Since I published my book, Up: How Positive Outlook Can Transform Our Health and Aging, I've been asked what's the most important factor for healthy aging. Is it our outlook, our risk factors for illness, like high blood pressure and obesity, or something else? Before I share my answer with you, let's explore how our outlook can guide us along a path toward healthy aging or, alternatively, disability and premature death.
From childhood to old age, our outlook fundamentally impacts our health and aging. It's the lens through which we view the world and it is characterized not by any single attitude, but by the shades of many traits. We all have positive traits, like optimism — the ability to see a bright future as real and to act to make it happen — being open-minded and living life with a sense of purpose. At the same time, we have degrees of so-called negative traits, like pessimism — expecting bad events in the future — hostility or anger and mistrust toward others.
Outlook is part of what makes you you. Up to half of our outlook is genetic — you may have inherited a happy-go-lucky streak from your mom or dad — but the rest bears the coloring and texture of our individual life experience, usually gelling into a unique and fairly stable perspective by age 20 or 30.
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The idea that psychological traits influence our health and health-related behaviors has long been established, although many may not be aware of how early in life the associations form.
Once we're in midlife and beyond, outlook is just as crucial, especially since our risk for disease naturally rises with age. My own research, tracking almost 100,000 women in their 50s, 60s and 70s over eight years, demonstrated that pessimistic women had higher rates of heart attack and died earlier than more optimistic women. And women high in cynical hostility, a type of anger involving an extreme distrust of most people, died earlier than their less hostile peers. Other studies around the globe have shown similar links between perspective and serious cardiovascular disease events, and death, in men and women. For example, Japanese adults who do not possess what that culture calls ikigai — living life with a strong sense of purpose — die sooner than those who do.
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Our brains are connected to every organ in our body through the nervous, endocrine and immune systems. The biochemistry happening above our neck — what we think and feel — has a direct path to everything below it. Knowing this, it's no surprise that pessimism, hostility and similar traits are associated with higher levels of stress and inflammation, now understood to be a shared biochemical foundation of many chronic illnesses.
So, to the question of which is more important for long-term health, our outlook or our risk factors for illness? It's both, of course. There is no question that our risk factors can make or break our chances at healthy aging. The American Heart Association has identified a "Simple 7" list of key steps you can take to reduce those risks and help ensure that you enter your later years with as much vigor as nature intended:
- Don't start smoking. If you do smoke, quit.
- Control your blood sugar.
- Control blood cholesterol.
- Manage blood pressure.
- Exercise most days of the week.
- Eat reasonable portions of healthy foods and cut back on unhealthy foods.
- Maintain a weight that is healthy for your height.
Following the heart association's list sounds easy enough. It's smart, too. Who wouldn't want to drastically reduce his or her risk of heart attack, stroke and early death? And yet, most of us don't follow through. Less than 1 percent of American adults achieve all seven steps; fewer than 20 percent reach even five.
Enter outlook. As we now know, a high degree of pessimism or hostility is not only associated with a greater burden of risk factors at all ages, it also projects worse health trajectories over time. Not only are hostile people more likely to be obese in the first place, as time goes by they continue to gain more weight than others. Similarly, they are more likely to smoke at any given age, and less likely to quit.
Outlook is, of course, not the only factor that determines how we will age. As my mentor, the academic physician and cardiovascular epidemiologist Dr. Lewis H. Kuller, has said, "The pessimist who doesn't smoke, takes medicine to control blood pressure and lipids and follows a healthy diet will do better than the optimist who smokes and drinks at the bar eating pickled pig's feet." True enough. But the evidence shows that the pessimist is less likely to follow such a healthy path.
Time to Make a Change
We don't yet have formal medical guidelines on how to change our outlook, but clinical trials have shown that a positive shift, at any age, translates into better health — children and adolescents taught to adopt a less pessimistic perspective, for example, have a lower risk of depression over time. If we deconstruct our outlook into its nuts and bolts — the specific patterns of thinking and feeling that drive so much of our lives — we can see both how it can lead us to unhealthy decisions and behaviors, and how we may be able to tweak it for our own benefit.
While we wait for the results of more and larger trials on exactly how outlook change affects future health prospects, it's important to understand that even small changes translate into big differences. Relinquishing a little of the fatalism that may be preventing you from living healthier — like the crutch of believing, "I have to die of something" as you overeat, drink or smoke — is a must.
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Recognizing how our outlook can lead us astray isn't meant to be self-punishing or berating. It's empowering and, above all, hopeful. My colleague and friend Dr. Chris Germer, a Harvard-affiliated clinical psychologist and author, encourages us to avoid "feeling bad about feeling bad" and instead to focus on what we can change in order to feel better. Is there anything you could be doing differently? Be honest with yourself. Then pick just one thing to change today — maybe it's exercising more. Maybe it's cutting out the daily 3 p.m. Snickers bar.
Given the abysmal state of our national health, most of us, myself included, could benefit from such changes. Achieving such goals, tiny as they may seem, means believing on some level that you can, and that is a fundamentally optimistic effort. Acknowledge even your small accomplishments along the way, and most of all, avoid the tendency we all sometimes have to choke our progress with fatalism or with worry about dashed hopes. That strategy will only get you one place: Right where you are now.