We are our own worst enemy

When, oh when, is the American medical community going to accept the reality that this country’s biggest healthcare problem isn’t insurance or medications; it’s fitness?

Americans are sick and dying because they spend too much time sitting and too little time moving, way too little time moving.

The latest reminders come in the form of new studies on cardiovascular diseases, which are back to being the nation’s biggest killer, and colon cancer.

“Together, heart disease, 22 percent of U.S. deaths (and) the leading cause of death for more than a century, and stroke, 5.3 percentof U.S. deaths, accounted for more than a quarter of all deaths in the U.S. in 2023, the latest year for which data is available, the American Heart Association reported last week.

Covid-19 – the disease that scared most of the world half to death after the newly evolved SARS-CoV-2 virus first appeared in China in 2020 – had by 2023 fallen to the bottom of the list of America’s top-10 killers with all forms of cancer – colon cancer among these – in second.

Colon cancer is attracting attention becuase of another report out last week, this one from the American Cancer Society, showing colorectal cancer rising from the fifth most common cause of cancer deaths in the early 1990s to first in 2023, largely due to a steady increase among people under the age of 50.

This comes even as mortality from other forms of cancer are in decline, though cases are up.

“The steady rise in colorectal deaths under 50 is even more alarming compared to the dramatic declines for lung and breast, even as breast cancer incidence is climbing,” Rebecca Siegel, the Society’s senior scientific director for surveillance research, said in a media statement. 

The decline in lung cancer appears linked to the declining number of American smokers. Cigarettes don’t cause lung cancer, but they greatly increase the risk of contracting the disease.

Siegel said she is waiting for “answers for why colorectal cancer rates are up,” but part of the answer is obvious:  Americans have stopped moving.

Scientific studies have for years reported a dose-response relationship between physical activity and colon cancer, with the latest research, published in January of last year in Nature, finding that the protective value of physical activity kept increasing up to a level of “1,879 metabolic equivalents (MET) per day.”

Move, move,  move

“Low physical activity increases the risk of colon cancer, while moderate to high-intensity physical activity can reduce the risk of colon cancer,” the study said. “The results of this study emphasize the importance of maintaining appropriate physical activity as a healthy way to prevent colon cancer.”

METs are a measure of all physical activity based on oxygen consumption. They range from 1 per minute when sitting up to 20 per minute when engaged in strenuous exercise.

A normal, hour-long walk at about 3 mph is estimated to generate 3.3 METs per minute or 198 for an hour. An hour of more strenuous uphill hiking would be good for about twice as many METS. An hour pedaling a bicycle at 16 to 19 mph is calculated at 720 METs.

Suffice to say, few Americans have to worry about racking up more than 1,800 METs in a day, although the author can admit to coming close to that number when regularly making a 15-mile bike ride from the Anchorage Hillside to work each day and then again home.

The Nature researchers stuck to people getting fewer than 1800 METS per day for their study, grouping them in a low-activity group, less than 120 METs per day; a moderate-activity group, 120 to 600 METS per day; and a high-activity group, 600 to 1,200 METs.

How much of a difference did these increases in physical activity (PA) make?

“The risk of colon cancer in the moderate PA group was reduced by 20.2 percent,” wrote the Fujian Medical University authors of the study, “and the risk of colon cancer in the high-intensity PA group by 53 percent. The results showed that low physical activity increased the risk of colon cancer and was indeed an unhealthy lifestyle, which was consistent with previous studies. Meanwhile, research has also shown that high-intensity physical activity can reduce the risk of colon cancer, consistent with previous studies.”

Cutting the individual risk of colon cancer by more than half is a big deal at a personal level, but even a 20 percent reduction in this disease is a big deal at the population level in a country that is spending by far more money on “health care” than any nation in the world.

The 2025 report from the International Organisation for Economic Co-operation and Development (OECD) puts current U.S. health care spending at $14,885 per year. Switzerland is second nearly $5,000 per person in arrears. 

All the other European countries, which are experiencing steady increases in the longevity of their citizens while life expectancy in the U.S. has flatlined, are spending less. Japan, which now boasts an average life expectancy of 85 years, according to the Worldometer tracker, is spending more than $9,000 per year less.

What is spent on medicines and procedures to treat one American these days would pay the cost for two and a half citizens of that Asian nation, and yet the despite this comparativdly low spending, the Japanese have a life span more than five years longer than the U.S. average of 79.61 years.

The U.S. was a world leader in life expectancy in the 1950s, with Norway, then the world leader, only about three years ahead. Life expectancy in Japan was, at that time, almost six years behind that of the U.S.

But Japan passed the U.S. in the 1970s and began pulling steadily away. Between the early 1970s and today, Japanese life expectancy increased by almost 16 percent. The U.S. improvement, despite the country’s exploding expenditures for health care, was but 11 percent.

All about money

A cynic might be tempted to blame what has happened in this country on a money-grubbing U.S. medical profession that generally accepts the well-documented evidence that Exercise is Medicine, but is more interested in making money by keeping Americans unhealthy so they can be sold medical treatments and drugs.

But the reality is more likely that the average American doctor is simply unwilling to voice the exercise issue with overweight and out-of-shape patients looking to avoid physical activity rather than embrace it, or he or she has joined the swarm of Americans who think the best way is always the easy way.

Face it. Americans have become so lazy that they can’t even slice their own lettuce anymore. They buy it precut and packaged, if they are willing to go to the supermarket to get it and then invest the energy to actually prepare a meal themselves.

Increasingly, steadily year by year, this is considered too much work.

 “…About 70 percent of U.S. consumers order food for delivery, 70 percent pick up takeout, and 68 percent dine at a restaurant – suggesting that a majority of people are doing all three in any given month. Restaurants are no longer just places to go to eat, but kitchens for meals consumed elsewhere,” research conducted by the Auguste Escoffier School of Culinary Arts concluded.

“The National Restaurant Association’s 2025 report found that 51 percent of U.S. consumers – including about two-thirds of Gen Z adults and Millennials – say ordering takeout from restaurants is an essential part of their lifestyle.

“Meanwhile, 41 percent of consumers (and approximately 60 percent of Gen Z/Millennials) say the same about food delivery.”

Ease and convenience have become the defining standards for the new American lifestyle. There is nothing inherently wrong with this, but every lack of movement decreases daily METs and adds to what is best described as the physiological decay associated with the sedentary lifestyle.

More than 20 years ago, researchers reporting in the peer-reviewed American Journal of Preventive Medicine concluded that “each additional hour spent in a car per day was associated with a 6 percent increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8 percent reduction in the likelihood of obesity.”

Since then, the time Americans spend sitting in their cars has only gone up while the kilometers (or miles) they walk per day has only gone down.

Twenty years ago, it was estimated that the average American was walking about 6,500 steps or around 4.5 kilometers per day. Today, the daily step count is down to 4,800, or about 3.5 kilometers despite research showing that people who “took 8000 steps or more one or two days during the week also showed substantially lower all-cause and cardiovascular mortality risk,” according to JAMA, the Journal of the American Medical Association.

The Journal observed that “physical inactivity is one of the major public health issues worldwide, contributing to an estimated 3.2 million deaths and imposing $54 billion in direct health care costs annually.”

It would appear the major health issue in the U.S., where physical inactivity is helping to drive the joint epidemics of obesity and metabolic syndrome, which has the American Heart Association warning that “in the foreseeable future, one half or more persons over 60 years of age will satisfy the current diagnostic criteria for the” latter chronic illness.

This is not good news in a country where, according to the U.S. Census, close to one in four residents are already over the age of 60. The costs of treating so many of the elderly are destined to be astronomical because so many are sitting around waiting for cardiovascular disease to kill them or dementia to disable them.

GLP-1 drugs – the Covid-esque vaccine equivalent for all the diseases linked to the sedentary lifestyle – were hoped to be the preventative for the latter, but Novo Nordisk reported in the middle of December that its already wildly popular GLP-1 – semaglutide- for treating diabetes, obesity and obesity-linked chronic illnesses failed to slow progression of Alzheimer’s disease in two, phase 3 trials.

This data, presented at the Clinical Trials on Alzheimer’s Disease meeting in San Diego, “quickly doused hopes that the drug indicated for Type 2 diabetes and obesity might have slowed cognitive decline in some participants,” the ALZ Forum reported.

Nova’s announcement preceded an even bigger setback for the latest miracle drug aimed at saving those who would rather sit than move.

The BJM, the journal of the British Medical Association, at the start of this year published a major, peer-reviewed, systematic review and meta-analysis warning that “cessation of (these) weight management medications (WMM) is followed by rapid weight regain and reversal of beneficial effects on cardiometabolic markers. Regain after WMM was faster than after behavioural weight management programs. These findings suggest caution in short-term use of these drugs without a more comprehensive approach to weight management.”

Meanwhile, the respected KFF Health News was at the start of the month headlining “Older Americans Quit Weight Loss Drugs in Droves” in a story citing various problems with “widely portrayed…wonder drugs, semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Zepbound, Mounjaro), and related medications.”

“Linda Burghardt, a researcher in Great Neck, New York, started taking Wegovy because her doctor thought it might reduce arthritis pain in her knees and hips,” it was reported there. “Within a month, she suffered several bouts of stomach upset that ‘went on for hours,’ she said. ‘I was crying on the bathroom floor.’ She stopped the drug.”

Retired computer systems analyst Bill Colbert, whose “cherished hobby”  or reenacting medieval combat involves “putting on 90 pounds of steel-plate armor and fighting with broadswords,” told KFF that Mounjaro lowered his blood glucose and helped him lose “18 pounds in two months.

“But ‘you could almost see the muscles melting away,’ he recalled. Feeling too weak to fight well at age 78, he also discontinued the drug and now relies on other diabetes medications.”

GLP-1s seem to be proving true the old adage that “life ain’t easy.” The big problem is you have to work at it. Blame hundreds of thousands of years of your predecessors evolving as creatures always in motion in a world where the lazy and weak quickly ended up dead.

Evolution has been in play here for hundreds of thousands of years. It created and then selected for an immune system strengthened by constant physical activity. Attempts to remedy the decay of that immune system with drugs in inactive, modern Americans has experienced some limited success, but the flaw of fitiness ignored was vividly on display during the Covid pandemic of the unfit and the unhealthy.

Unfortunately, as the pandemic killed hundreds of thousands of Americans already suffering from chronic diseases, the fitness message never made headlines, and it still hasn’t. The medical community today seems more interested in wringing its hands over the strange vaccine beliefs of Health and Human Services’ Secretary Robert Kennedy Jr.

Look, it’s foolish to fail to vaccinate your children against measles. The measles vaccine has been in use for generations and has proven itself safe. But let’s consider the numbers here. There were 2,255 confirmed measles cases nationwide last year, and three deaths.

The plague of physical inactivity in this country contributes to more deaths every five minutes.

“On average, every 34 seconds, someone died of cardiovascular disease in 2023,” the Heart Association reported.

““We know that as much as 80 percent of heart disease and stroke is preventable with lifestyle changes and many chronic health conditions that contribute to poor cardiovascular health are manageable,” said Dr. Stacey Rosen,  the volunteer president of the American Heart Association. “Improving your cardiovascular health is possible. However, it will take a concerted effort.”

And there’s the problem. Americans are way more into ease than effort even if it is disabling and killing them.

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