In 2018, Americans spent $3.67 Trillion on healthcare, amounting to 19.5% of GDP, up from 5.2% of GDP in 1960. It might not be such a bitter pill if Americans were becoming correspondingly healthier over time. But we’re not. Everyone knows that despite our hefty increases in spending over the decades, we’ve also become heftier ourselves, causing our health to deteriorate.
Essentially, we’re not eating right nor getting enough exercise, which has led us to become fat. And it’s not just the disadvantaged classes who have weight problems. Laziness and bad eating habits pervade society, from the rich (about 1/3 are obese) to the poor (almost half are obese). In fact, our bad habits (poor diet, inactivity, and smoking) contribute to 8 of the 10 top causes of death (2/3 of all deaths) in the US (see Figure 1).
What’s so tough about being healthy that so many of us have so much trouble with it?
Factors Contributing to Unhealthy Living
Since the post-WWII era, changes in technology and society have made it harder in many respects for us to maintain healthy lifestyles (more detailed information on post-WWII changes leading to unhealthy lifestyles can be found in a previous blogpost “Why Are Healthcare Costs So High?”). The follow issues have all contributed to the problem.
- Migration: Americans have increasingly migrated away from rural areas and labor-intensive manufacturing jobs and toward urban areas and non-labor-intensive services. As a result, we spend less time each day exerting physical effort at work.
- Labor Saving Technologies: Technological improvements, for example, in transportation, communications, and household chores, have decreased our physical exertion on activities we undertake outside of work.
- Increasing Availability Of Cheap, Processed Foods: Technologies in agriculture and food processing have dramatically reduced the cost of food. At the same time, technology has enabled widespread availability of cheap, processed food.
- Working Women: With the advent of The Pill and no-fault divorce, more women have jobs, leaving them less time to prepare healthy meals at home for their families.
- More Leisure Time And Leisure Activities More Sedentary: Today we generally have more leisure time, which we increasingly spend engaged in more passive activities.
- Society’s Accommodations Of Heavier People: As more of us have become heavier, we have become more accommodating of heavy people. There’s less of a social stigma toward heavy people. Plus, it’s easier to find clothing, accessories, and other accommodations, which makes it easier to be overweight.
Relentless Messaging and Hectic Lifestyles Have Pushed Us Over the Edge
I believe labor-saving technologies and shifts toward more sedentary lifestyles have certainly contributed our health problems. And greater availability of cheap, processed foods has further exacerbated the situation. However, I believe that what has truly tipped the scales against our efforts to be healthy are two other changes in society: Relentless messaging to eat, while being simultaneously sapped of the willpower needed to resist those constant temptations.
We’ve been challenged by many other difficult tasks in our lives, such as learning to read or write, drive a car, or use a computer. Yet, there’s an important difference between these types of efforts and the effort needed to live a healthy life: the duration of effort needed to succeed. Specifically, learning to read and write takes a lot of effort in the beginning. However, once we learn how to do these things, they quickly become habitual — something we can do on autopilot, without requiring any conscious effort. Being healthy, on the other hand, requires constant, conscious effort and willpower, in the face of relentless temptation to stray. Unfortunately, our willpower is too often sapped due to overload by stress and other mental and emotional activities in our daily lives. If we were not otherwise being deprived of this energy, we would be better able to resist unhealthy temptations.
Two separate issues here need to be unpacked: (i) We are faced with relentless messaging to eat, which means we need conscious effort and willpower to stay the course of healthy living. Yet, (ii) our willpower has been drained by increasingly hectic and stressful lifestyles.
We Are Faced with Relentless Messaging to Eat
Food providers have mastered the art of making food widely available, easy to buy, and convenient to eat. Wherever we go, we are tempted with food, from grocery stores, restaurants, and gas stations; to electronics, office supply, and clothing stores; to work lunchrooms and recreation centers. Food is everywhere.
Even if food isn’t physically present, thanks to technology, food suppliers are continually finding new ways to bombard us with advertisements for food. Traditional sites we see food advertised include: Newspapers, magazines, and mail; TV, movies, and radio; buildings and billboards; buses and bus stops; and athletic clothing, equipment, and arenas. Of course, now that we’ve become attached to our phone screens, we’re constantly being flooded with ads on all the ad-supported sites we visit. All this doesn’t even include some of the more novel locations suppliers are finding to hit us with ads, such as on tattoos or in the middle of the street.
Changes in social norms, perhaps even more insidious than constant ad assaults, have also led us to increase our food intake. For example, portion sizes have increased: today’s portions are more than twice the size of portions served in the 1970s. When more food is placed is front us, we generally eat more, so larger portion are contributing to our weight problem. Also, we’re eating out more often than we used to, and we tend to eat more food in general — and more unhealthy food in particular — when we eat in restaurants.
Furthermore, it has become common for us to eat throughout the day, even while we’re doing other things, from surfing or working on our computers, to driving in our cars, to walking down the street. I have a cousin who lives in Switzerland. Years ago, when he was in the US for a visit, he remarked, “When did Americans become so thirsty?!? Everyone is drinking something as they walk down the road. If they’re thirsty, why don’t they have a glass of water before they leave?”
And as final example, as mentioned earlier, as our weight has increased, it has become more socially acceptable to be heavy. There’s less of stigma associated with being overweight, and accommodations have become more widely available for heavier people.
Our environment is increasingly characterized by cheap and easy access to food, relentless advertisements for food, and changes in social norms, all of which provide constant cues for us to eat. Given the relentless pressure, it requires increasing amounts of conscious effort and willpower to not overeat.
Our Willpower Has Been Sapped by Increasingly Hectic and Stressful Lifestyles
The American Psychological Association defines willpower as “the ability to resist short-term temptations in order to meet long-term goals.” As we’ve been increasingly seduced by the lure of food, our demand for willpower to resist all the temptations has skyrocketed. Yet, our supply of willpower that would otherwise enable us to resist has been increasingly sapped by other needs, leaving us without sufficient ability to resist.
Our current, chaotic and stress-filled lives have been draining all our mental energy, leaving none left to resist other temptations, including the relentless invitation to eat. In The Science of Willpower, Lia Steakley at Stanford Medicine describes how stress makes it “harder to find our willpower”:
The biology of stress and the biology of willpower are simply incompatible. So any time we’re under chronic stress it’s harder to find our willpower. The fight-or-flight response floods the body with energy to act instinctively and steals it from the areas of the brain needed for wise decision-making. Stress also encourages you to focus on immediate, short-term goals and outcomes, but self-control requires keeping the big picture in mind. Learning how to better manage your stress …is one of the most important things you can do to improve your willpower.
Lia Steakley describes factors in our lives other than stress that are also draining our stores of willpower. For example, both sleep deprivation and bad nutrition impair our brain’s ability to use energy efficiently.
Furthermore, our need to do so many things at once – our constant multitasking – is also depleting our mental energy, leaving too little left to resist temptation. Behavioral Neuroscientist, Daniel Levitin says that when we multitask, we’re actually quickly switching between tasks. He notes that continual mental switching taxes our energy, “making us feel tired much more quickly than if we sustain attention on one thing.”
Finally, the sheer relentlessness of food temptations and the need to continually resist those temptations in and of themselves exhaust our willpower. As the American Psychological Association puts it:
In an environment where unhealthy (and mouthwatering) food choices are everywhere, resisting temptation is likely to deplete willpower, chipping away at the resolve of even highly motivated dieters.
Mechanisms for Improving Willpower
Society is creating a challenging environment, indeed, in which to live a healthy life. Fortunately, there are steps we can take to regain control over our behavior and successfully resist the constant lure of food. The American Psychological Association provides some healthy behaviors to help increase willpower and successfully resist the temptation to overeat.
Extrinsic motivation is the desire to act in order to gain a reward or avoid punishment. In contrast, intrinsic motivation is the desire to act because the action is personally rewarding — the behavior is its own reward. The APA suggests that we develop intrinsic motivation to be healthy. In this case, temptation to overeat is easier to resist because doing so depletes less willpower than does extrinsically motivated resistance to eating.
Regarding using intrinsic motivation to succeed in behavioral change, I particularly love this thought from Personal Growth Guru, Jim Taylor, PhD:
The difficult nature of making changes means that you will likely be putting in effort that will take you far beyond the point at which it is inspiring or fun. This junction is what I call The Grind, which starts when actions necessary to produce meaningful change become stressful, tiring, and tedious. The Grind is also the point at which your efforts toward change really count. The Grind is what separates those who are able to change from those who are not. Many people who reach this point in the process of change either ease up or give up because change is just too darned hard. But truly motivated people reach The Grind and keep on going.
Second, the APA suggests using the “out of sight, out of mind” principle to help avoid temptation. Keeping food out of sight or less readily accessible goes a long way in increasing our ability to resist.
Next, the APA suggests using a technique called an “implementation intention.” As the APA describes it:
Usually these intentions take the form of “if-then” statements that help people plan for situations that are likely to foil their resolve. For example, someone who is watching their alcohol intake might say before a party, “If anyone offers me a drink, then I’ll ask for club soda with lime.” Research among adolescents and adults has found that implementation intentions improve self-control, even among people whose willpower has been depleted by laboratory tasks. Having a plan in place ahead of time may allow you to make decisions in the moment without having to draw on your willpower.
Interestingly, the APA indicates that “regularly exerting self-control may improve willpower strength,” just like lifting weights builds muscle strength.
Studies have shown that using mental energy – including exerting willpower -- depletes glucose levels in the brain. It follows that “eating regularly to maintain blood-sugar levels in the brain may help refuel run-down willpower stores.”
Finally, the APA suggests we start by focusing on one goal at a time, taken in small steps, to avoid depleting our willpower when trying to achieve our goals.