The shape of America’s Met-S problem/Wikimedia Commons

The true American killer

What should have been the main lesson learned by the survivors of the pandemic of the old and the ill would appear to have been missed by those most vulnerable in these unUnited States.

Researchers from Harvard University Medical School, Massachusetts General Hospital and the University of California-San Diego School of Medicine are now reporting a post-pandemic spike in metabolic syndrome among Americans over age 60.

Metabolic syndrome, or MetS as it is often called, is a cluster of ailments largely linked to a lack of physical activity and poor diets. Under normal circumstances, it doubles or triples one’s risks of an early death.

During the pandemic, it was found to greatly increase the risk of being hospitalized or killed by the newly evolved coronavirus that came to be known as “severe acute respiratory syndrome coronavirus 2  or simply SARS-CoV-2. Spanish researchers early on linked it to a 2.3 times greater risk of death for those infected with the virus that causes the disease now known as Covid-19.

Since that 2021 scientific discovery, MetS has also been tied to what is now commonly called “long Covid,” the lingering affects of Covid-19  plaguing some survivors of the disease.

“The Covid-19 pandemic has posed unprecedented challenges, especially for individuals with underlying comorbidities. Among these, metabolic syndrome (MetS) – characterized by central obesity, dyslipidemia, hypertension, and insulin resistance – has emerged as a key determinant of adverse outcomes,” researchers from Indian reported in the peer-reviewed European Journal of Cardiovascular Medicine in April.

Researchers have yet to find a ‘cure’ for long Covid, although those at the Walter and Eliza Hall Institute of Medical Research in Australia say they have found a drug compound that works in mice.

Still, as with many of the diseases that plague the human species, prevention is the best cure, and exercise is a well-documented and free ‘medicine’ although few physicians have embraced the idea.

Enemies of the people?

“Exercise is Medicine,” a global health initiative managed by the American College of Sports Medicine (ACSM), won’t say how many physicians are among its members worldwide, but in 2024 admitted “we are not moving the needle regarding the proportion of U.S. adults who are being engaged in discussions about physical activity by their physician or healthcare professional; in fact, we might be regressing. In 2000, 28 percent of a random sample of adults reported receiving advice from their physicians to engage in regular exercise.”

The number was reported to be down to “22.9 percent of adult women and 17.8 percent of adult men” by 2022, despite the pandemic, “with the lowest observed rates in adults 18 to 34 years – 16 percent of women; 9.5 percent of men. 

Given all the “smart watches” now on the wrists of Americans, it would be easy for doctors to add a “steps per day” question to the medical forms patients are invariably required to fill out, but you’d be hard-pressed to find a medical practice doing this.

Both the American Medical Association and the American Academy of Family Physicians have pointed out step counts as an easy measure of what patients are doing to stay healthy, but neither has suggested to doctors that make it a regular practice to track about step counts.

Maybe because it’s just easier to prescribe them a drug. The ACSM reported that while physician queries as to regular exercise were going down the “prescription volumes for GLP-1 medications (a new type of weight loss drug) increased 300 percent” between the first quarter of 2020 and the end of 2022.

GLP-1s are now being touted as a treatment for many of the chronic diseases plaguing or threatening Americans – from diabetes to dementia – although researchers also reporting the drug’s effectiveness appears to fade quickly unless users exercise regularly after getting off the drug.

“When GLP-1 receptor agoinst treatment is stopped, appetite inhibition and improved eating behaviours are lost, and the participants do not have any available means to counteract these changes, which is the likely cause for the observed rapid weight regain,” reported Danish researchers who conducted a randomised, placebo-controlled trial of GLP-1s. 

RCTS – randomised controlled trials – are considered the gold standard in medical studies. The researchers, whose work was published in the peer-reviewed eClinicalMedicine in 2024, concluded that in order to make GLP-1s effective over the long term, “physical activity interventions, where increased physical activity in principle can be continued in a real-world setting” are necessary to ensure “treatment effects can be maintained.”

The alternative, of course, is to keep people on GLP-1s forever. The consequences of this are unknown, but writing prescriptions is easier for physicians than whose talking to patients who often ignore, or even rebel, at the suggestion of exercise.

And, of course, the drugs are a gold mine for both clinics and drug companies.

Recognizing this obstacle, the leaders of the Exercise is Medicine initiative challenged “all ACSM members who work in and are affiliated with healthcare settings to find like-minded colleagues and leaders who can champion the clinical integration and adoption of the Physical Activity Vital Sign, enhance the integration of physical activity into the clinical workflow, and implementeferral schemes to medical and community fitness centers or programs.”

Good luck with that.

There appear to be very few doctors involved with ACSM. The group claims to be “the largest sports medicine and exercise science organization in the world, with nearly 50,000 international, national and regional members and certified fitness professionals.”

If all 50,000 of those members were U.S. doctors, and it appears most of them aren’t, they would represent less than 5 percent of the more than 1.08 million licensed physicians the Federation of State Medical Boards report are resident in the U.S. 

Money, money, money

The facts here might almost lead one to conclude most American doctors are more interested in earning comfortable incomes and maintaining “patients” than in creating healthy Americans who visit their facilities only once a year for annual physicals.

The average Alaska physician now earns $357,000 per year and appears underpaid, according to the Physician Side Gigs website that tracks salaries state by state. Forty-one states have higher averages, and many of them boast far lower costs of living.

Iowa, which leads the salary scale with an average of $464,000 per year, has the seventh lowest cost of living in the country. Alaska is down at 39th, primarily due a relatively low cost of housing. Housing costs raise California to the U.S. leader in cost of living with Washington state not far behind, but average doctor salaries there are reported to be $62,000 more per year than in Alaska.

Modern medicine has become big business in America. The U.S. “health care industry” is now reported to be worth $4.87 trillion with an expected growth to $7.64 trillion by 2033. But the industry is really not about “health care.”

The American health care industry is actually a medical industry pushing everything from Brazilian butt lifts to lifesaving chemotherapy. Without patients, the business goes bust just like any other business that lacks for clients or customers.

Thus, there is really no incentive for the medical industry to make America healthy again even if the country remains blessed with a good number of caring and well-meaning doctors who truly do want to help people.

Economic incentives, however, don’t care about people.

This might help explain why the pandemic of the ill and old – who comprised the overwhelming majority of the more than 1.2 million Americans killed by Covid – wasn’t used to leverage awareness of the needed for improving the fitness of the average American, and why the focu is now on costly GLP-1 drugs, rather than physical activity and diet, to treat MetS even though medical researchers were 20 years ago warning that “similar to other chronic diseases, the metabolic syndrome is a complex, lifestyle-dependent illness.

“Its solution is not difficult to achieve: eat less, exercise more. These solutions must become part of everyday life and be woven into our social life to be effective. Health care professionals need to help people to understand the potential benefits that may result from the introduction of dietary patterns and exercise, and support them in adopting and adhering to these behavioral patterns.”

This clearly didn’t happen.

The number of people with metabolic syndrome has only grown since the early 2000s, according to the highly respected Mayo Clinic, which reports that “up to one-third of U.S. adults have it. Healthy lifestyle changes can slow or stop metabolic syndrome from causing serious health conditions.”

The latest study of MetS prevalence, published this week as a research letter on the JAMA Network, put the number above a third. The letter reported “a nonsignificant upward trend from 35.4 percent (of the population) in 2013-2014 to 38.5 percent in 2021-2023.

This trend was driven by that large and troubling uptick in prevalence among those aged 60 and older, a group in which MetS prevalence went from 50 percent in 2013-2014 to 62.4 percent in 2021-2023. The good news was that the syndrome has actually declined somewhat among those aged 40 to 59 after peaking near 50 percent in 2015-16 and has begun to decline among those aged 20 to 39 after a steady rise from 2013-14 to 2017-2020.

“Notable variations across subgroups were observed, particularly among adults aged 60 years or older and non-Hispanic Black adults, who had significant increases in metabolic syndrome prevalence,” the authors of the letter added. “These findings may reflect differential barriers to health care access, greater exposure to chronic stressors, and behavioral factors (such as reduced physical activity and increased sedentary time), which disproportionately affect these populations.

“This increase is especially concerning given the aging U.S. population, already high cardiovascular risk in older adults, and persistent structural inequities influencing metabolic health in non-Hispanic Black populations.”

The 60 and over age group is heavily weighted toward people of retirement age, generally 65 or older, and that population is steadily growing as the last of the “Baby Boomer” generation ages. The pandemic, which killed hundreds of thousands in this age group, slowed the growth rate, but not all that much given what the U.S. Census Bureau reported as an increase of 15.5 million Americans age 65 and older between 2010 and 2020.

“The U.S. population age 65 and over grew nearly five times faster than the total population over the 100 years from 1920 to 2020,” the Census reported in 2023. “The older population increased by 50.9 million, from 4.9 million or 4.7 percent of the total U.S. population in 1920, to 55.8 million, 16.8 percent, in 2020. This represents a growth rate of about 1,000 percent, almost five times that of the total population, about 200 percent.”

“In 2020, about 1 in 6 people in the United States were age 65 and over. In 1920, this proportion was less than 1 in 20.”

With an estimated two-thirds of the population over age-60 already sick with MetS, the costs of caring for these older Americans aren’t going to decrease anytime soon, and the national Medicare program for the elderly that began in 1970 with a cost of $750 billion had already grown to $1,029.8 billion by 2023, according to the National Health Expenditure Fact Sheet produced by the Centers for Medicare & Medicaid Services.

It topped spending on Medicaid for the poor by $158 billion and accounted for 21 percent of all U.S. spending for medical care and about 3.7 percent of the gross domestic product (GDP).

This, according to World Bank data, amounts to about 40 percent of what Finland spends on universal, public medical care for Finns of all ages. But Finland in the 1970s started a program to improve public health that continues to this day.

Cheap solutions

“Thirty years ago, Finland was one of the world’s unhealthiest nations. Diet was poor, people were inactive and heart disease was at record levels,” The Guardian reported in 2005. “Now it’s one of the fittest countries on earth.”

The Guardian’s examination of Finland’s success story found that what Finland did was pretty simple. Government officials convinced Finns to eat better and exercise more.

“Finland is anything but typical of the world,” the Guardian’s Ian Sample reported from Tampere, the country’s third largest city, where ‘Tuomo and Leo” were “making final preparations before heading off for maybe 20 kilometers of cross-country skiing around the city’s park” where “there are dozens of brightly coloured figures out there plodding through the snow during their lunchtimes.

“There is nothing particular about Tampere that brings the skiers here or, for that matter, the cyclists, pedestrians and Nordic walkers who pick their way along the paths and pavements, skiers robbed of their skis. Apart from a preponderance of red brick and factories that earned it the guidebook moniker, ‘the Manchester of Finland’.”

But Tampere, he added, had become typical of Finland, a country that is “according to sports and health experts…one of only two countries to have halted the downward spiral towards terminal couch potatoism, or sedentary inactivity to use the official parlance.”

That change helped to reduce the number of men dying from cardiovascular heart disease by 65 percent and accompanied by a campaign to reduce smoking, it cut lung cancer deaths by a similar amount.

Meanwhile, in America, the solution is to find medical treatments for everything, which helps explain why the country’s ‘health care’ costs have reached an average of $14,570 per person per year and continue to rise.

This spending amounts to 17.6 percent of the nation’s Gross Domestic Product (GDP). And it is about twice what Canada spends to provide universal health care for all Canadians.

Canadian medical spending was “expected to reach $399 billion in 2025, or $9,626 per Canadian (about $7,000 US),” according to the Canadian Institute for Health Information, which “anticipated that health expenditures will represent 12.7 percent of Canada’s gross domestic product (GDP) in 2025.”

Canadians spend a lot less on medicine than Americans, and yet manage to stay considerably healthier. This is true of a long list of countries that now lead the list of the world’s healthiest.

Singapore now ranks number one on that list, according to World Population Review, and spends about $6,658 per person, according to World Bank numbers.

Japan is number two on the healthiest list and spends less than $3,900 per person despite its aged population. And the big-spending U.S.?

Its 66th on the list behind Thailand, Russia and Turkmenistan, and way, way behind most other Western countries. It ought to be a national embarrassment, but some it isn’t. Is it that so many people are making money off the sorry state of American health?

Or is it that Americans have become so lazy they are no longer willing to do what needs to be done to take care of themselves?