I recently noted the irony that a foremost expert on precision medicine wrote a book about longevity, and his main recommendations all boil down to lifestyle. (1) My own list of lifestyle advice closely match his, but herein I want to emphasize what I see as the root cause of our chronic disease epidemic: stress.
Stress: The Overlooked Culprit
Stress rarely gets the attention it deserves because it’s hard for clinicians to measure. It’s also sidelined because medicine itself is steeped in stress. Doctors, nurses, administrators—everyone in health care imposes tremendous pressure on themselves. Electronic medical records are often blamed for burnout, but EMRs are just the final straw. The real issue is relentless, mostly self-imposed demands.
I remember a med school professor saying he could never assign too much material to students because they’d somehow manage. What struck me was his willingness to pile on more than was humanly possible, with little empathy for the toll it took. Medicine has a blind spot when it comes to stress, and I was no exception.
As a faculty member in Preventive Cardiology at the University of Pittsburgh in the 1990s, I attended a lecture on the biochemical responses to stress at the tissue and cellular level. Precision medicine seemingly blames “inflammation” for every chronic condition, but “inflammation” has become a catch-all term. The talk was impressive, but I left without a clear notion of how to prevent heart disease through stress management. After all, everyone has stress — how much is too much?
Today, my perspective is more integrative. Americans cope with stress mainly by eating pro-inflammatory convenience foods and using products that promote being sedentary. For 3 generations, we’ve taught our youth a lifestyle that produces chronic conditions.
Stress Fuels Unhealthy Choices
Stress doesn’t just affect us emotionally; it drives unhealthy decisions across all aspects of lifestyle. Not just through worry, but mainly through lack of time and money.
I can’t speak for other countries, but Americans try to “have it all.” The most common excuse I hear from patients is, “Doc, I don’t have time to…” – whether it’s about exercising, making a salad, cooking at home or getting enough sleep. Feeling like we don’t have enough time leads to sedentary habits and reliance on what Michael Pollan calls “edible food-like substances.” (2)
Just yesterday, I saw a young woman on Cornell’s campus run a stop sign on her electric scooter, causing me to ponder on previous generations of Cornell students who had to walk. Does the woman I saw use the time she saved to exercise in a gym? Or has she traded walking – active transportation – to have time for other priorities? For too many Americans, it’s other priorities.
When I ask patients what they need, they usually say to lose weight or more exercise. Almost no one says they need to simplify their lives or reduce stress.
The Changing American Family
For most Americans, home equity is the main source of wealth. (3) Former Secretary of Labor Robert Reich points out that women gained independence in the 60s and 70s, pursued higher education and built careers. As a consequence, many families today are dual-income households.
As a latchkey only child of a single mother in the 1960s, I saw firsthand how hard it was for women. I’m all for women getting educations and equal pay — my mother would disown me if I weren’t! But unlike the idyllic family life portrayed in the 1960s TV show “Leave it to Beaver”, today’s dual-income households don’t have a June Cleaver in the roll of homemaker – now estimated to be worth $205,000 a year! (4)
A few years ago, a group of high school students confessed to a workgroup in which I participated that they rarely had sit-down family meals. Not even on Sundays. Instead, everyone reheated food or leftovers in a microwave oven, eating whenever they could fit a meal into their day. One student’s only “sit-down family meal” was at his alternative school, where students and faculty ate lunch together on Fridays. This mirrored what my adult patients were telling me: between work, chores and chauffeuring kids, they simply didn’t have time for healthy habits.
Many patients know they’re setting a bad example for their children or grandchildren. And many grandparents today find themselves raising kids again because their own children are single parents. According to Reich, middle-class families use dual incomes and help from elders to keep up, some hiring domestic help so both parents can work.
This shift from the nuclear family of the 1950s and 60s has been progressing for three generations. I’m neither being judgmental nor saying we should go back. This is just the way we live now, and we’re blind to how it affects our health.
The Vicious Cycle
Wanting more “stuff” – both things and experiences – is overwhelming and leads to cutting corners: buying processed foods, skipping exercise, staying up late to finish chores, having a drink or a smoke to relax and missing out on family meals. The food industry gets blamed for pushing Pollan’s “edible food-like substances,” but from a capitalist perspective they’re mainly meeting market demand. Electric scooters are a rage, but they replace walking with inactive transportation.
Americans want convenience and to save time, because time is money. (5) It doesn’t help us that industrial processing to turn raw foods into commodities (grain meal, oils, syrups, etc.) facilitates a highly profitable business model (though not for farmers) of making products that serve our demand for convenience but that are pro-inflammatory and contribute to chronic conditions. (6) Our society’s priorities leave people with insufficient time and money to meet their priorities, which drives unhealthy lifestyle choices.
The Path Forward
It’s tough to dial back ambitions and reset priorities. It’s natural to look around, blame the chaos while not seeing our own contribution. But the secret to health and well-being is letting go of “stuff”. It’s making the time to prepare whole foods, to dine, to spend high-quality time with loved ones and to be active enough to be tired so that we sleep soundly at the end of the day. The real secret? Stop asking too much of ourselves.
Life is stressful even when we make healthy choices. Time will tell whether healthy habits alone can counteract the biochemical effects of a stressful life. I suspect not entirely so. But if we keep piling on stress and convenience lifestyle while trying to fix the damage with precision polypharmacy…well, as my father used to quip, “It’ll never fly, Orville”.
Geoffrey E. Moore, MD FACSM
References
1) Moore GE. On healthspan and precision medicine. June 9, 2025.
https://sustainablehealthsystems.com/blog/healthspan-and-precision-medicine
2) Pollan M. In Defense of Food: An Eater’s Manifesto. Penguin, NY, 2008. ISBN: 0-14-314274-7
3) Reich R. Wealth & Poverty, class 1. April 7, 2023.
https://robertreich.substack.com/p/first-class
4) Moran P. How Much Is a Stay-at-Home Parent Worth? January 15, 2025.
https://www.investopedia.com/financial-edge/0112/how-much-is-a-homemaker-worth.aspx
5) Franklin B. Works of the Late Doctor Benjamin Franklin: Consisting of His Life, Written by Himself, Together with Essays, Humorous, Moral & Literary, Chiefly in the Manner of The Spectator. Ireland, P. Wogan, P. Byrne, J. Moore, and W. Jones, 1793.
6) Asensi TM, et al. Low-grade inflammation and ultra-processed foods consumption: a review. Nutrients. 2023 Mar 22;15(6):1546.
https://www.mdpi.com/2072-6643/15/6/1546
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