Introduction
Chronic diseases pose a massive public health challenge in the United States. Six in ten (44) Americans live with at least one chronic illness, and four in ten (44) have multiple chronic conditions. These illnesses, including heart disease, cancer, diabetes, and others, are the leading causes of death and disability, and they drive an overwhelming share of healthcare utilization. About 90% (45) of the nation’s $4.5 trillion (45)annual health expenditures are for people with chronic health conditions. Beyond the human toll, chronic diseases strain healthcare systems and the economy through direct medical costs and lost productivity. Addressing chronic diseases through prevention, early detection, and improved healthcare is essential to improving public health and reducing healthcare costs.
Top 5 Chronic Diseases Affecting Americans
Heart disease, coronary artery disease (CAD), heart failure, and arrhythmias remain the leading chronic diseases (46) in the United States. Among these, CAD is the most prevalent, occurring when plaque builds up in the arteries, restricting blood flow and increasing the risk of heart attacks. Heart disease can affect individuals of all ages but is more prevalent in older adults, those with a family history, and people with certain lifestyle-related risk factors. It is the number one cause of death and is responsible for 1 in every five deaths (46). In 2022 alone, 702,880 (47) Americans died from heart disease. Prevalence is high; roughly 5.5% (48) of U.S. adults have been diagnosed with coronary heart disease. When including conditions like hypertension and stroke, nearly half (49) of American adults have some type of cardiovascular disease. This widespread prevalence underpins the enormous public health impact of heart disease, which often leads to heart attacks, heart failure, and chronic disability.
Cancer is a group of diseases characterized by uncontrolled cell growth, and collectively, it is the second leading cause of death (45) in the United States. Each year, 1.7 million people (45) are diagnosed with cancer, and more than 600,00 people (45) die. Cancer is the second leading cause of death in the United States. Due to advances in detection and treatment, more people are surviving cancer than ever before. An estimated 18.1 million (50) Americans were living as cancer survivors in 2022, and this number is projected to increase to 22.5 million (50) by 2032.
Nevertheless, cancers such as lung, colorectal, breast, prostate, and pancreatic cancer remain prevalent and deadly. Cancer’s impact on public health is profound, not only in mortality but in long-term morbidity.
Chronic respiratory diseases, primarily chronic obstructive pulmonary disease (COPD), are another top chronic illness in the United States. COPD is an umbrella term that includes emphysema and chronic bronchitis, conditions usually caused by long-term smoking that damages the lungs and airways. COPD affects an estimated 14.2 million (51) U.S. adults, which is about 6.5% of the adult population, as of 2021. It tends to be more common in older adults and those with a history of smoking. Chronic lower respiratory diseases were the 4th leading cause of death in the country, with around 150,000 deaths (52) each year. COPD’s public health impact is significant: it causes chronic disability by limiting sufferers’ ability to breathe and exercise, and it leads to frequent hospitalizations for exacerbations.
Diabetes is one of the most common chronic diseases, affecting how the body regulates blood sugar. The vast majority of cases are type 2 diabetes (53), which is often related to obesity, diet, and inactivity, whereas type 1 diabetes (54) accounts for a smaller fraction. More than 38 million (55) Americans have diabetes (about 11% of the population), and an additional 96–98 million (56) adults have prediabetes, a state of elevated blood sugar that often progresses to type 2 diabetes. Diabetes contributes to significant morbidity and mortality. It is the seventh leading cause of death in the U.S. and a significant cause of blindness, kidney failure, heart attacks, stroke, and limb amputations. Diabetes is among the most expensive chronic diseases. In 2022, the total estimated diagnosis cost was $413 billion (57) in the United States. The American Diabetes Association has estimated direct medical costs alone at around $237 billion (57) (as of 2017), with another $90+ billion (57) in reduced productivity, further highlighting diabetes’s substantial economic burden. Costs stem from daily management and from treating complications. People with diabetes have about 2.3 times (58) higher healthcare expenditures on average than those without diabetes.
Obesity is a chronic disease characterized by an excessive accumulation of body fat, typically defined by a body mass index (BMI) of 30 or higher (59) in adults. It has become alarmingly common in the United States. Currently, about 42% (60) of U.S. adults are obese, and an additional 30% (60) are overweight, meaning over 70% (60) of adults are above a healthy weight. Childhood obesity is also significant (around 20% (61) of children are obese). Obesity is a primary public health concern not only as a condition itself but as a driver of many other chronic diseases. It substantially raises the risk of type 2 diabetes, hypertension, heart disease, stroke, many types of cancer, osteoarthritis, sleep apnea, fatty liver disease, and more. The impact on public health is enormous: obesity is associated with reduced life expectancy and quality of life. The prevalence of obesity has been increasing for decades, making it a key target for prevention efforts.
How Did We Get So Unhealthy?
The mid-20th century saw a rise in heart disease, coinciding with increased consumption of processed foods high in trans fats (62) and sugars. The introduction of hydrogenated oils (63) and convenience foods contributed to dietary patterns associated with cardiovascular risks. The industrial boom increased exposure to environmental carcinogens (64), such as asbestos and certain chemicals. Occupational exposure (64) and pollution have been linked to higher cancer rates. The introduction of high-fructose corn syrup (65) in the 1970s and the emergence of sugary beverages have been associated with rising obesity and type 2 diabetes rates. Urbanization (66) and increased exposure to indoor allergens and pollutants have contributed to rising asthma prevalence and chronic respiratory diseases. The shift towards sedentary lifestyles (67), with increased screen time and reduced physical activity, has been linked to higher stroke incidence and obesity.
The rise of fast food restaurants and the popularity of TV dinners (68) in the mid-20th century revolutionized how Americans approached meals, shifting the focus from home-cooked, time-intensive dishes to quick, convenient options. Chains like McDonald’s and Burger King popularized the idea of affordable, consistent food that could be eaten on the go, appealing especially to busy families and working individuals. These innovations catered to the growing demand for convenience. They marked a shift toward highly processed, preservative-laden foods that often lacked nutritional value, contributing to long-term health issues such as obesity, diabetes, and heart disease.
At the same time, regulatory and industrial changes such as the introduction of the GRAS (69) (Generally Recognized As Safe) designation and the rise of industrial agriculture, often referred to as “Big Ag,” (70) further influenced what people consumed. GRAS (69) allowed thousands of food additives to enter the market without rigorous, long-term testing, contributing to the widespread use of preservatives, artificial colors, and flavorings. Meanwhile, Big Ag (70) emphasized mass production, efficiency, and profit, often at the expense of nutritional quality and environmental sustainability. These societal and industrial shifts have significantly shaped the modern American diet, often prioritizing speed and convenience over health and tradition.
The Standard American Diet (71) (SAD) has undergone a significant transformation over the past century, moving away from whole, nutrient-dense foods toward a highly processed, calorie-dense, and nutrient-poor way of eating. In the early 20th century (72), most meals were prepared at home using fresh ingredients, and diets were rich in vegetables, whole grains, and locally sourced proteins. However, with the industrialization (72) of agriculture, the rise of convenience foods, and the growing presence of fast food chains in the post-World War II era, Americans began consuming more added sugars, refined carbohydrates, unhealthy fats, and sodium. This shift (71) in eating habits has led to an overconsumption of calories with little nutritional value while physical activity levels have declined, creating the perfect storm for chronic health conditions.
While direct causation between the SAD and chronic disease is difficult to prove in academic literature, strong correlative data support the link. Since the 1970s (73), when processed and convenience foods became dietary staples, obesity rates in the U.S. have more than doubled. According to the CDC (74), over 42% of American adults are now classified as obese, and rates of metabolic syndrome, type 2 diabetes, and cardiovascular disease have climbed alongside these trends. Additionally, increased sugar-sweetened beverages and ultra-processed food intake have been associated with higher risks (75) of insulin resistance and inflammation. These statistics, combined with the timeline of dietary changes, make a compelling case that the evolution of the SAD is closely tied to the nation’s current metabolic health crisis.
The Pharmaceutical Grasp
Over the past decades, there has been a notable increase (88) in prescriptions related to these chronic diseases. Factors contributing to this trend include aging populations, higher prevalence of risk factors, and improved diagnostic capabilities. For instance, spending on retail prescription drugs has risen rapidly over the past three decades, with per capita spending increasing from $101 (89) in 1960 to $1,147 (89) in 2021. A growing and aging population with more chronic conditions means more people are being treated, and more prescriptions are dispensed. U.S. prescription drug spending has climbed from roughly $350 billion (90) in 2020 to around $450 billion (90) by 2023, growing at high single-digit to double-digit rates annually.
The number of prescriptions filled yearly remains enormous, over 6 billion (91), and that number continues to trend upward. The reliance on prescription medications for chronic disease management has grown significantly. In 1999–2000, approximately 51% (92) of U.S. adults reported using at least one prescription drug in the past month. By 2011–2012, this figure had risen to 59% (92). Among adults aged 40–79, nearly 7 in 10 (93) used at least one prescription drug in the past month, with around 1 in 5 using five or more. This increase reflects a growing prevalence of chronic conditions and an aging population, leading to higher medication utilization.
Pharmaceutical interventions (94) for heart disease include statins and ACE Inhibitors, which are used to prevent blood clots. While there are many different pharmaceutical interventions for cancer, the primary treatments include chemotherapy (95), targeted therapy (96), and immunotherapy (97). Medications such as bronchodilators (98), inhaled corticosteroids (99), and combination inhalers are common for chronic respiratory diseases. Treatment for diabetes includes Metformin (100), Insulin (101), or SGLT2 inhibitors, GLP-1 agonists, and sulfonylureas (102). Pharmacotherapy (103) for obesity has advanced in recent years with appetite suppressants, GLP-1 agonists, or combinations such as bupropion/naltrexone. These medications address the physiological aspects of chronic conditions, while healthcare providers often recommend lifestyle modifications, such as improved diet, increased physical activity, and smoking cessation, to enhance overall health outcomes.
Making America Healthy Again
The U.S. healthcare system (104) predominantly relies on medications as the primary means of managing chronic diseases. While lifestyle modifications are recognized for their preventive and therapeutic benefits, they are often underutilized in clinical practice. Integrating a MAHA (105) viewpoint offers a more holistic healing and whole-food nutrition-focused approach to chronic disease management. This emphasizes addressing root causes (106) through personalized lifestyle interventions, such as engaging in regular physical activity and implementing stress management techniques. By focusing on these foundational aspects of health, the MAHA (107) model aims to not only manage but potentially reverse (105) certain chronic conditions, leading to improved overall well-being and reduced healthcare costs.
Diet plays a huge role in the development of various chronic diseases. The ketogenic diet (108) a high-fat, low-carbohydrate nutritional approach, has shown promising therapeutic benefits in the treatment of various chronic and neurological conditions. Developed initially to manage epilepsy, the diet has been clinically proven to reduce seizure frequency (108) by altering brain metabolism and enhancing mitochondrial function. Beyond epilepsy, emerging research suggests that the ketogenic diet may also play a supportive role in cancer therapy (109) by lowering blood glucose levels and reducing insulin, effectively starving glucose-dependent cancer cells while promoting metabolic health. Additionally, its anti-inflammatory (110) effects and ability to modulate immune responses make it a potential intervention for autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. By shifting the body’s energy source from glucose to ketones, the ketogenic diet targets the metabolic dysfunctions underlying many chronic illnesses, offering a non-pharmaceutical pathway to improved health outcomes (110).
Exercise (111) is a cornerstone of physical and mental health, playing a vital role in preventing and managing chronic diseases (111) like high blood pressure and heart disease. Regular physical activity helps strengthen the heart, improve circulation, lower cholesterol, and regulate blood pressure. Even moderate forms of exercise, such as brisk walking or cycling, enhance cardiovascular efficiency and support healthy weight management. Beyond the physiological benefits, exercise stimulates the release of endorphins, which naturally reduce stress and promote emotional well-being (111). Engaging in sports or other physical activities provides an added benefit by combining the advantages of exercise with the power of social connection.
Playing on a team or even joining a community fitness class fosters a sense of camaraderie and accountability. Social physical activity (112) also creates opportunities for laughter, shared goals, and emotional support, elements that combat loneliness and reduce cortisol levels, the body’s primary stress hormone. Group-based exercise supports heart health and contributes to a more balanced lifestyle by relieving stress and enhancing mood. In this way, staying active with others becomes a powerful, enjoyable strategy to manage and prevent high blood pressure and heart-related conditions.
Conclusion
Looking ahead, the future of chronic disease management is cautiously optimistic. Policy changes could make treatments more accessible and prioritize long-term wellness. Education about the impact of clean eating and holistic wellness could enlighten the population to take their health back into their own hands. Science is also rapidly advancing; we may see cures or highly effective treatments emerge for conditions managed only symptomatically today. By prioritizing prevention, early intervention, and medical advancements, policymakers, healthcare providers, and individuals can work together to reduce the prevalence and impact of chronic diseases, ultimately fostering a healthier and more resilient society.
Natalie Hart is a Junior at the University of Miami, majoring in Public Health with minors in Biology and Health Management and Policy. You can find her on LinkedIn here.
FAQ:
Q: What are the key components of an effective chronic disease management plan?
A: An effective chronic disease management plan includes several key components to help individuals maintain their health and improve their quality of life. These include adopting a healthy diet, engaging in regular physical activity, managing stress, and avoiding harmful habits like smoking or excessive alcohol consumption. Utilizing digital tools, such as Revero, can help patients track symptoms, medication adherence, and health data for better disease management by using personalized nutrition therapy to reduce blood sugar and inflammation.
Q: How can lifestyle changes help in managing chronic diseases?
A: Lifestyle changes play a crucial role in managing chronic diseases. They improve overall health, reducing symptoms and preventing complications. By eating a balanced diet rich in fruits, vegetables, whole grains, and proteins, patients can find improvement in blood sugar levels, blood pressure, and cholesterol levels, which are essential for managing conditions like diabetes and heart disease. Other lifestyle changes, such as reducing smoking, limiting alcohol intake, and avoiding processed foods, can significantly improve health outcomes and reduce the risk of disease progression. Patients can track blood sugar, blood pressure, and other vital health markers, which helps in the early detection and management of potential issues.
Q: What role do healthcare providers play in chronic disease management?
A: Healthcare providers play a vital role in chronic disease management by offering medical guidance, treatment, and support to help patients effectively manage their conditions. Providers can help educate patients about their conditions, treatment options, symptom management, and lifestyle changes to empower them in self-care. Managing a chronic illness can be overwhelming and challenging, but healthcare providers offer guidance, counseling referrals, and encouragement to help patients cope.
Q: How can patients stay motivated to follow their treatment plans?
A: Patients can break down long-term health goals into smaller, achievable steps to make the process more manageable and rewarding. Establishing a daily schedule for medications, exercise, and healthy eating can help them build consistency. Patients could consider celebrating small victories, such as improved test results or consistent adherence to a routine, which can reinforce motivation. They can find ways to make treatment routine enjoyable, such as pairing medication time with a favorite activity or incorporating exercise into social outings.
