants in our study expressed the value of altering cognitive appraisals, especially when the lifestyle changes were experienced as challenging, depleting, or overwhelming. Lazarus [ 21 ] defined the term cognitive appraisal as one’s personal interpretation of and response to a stressful situation. Cognitive appraisals are evaluations of possibilities when faced with challenge or threat that can lay a cognitive foundation for coping with stressful events as they occur. Indeed, the appraisal that an individual makes of a stressful situation can affect the response to relapse in the context of health behaviour change—either to accept the relapse and continue moving toward a healthy lifestyle, or to give up in the face of perceived failure. Of note, cognitive appraisals can be conscious or non-conscious—intuitive and automatic. Interestingly, some participants experienced satisfaction as they uncovered and re-evaluated their cognitive patterns, as doing so provided tools for managing their health behaviour change and maintenance. This is encouraging, as if HLCs can promote internal strength in participants through the alteration of their cognitive appraisals then the possibilities for maintenance of lifestyle changes might increase. Similarly, research has shown that adding cognitive therapy to standard obesity treatment is beneficial for psychological health, behavioural persistence, and weight control over time [ 23 ]. If ignored, then maladaptive cognitions can function as “tripwires” as shown in a large qualitative study by Byrne and colleagues [ 24 ], who found that overweight individuals who struggled to maintain a healthy lifestyle were “stuck” in a dichotomous thinking style.

Most participants in our study expressed that they made behavioural adjustments (in addition to altering cognitive appraisals) as a strategy for coping with painful experiences—from muting the painful experiences with, for example, overeating to more healthy strategies described below. Byrne and colleagues [ 24 ] found that relapses among overweight individuals who struggled to maintain a healthy lifestyle were associated with eating behaviour that was used to regulate mood and manage stressful life events, and some participants in our study described being “stuck” in such patterns. One emotion that was especially difficult for participants to manage was shame, as fear of being body shamed and objectified for being overweight could trigger avoidance of health-promoting activities and situations [ 43 ]. Indeed, often shame is a central part of how overweight and obese individuals conceptualize themselves, as they tend to feel guilty for having the “wrong” lifestyle [ 13 ]. Although difficult, some participants expressed the possibility for liberation from the perceived condemnation from others, which enhanced their competence for and commitment to lifestyle changes. Ferrer and Mendes [ 22 ] described emotion regulation and coping processes as more effective than risky behaviours such as binge eating and drug use to downregulate unpleasant affect. Finally, some participants made behavioural adjustments such as hiking in the peace of nature, socializing, yoga, and physical activities, which is congruent with research showing that exercise can upregulate mood [ 25 ] and that positive affect can enhance autonomous motivation [ 15 , 34 , 44 ].

Self-regulation skills

Most participants in our study expressed the importance of goal setting, creating space for new behaviours, and monitoring satisfaction with outcomes as key factors that were relevant for the maintenance of health behaviour change. Although participants viewed health as an overarching goal, they also had specific short-term goals to assist in their process toward lifestyle changes, including to eat supper every day and go for a 30-min walk every day. Successful goal setting involves deciding the goals to pursue and the criteria for success or failure [ 19 ], which has been shown to be effective for behaviour change [ 45 ], although previous research on goal setting has been equivocal [ 46 ]. Interestingly, SDT makes an important distinction between goals that have intrinsic content and are conducive to basic psychological need satisfaction and well-being versus goals that have extrinsic content and can frustrate basic psychological needs and yield ill-being [ 18 , 42 ]. With this distinction, it might be that setting extrinsic goals is unassociated or inversely associated with goal attainment, whereas setting intrinsic goals is conducive to health behaviour change and maintenance [ 47 ].

Further, participants in our study expressed the importance of thorough planning and making prioritizations for goal pursuit. Lifestyle changes can be time consuming and can affect relations with others, and indeed conflicting identities (for example, parent versus exerciser) can undermine the behaviours on which a healthy lifestyle is predicated even when disease risk is present [ 48 ]. Therefore, thorough planning and prioritization can “bridge the gap” between cognition and action, encourage the individual to think prospectively about the future, and reveal obstacles and challenges that might otherwise impede success at attaining goals [ 20 ].

Most participants in our study expressed the value of monitoring and evaluating their goal progress, as satisfaction, or lack thereof, with outcomes fueled ongoing goal pursuit and prompted the necessary adjustments to promote success. This finding is aligned with the work of Rothman [ 49 ], who suggested that the initiation of new behaviours is based on expectations of success whereas the maintenance of new behaviours is based on satisfaction with one’s achievements. Also, in line with our findings, Rothman suggested that high expectations at the outset can create problems for continued pursuit of new behaviours, as one might be dissatisfied with the outcomes if the standards are set too high. Indeed, Byrne and colleagues [ 24 ] found that dissatisfaction with weight-related outcomes can increase the likelihood of relapse among overweight individuals, such that too-high expectations can hinder the maintenance of healthy lifestyle behaviours.

Strengths and limitations of the study

The findings from the current study provide subjective, first-person accounts that extend knowledge gained from the quantitative literature on the initiation and maintenance of lifestyle changes. Although the sample was of medium size, as typical sample sizes for such research tend to vary from 5 to 25 participants [ 32 ], the information power can be regarded as rich because the aim was narrow, the participants held characteristics that were truly specific to the aim, the study was grounded in an evidence-based theoretical perspective (namely, SDT), and the dialogue from the qualitative interviews was of high quality [ 29 ]. Still, the transferability of the findings would be stronger if the sample size was larger and the informants came from various HLCs. Nevertheless, the variation in age, gender, employment status, weight category, and mental health in our sample reflected the diversity found in other HLCs, which enhances the representativeness of the findings [ 9 , 50 , 51 ]. That being said, it is important to note the large amount of dropout from the multi-method research project as a limitation, such that participants who were in the current study could have held different perspectives than those who left the project. Still, the current study makes an important contribution even with this limitation in mind.

Investigators with different backgrounds were involved in data analysis, which encouraged the emergence of diverse perspectives prior to the conclusion on themes. The inputs that were made at different phases of the analysis process have been saved and are available for review in order to enhance the credibility of the findings. One important limitation, though, is that there was no follow-up with the participants. Also, the current study did not distinguish the processes of initiation and maintenance of health behaviour change in participants’ experiences.

The broad use of quotes in the Results section affords the reader an opportunity to confirm—or disconfirm—the findings [ 51 ]. The interviewer was forthcoming about her work in an HLC, but this could have left some participants with the desire to “decorate” their experiences. That being said, it is important to highlight the fact that participants offered rich accounts of their experiences with success and failure in an HLC.

The current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants’ experiences. In line with SDT, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritazations in order to balance healthy lifestyle behaviours with the routines of “daily life” while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways.

Acknowledgements

The authors would like to thank the participants who contributed to this study and the HLC employees who recruited the participants. The authors would also like to thank the Municipality of Stavanger and those in charge of facilitating approval of the study.

Abbreviations

Authors’ contributions.

CHS contributed to the design of the study and applied for the necessary approvals; collaborated with the personnel who recruited the study participants; conducted the interviews, transcribed the interviews, and collaborated in data analysis; and was the primary contributor to the writing of the article. CPN contributed to the writing of the article. SMD and LEB contributed to the design of the study, data analysis, and the writing of the article. AMLH contributed to data analysis and the writing of the article. All authors have made critical comments on the article, reviewed the article for its intellectual content, and approved the submission of the final version.

No funding was obtained for this study.

Availability of data and materials

Ethics approval and consent to participate.

The Regional Committee for Medical and Health Research Ethics in Norway was given a written description of the project and concluded that special ethics approval was not necessary for this study based on the Legal Act of Health Research, which states that evaluations of pre-existing services do not require approval from the Ethics Committee. That being said, the project was mandated to be performed in a manner that protected privacy and confidentiality. The Data Protection Officer in the Municipality of Stavanger and the Norwegian Data Protection Authority granted permission for collecting and storing the data. All participants provided informed written consent after receiving information about the purpose and procedures of this study as well as how data would be handled in a secure way.

Consent for publication

Not applicable.

Competing interests

The authors declare that there are no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Fire ants are threatening the Aussie way of life for some families. Here's what you need to know

Colleen Lavender has raised her kids to love the outdoors and every opportunity they have, they're on their bikes or going for a walk.

That all changed when her 11-year-old daughter Lily was playing in a park a fortnight ago in the Scenic Rim town of Jimboomba, south of Brisbane, where they live.

Lily accidentally disturbed a fire ant nest, setting off an angry swarm of ants to attack her body.

She was left with more than 50 red welts capped with angry white pustules along her arms.

Woman pours treatment on fire ants in backyard.

"She had quite a bit of swelling up her arm, she felt like she was on fire and couldn't sit still, she was so teary," Ms Lavender said.

With fire ant nests in their backyard and along local roads and parks, the Lavenders have changed their active habits to avoid the invasive species.

She's worried the continued spread of the ants could change the outdoors lifestyle Australians know and love.

"We're careful what we do now, we don't walk around barefoot anymore like Aussie kids used to do," Ms Lavender said.

What are fire ants and how did they get here?

Fire ants are an invasive species originally from South America. They have an aggressive temperament and a nasty sting.

They're 2 to 6 millimetres in length and are coppery-brown in colour.

The ants were first detected in Australia in Brisbane in 2001 and it's likely the pest arrived in shipping containers from the US.

Their nests are unique because they have no obvious entry or exit holes and look like dome-shaped mounds or patches of disturbed dirt.

Australia is the perfect environment for fire ants to inhabit – they have no natural predators here and 95 per cent of the country's climate is suitable for them.

They easily spread above and under ground, can fly up to 5 kilometres, and can even form rafts to float across water.

Why are they such a threat?

The ants eat animals and insects that nest on the ground, including lizards, frogs, and mammals.

The National Fire Ant Eradication Plan said the pest would have "a flow-on effect to the entire ecosystem with the potential to eliminate species".

In the US, fire ants have had a huge impact on crops such as corn and potatoes.

There's concern the same issues could emerge in Australia, with more than 50 agricultural and horticultural crops at risk of being affected by infestations.

Do they bite?

National allergy bodies told a Senate Inquiry into Red Imported Fire Ants that 174,000 people could develop severe allergic reactions to the insect's bite if it became endemic in Australia.

One submission told the inquiry that anaphylaxis from fire ant stings was three times more common than bee stings.

The invasive species have been responsible for hundreds of deaths in the US since the 1990s .

If the fire ants are left to spread across the country, economic modelling from the Australia Institute has indicated that it would cost the government more than $22 billion by the 2040s.

A woman wearing a t-shirt and jeans sits on the front step and puts on pink sneakers.

How far have they spread?

Fire ants have been found just south of Ballina in New South Wales , west to Oakey, just north of Toowoomba in Queensland and north to Morayfield north of Brisbane.

In Queensland, Moreton Bay, Somerset, Lockyer Valley, Southern Downs, Scenic Rim and the Gold Coast are the focus of critical eradication work.

A map of where fire ants have been located.

There are two fire ant biosecurity zones that spread across parts of south-east Queensland.

If you live in either of these zones there are interstate and intrastate restrictions on how you can transport organic materials, due to the risk of further infestation.

What's being done about them?

The state and federal governments are spending an extra half a billion dollars on the National Fire Ant Eradication Plan to combat the ants' spread.

One key stage of the plan is surveillance – which includes having remote sensing technology mounted to helicopters to scan properties from the air for fire ant nests.

The images of landscapes are then analysed by artificial intelligence to pick up whether there are nests there. Field officers and odour detection dogs continue to survey targeted properties at regular intervals.

A baiting program is underway in northern NSW and treatment is available to use in Queensland.

Is the treatment safe?

There are two types of bait available for treating fire ants in Australia – insect growth repellent and fast-acting insecticide.

The baits are made up of corn grit soaked in soybean oil and are designed so that ants collect it and bring it back to the colony for other ants to eat. It'll then kill worker ants, larvae and the queen ant, before breaking down quickly.

It's safe for humans and pets.

What do I do if I find fire ants on my property?

You can report an infestation to the National Fire Ant Eradication Program by calling 13 25 23 and it's recommended that you treat your property as soon as possible by purchasing fire ant bait from a local or online retailer.

If you're living in a Queensland infestation zone, it's recommended that you treat your property even if nests aren't visible.

NSW residents who suspect they have found fire ants should not treat the area. Instead, they should call the NSW Department of Primary Industries on 1800 680 244 immediately.

X (formerly Twitter)

By land and by air, baiting program combats fire ant incursion in northern New South Wales

'Out of control' fire ants pose a serious health risk to Australians if pests become endemic

Blisters and pain as fire ant nest uncovered in NSW outbreak

A man's arm with many blisters on it from fire ant bites

Animal Science
Murwillumbah
Pest Management
Upper Coomera

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Impact of Lifestyle on Health

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7 Positive Lifestyle Factors That Promote Good Health

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Essay on Healthy Lifestyle

Self-Discipline

Punctuality

Prevention of Lifestyle Diseases

Unhealthy Lifestyle

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Changing Your Habits for Better Health

What stage of change are you in?

Contemplation: “I’m thinking about it.”

Preparation: “I have made up my mind to take action.”

Action: “I have started to make changes.”

Maintenance: “I have a new routine.”

Healthy Eating

Track your progress

Overcome roadblocks

Reward yourself

Add variety and stay motivated

Deal with unexpected setbacks

Challenge yourself!

What are clinical trials, and are they right for you?

What clinical trials are open?

Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands

Statistical analyses

Lifestyle changes during the COVID-19 pandemic

Factors independently associated with changes into lifestyle (healthy/unhealthy)

Differences in COVID-19-related lifestyle changes between CAM users and non-CAM users

Intention to continue lifestyle changes and the required support

Availability of data and materials

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