March 20, 2026
Source/Image licensed from Ingram Image
Americans say they want to live long, healthy lives. But many find it a struggle to adopt healthy lifestyles — the surest path to longevity.
Amid America's search for longevity, there's a conversation we still need to have. It isn't about technology, insurance or drug prices. It's more personal — and it has the potential for significant impact. The discussion centers on a health approach grounded in long-established, evidence-based science that has not yet been broadly absorbed into American culture: the missing piece in today's longevity dialogue.
In my last column, I described how the goal of longevity sits within an American health paradox. Though multiple generations say they want longer lives — and surveys show more than half of Americans would prefer a shorter life over a longer one marked by illness — we fall far short. The United States leads the world with a 12-year gap between our lifespan and healthspan — the number of years we remain healthy and able to enjoy the benefits of living longer.
The paradox runs deeper. While the United States spends roughly double that of comparable countries on health care, our health outcomes are merely middle of the pack. Upwards of 70% of Americans are overweight or obese despite ample fitness and dietary choices, and trends show that chronic disease is on the rise.
So, while generations aspire to live long, healthy lives — and we've made a robust investment in health — the results suggest the core problem isn't the money or the medicine. It's a need for another approach.
In that same column, I presented evidence that medical experts know quite well how to close this gap. Experts from Harvard suggest that 75% of our healthspan is largely shaped by how we care for our bodies and minds. In short: our lifestyle. Notwithstanding this evidence, polls show that Americans are counting on advances in technology, not lifestyle, to help them live longer, healthier lives. That expectation points to the missing piece in this crucial conversation.
How we live is a major contributor to our health. So much so that cardiovascular conditions, diabetes, obesity and mental health disorders are described as "lifestyle diseases." Sedentary routines, deferred medical care and comparatively little exercise or healthy eating all contribute to the lifespan-healthspan gap.
Experts like Dr. Eric Topol, of the Scripps Research Translational Institute in San Diego, underscore the sentiments of many medical researchers, noting "nothing surpasses regular exercise for promotion of healthy aging." He calls exercise "the single most effective medical intervention that we know." Yet while healthy lifestyles have been promoted for decades, what remains elusive is the motivation to start — and sustain — healthy behaviors. Decades of social science suggest that the missing piece is the emotional force within us that can support behavior change.
For almost a century, social scientists have examined what motivates healthy behavior and found that social factors and internal emotions — like the happiness we derive from our most precious relationships — can be powerful drivers of healthy living. Yet despite the limitations of medical models grounded primarily in physical and natural science, social and behavioral factors have not found meaningful adoption in the cultural mainstream.
Yes, medical schools teach motivational interviewing, a technique designed to help ambivalent patients move toward behavior change. And lifestyle medicine, a specialty emphasizing behavioral changes, is gaining attention. But neither has been substantially integrated into mainstream medical practice, our cultural norms or health policy. And it's reasonable to argue that controlling personal behavior sits largely outside the ability of medical providers: if someone doesn't visit a doctor, doesn't adhere to directives, or knowingly engages in unhealthy behaviors, it's unfair to place accountability on the medical establishment.
Then there's behavioral economics — the idea that financial incentives can prompt behavioral changes that lead to healthier lifestyles. Whether cash or vouchers that can be exchanged for desirable items, the enthusiasm for using incentives to influence health behavior has emerged as the economic and social costs of unhealthy behaviors grow, and findings that health behaviors can be significantly affected by the structure of economic incentives.
Experts believe that financial incentives — like your health insurer subsidizing your gym membership — can help spur new habits, break old habits, provide upfront incentives and remove barriers. While behavioral economics leverages psychology, and these short-term steps may get people started, some question their long-term viability if the incentives stop. That's why many believe that a stronger, emotionally based approach can more meaningfully complement the work of clinicians over the long haul.
The research on how social and emotional factors affect our health is longstanding — and it continues to grow. Since 1938, the Harvard Study on Adult Development has followed participants longitudinally (originally men, later expanded to include their wives) to uncover the secrets of a healthy, happy life. After more than 80 years, Harvard's researchers conclude that "our relationships and how happy we are in our relationships have a powerful influence on our health."
In the 1970s, psychologists Richard Ryan and Edward Deci developed Self-Determination Theory. Their work highlighted the power of intrinsic or internal motivation and the importance of aligning broader life goals with health behavior change.
More recently, a study in the Canadian Journal of Cardiology found that the quality of intimate relationships can significantly affect heart health outcomes and recovery.
In a survey I conducted of 1,000 men over 50 — prescreened as leading a healthy lifestyle — I found that their principal source of inspiration were their social and emotional relationships, typically with spouses and significant others. These men viewed diet and exercise as a means to an end. Their ultimate goal — the purpose behind their behaviors — was to deepen those relationships. The science is strong and growing. The challenge is to bring this motivational message deeper into the mainstream and promote adoption.
American interest in longevity spans generations, but it's conditioned on the quality of those extra years. Without quality, many Americans say they would forgo the extra time. Unfortunately, our actions often don't match that sentiment: we expect technology to deliver the quality years we seek despite medical evidence that lifestyle, especially diet and exercise, is the most reliable path to longevity.
To avoid the unprecedented personal consequences represented in the data, stronger application of the social sciences (psychiatry, psychology, sociology) and leveraging our emotional relationships represents an approach to confront the American health paradox. But most of all, individuals must take responsibility by rejecting passive approaches and using their unique ability to leverage their relationships to control their own health destiny.
In the final installment of this three-part series, I'll show you how to build your own motivational platform. In addition, I'll share several evidence-based factors that work in your favor and discuss the added benefits to your personal life. It's a formula for health, happiness and longevity. A winning formula.
