Draw an Informed Conclusion

The number of obese adults in the United States has doubled since the early 1960s.

Today, more than two-thirds of adults in the country are considered overweight or obese, putting them at risk for coronary heart disease, high blood pressure, stroke, joint problems, some forms of cancer, and type 2 diabetes. The most recent five-year survey found that more adult women in the United States are obese than men, a trend that Women's Health Research at Yale hopes to understand and help to remedy.

There are many reasons for the obesity epidemic, including sedentary lifestyles with people watching TV or playing video games for many hours and sitting in cars for long commutes to a job where many spend hours at a desk, unnecessarily large portions for meals served at restaurants and at home, the ubiquity of fast food advertising, the popularity of soft drinks and other food and beverages with added sugar, and lack of access to healthy foods due to convenience or price.

But it is not necessary to redesign modern society or completely overhaul diets to make significant improvements in health.

“Small changes can make a big difference,” said Dr. Margaret Grey, the Annie Goodrich Professor of Nursing at Yale School of Medicine and the Deputy Director of the Yale Center for Clinical Investigation.

Studies have shown that eating a little healthier and exercising for about 30 minutes five days a week can reduce weight and delay and maybe even prevent type 2 diabetes, which involves higher risks of heart disease and depression for women.

“People should aim for losing about 5 percent of their total body weight to start,” Grey said. “Every little bit counts, and it’s never too late.”

Grey recommends that people seeking to control their weight set small, attainable goals such as taking three 10-minute walks each day. It’s helpful to actually set the time aside in a calendar or daily planner, she said. “Any type of exercise will do,” Grey said. “The idea is to get your heart rate up. Take the stairs instead of taking an elevator. Dance at home with your kids. It can be fun.”

In addition, Grey recommends that people pay attention to portion sizes when they eat. Use smaller plates instead of filling up a big one with food. Make sure to eat breakfast so the day starts with a full stomach. Indulge in small, healthy snacks over the course of the day instead of holding out for big meals.

Making small changes when shopping and cooking can also lead to better health, she said. Buy low fat instead of whole milk. Bake or grill food instead of frying it.

The idea isn’t to starve yourself or deprive you of the things you like, Grey said. But to make a tweak here and there to gradually improve overall eating habits. And so that treats become something you actually treat yourself to and not an everyday habit.

“Obesity is a big problem that requires serious attention,” she said. “But we can all get to a healthier place while taking small steps.”

Every year, about 1.5 million people in the United States break a bone that has been weakened by osteoporosis. And the disease – in which bone tissue is not replaced as rapidly as it naturally breaks down – affects more women than men. About four of every 10 white women who are at least 50 years old will eventually break a hip, spine or wrist. (1)

But while the disease is more common among white women, it affects men and women of all races. What’s worse, many people don’t even know they have osteoporosis until they break a bone. For people who are particularly frail or elderly, a broken bone can lead to a deterioration in their physical and mental health that leads to death, particularly within the first year after a fracture. (1)

“That’s the bad news,” said Dr. Karl L. Insogna, a Professor of Medicine at Yale Medical School and Director of Yale Bone Center. “The good news is that there are many things girls can do from a very young age to help prevent the development of osteoporosis. And even for adults, it’s never too late to start doing the right things.”

Women are born with less bone mass than men, and they lose it faster, especially after menopause. White women in particular are highly susceptible to rapid loss of bone density. According to a 1998 study, white women lose 1/3 of their bone mass density between the ages of 20 and 80. Men over that same period lose only 1/4 of their bone mass density. (2)

Dr. Insogna said the goal is to act as early as possible.

“Bones need calcium for regular growth and maintenance,” he said. “And the body needs vitamin D to help absorb that calcium. The sun’s rays on the skin create vitamin D, though for many people it’s not advisable or practical to be regularly exposed to the sun, and they should eat foods rich in vitamin D instead.”

Exercise also plays an important role in building core strength and balance to reduce the risk of falling. Aerobic exercise can help, but Dr. Insogna said it’s more important to maintain balance and strengthen muscles in the abdomen, back, and pelvis.

After menopause, women should see their health care provider about a bone mineral density test to see if they are on track for avoiding osteoporosis.

“So many of my patients are stunned to learn they have osteoporosis,” Insogna said. “But with the proper diet and regular exercise, it’s something many people can avoid.”


  1. Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 4, The Frequency of Bone Disease.
  2. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporosis Int. 1998;8(5):468–9.

The percentage of adult smokers in the United States has dropped steadily over the last five decades, from 42 percent in 1965 to 17 percent in 2013.

That’s the good news.

But even as fewer adults and high school students smoke today than at previous peaks, smoking remains the leading cause of preventable death and illness in the country. Every year, 480,000 Americans die of smoking-related diseases.

And not all smokers are the same.

While fewer women than men smoke, studies have shown that women are more susceptible to tobacco-related health conditions such as cardiovascular disease, respiratory disease, and stroke. Women who smoke also experience increased risks of cervical cancer, lower bone density, estrogen deficiency disorders, menstrual cycle disorders, conception delay, infertility, and pregnancy complications. Since 1987, lung cancer has surpassed breast cancer as the number one cause of cancer death for women.

“For women and men, smoking continues to disrupt and shorten lives,” said Dr. Sherry McKee, Director of the Yale Specialized Center of Research (SCOR) developing gender-sensitive treatments for tobacco dependence. “But women also face more difficulty when trying to quit.”

At the Yale-SCOR, Dr. McKee and her team have added to a substantial collection of evidence showing that first-line smoking cessation medications using nicotine replacement, such as the nicotine patch, do not appear to work as well for women as for men.

“While men might smoke to satisfy a craving for nicotine, women smoke more to manage their moods,” McKee said. “And the relationship between stress and smoking appears to be stronger in women than men, leaving women less able to quit or more likely to restart smoking after stressful events such as a financial setback.”

The patch can help men satisfy their craving for nicotine and ease biological symptoms of withdrawal from nicotine dependency. But for women, just treating nicotine withdrawal does not help reduce negative moods, enhance positive moods, or manage stress, appetite, and weight.

At a basic level, women often smoke for different reasons than men.

“People with depression are more likely to smoke, and depression affects twice as many women as men,” said Dr. Carolyn M. Mazure, Director of WHRY and Scientific Director of the Yale-SCOR. “Women may also be more vulnerable to depression following an attempt to quit smoking.”

In addition, women are more likely to smoke or to restart smoking after a quit attempt when facing stress. Because smoking suppresses appetite, women also often smoke to control their weight. And because women are more likely to be concerned about gaining weight if they quit, they are often less motivated to quit and more likely to relapse after a quit attempt.

Thankfully for women, the Yale-SCOR has conducted the first-ever demonstration that women have a preferential response to a specific smoking cessation medication.

In a study published in October by the journal Nicotine and Tobacco Research, the Yale-SCOR has shown that the prescription medication varenicline, marketed as Chantix, was more effective earlier in women though equally effective for women and men after one year. The medication does not contain nicotine but works by blocking the pleasurable effects of nicotine in the brain.

Because women are more likely to relapse after a quit attempt, and because relapses tend to occur soon after the beginning of a quit attempt, the earlier effectiveness of varenicline in women can help women get over that hump toward successfully quitting.

Other advice for women seeking to throw out their cigarettes for good include finding other ways to manage negative moods, accepting that maybe gaining a few pounds will be worth the health benefits of not smoking, enlisting the support of family and friends, and limiting coffee and alcoholic beverages, which can increase cigarette cravings when quitting.

Researchers have demonstrated tremendous benefits of quitting.

Regardless of a smoker’s age, the risk of heart disease and stroke decreases up to 50 percent in the first year after quitting. By 15 years, the risk of coronary heart disease is the same as a non-smoker.

By quitting before turning 40, a smoker can reduce the chance of dying early from smoke-related diseases by about 90 percent. Quitting between the ages of 45 and 54 reduces premature smoke-related death by about 66 percent.

In addition, quitting smoking reduces the risk of developing and dying from cancer. Even if a smoker already has cancer, quitting can improve the effectiveness of treatments, lower the risk of further tumors, and increase rates of survival.

This video was supported in part by The Grace J. Fippinger Foundation.

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