4. What is as unhealthy as 100 extra pounds of weight?
Over the last couple of weeks, we looked at how emotional neglect in infancy has destructive consequences, such as early death and increased rates of cancer. That is a problem. And I am going to follow the classic framework of stating the problem, then agitating it, before presenting you with the solution. You have seen this many times in advertisements. The problem is shoved in your face “Do you have ring-around the collar?” It is then agitated. “Do people stare at your neck, curl their lip in disgust, and then walk away? Are you facing catastrophic social rejection?” Come to think of it, the copywriter would probably delete the last sentence, there is no point over-reaching and losing credibility. The ad will agitate the problem though, “Do you hate seeing stains on your collar?” Then the solution is presented “Get your collars a perfect white with KuelKleen laundry detergent!”
Truth is, social disconnection is a far bigger problem than we thought. Our focus has been so much that genes determine biology, that we ignore how much relationships wire biology. For example, researchers followed 2570 men in Finland for 20 years. They conducted the surveys, collected the medical data, and found that “loneliness among middle-aged men is associated with an increased likelihood of cancer.”[i] The fact that this is a longitudinal study gives it more weight. It was not that these men were free of cancer first, and then were abandoned by friends and family when they got the disease. No, they were free of cancer at the beginning of the study, and those who were lonely, were more likely to develop it later. This is not a one-off finding either. This has been confirmed over and over. A summary of 90 studies, including over 2 million people, found that socially isolated people had a 24% higher risk of dying of cancer. Socially isolated women who had breast cancer had a 33% higher risk of dying of cancer, and a 51% higher risk of dying from any cause.[ii] It is important to realize that these are longitudinal studies. When you follow people over time, you can tease apart which factor influences what outcome. And here is robust evidence that loneliness and social isolation increase the risk of getting cancer in the first place, and of dying early.
Social disconnection does not just raise the risk of dying early from cancer. It raises the risk from any cause, such as heart disease, stroke, or more. The risk of early mortality from a lack of social relationships is equal to the risk associated with grades 2 and 3 obesity.[iii] Turns out that grade 3 obesity is carrying 100 extra pounds on your frame. We know that having that much extra weight is very unhealthy. Yet we do not know that having very few friends, or little contact with family, is just as destructive to our health. I was not aware of how lethal loneliness is until I started researching it, and I am a psychologist!
How can we start to solve this dangerous problem? The first change is to consider social connection to be a fundamental dimension of your health. There are various things that we evaluate our health on, such as the number of vegetables and fruits we eat in a day. Or the minutes of brisk exercise we get in a week. People refer to these dimensions all the time, saying things like “I shouldn’t eat that, it is bad for me.” Or, they will proudly say that they lost 14 pounds. Physicians use these dimensions in their office as well when they do an annual check-up. They inquire about smoking, weigh their patients, record blood pressure and more. But does any physician ask about how socially isolated their patients are? Do any of them tell their patients that being quite lonely has the same negative impact on health as carrying 100 extra pounds of weight? They do not, because the doctor does not know it. If she does not know it, she cannot talk to her patient about how to improve his social connections, and thereby significantly reduce his risk of cancer and any early death.
Once you do consider it a fundamental dimension of health, then the decisions you make change dramatically. I was working with a client recently, who was quite health conscious. I could see exercise equipment in the background as we met over video. He talked about moving to Los Angeles[iv] because he wanted to work hard and advance his career. I inquired if he had family or friends in L.A. He said he did not know anyone. I summarized “Ok, you are going to a huge city where you do not know a soul, and will work a lot, which will really cut into your chances to make friends. Did you know that being very socially isolated has the same negative impact on your health as smoking 15 cigarettes a day?”[v] His eyes zoomed out, and he said “I had no idea. It did not even cross my mind to think about whether I would be lonely or not. I just wanted to move up in my career.” Naturally, the decision to move cities or stay is up to him. However, now he will make the decision in light of a very important health dimension. Is advancing his career worth taking on a health risk equal to smoking close to a pack a day?
Another result of seeing it as a fundamental dimension of health is to measure it. We weigh ourselves or wear smart watches that count the number of steps we take in a day. We act based on those numbers. We skip snacking on salty crunchies[vi] if we want our weight to go down or take the dog out again to hit 10,000 steps a day. But even though half of US adults report feeling lonely, we do not measure how lonely we are. Thus, we do not know whether we need to take steps to change it or not.
I have included a brief and valid scale to assess your level of loneliness below.[vii]
Hardly Ever Some of the Time Often
How often do you feel that you lack companionship? 1 2 3
How often do you feel left out? 1 2 3
How often do you feel isolated from others? 1 2 3
Once you fill in the scale, you will get a score from 3 to 9. Scores equal to 6 or higher are indicative of significant loneliness. [viii] A quarter of Americans fall into that category. And because I like to bang the drum that social connection is a major dimension of our health, older Americans who are consistently lonely have 56% higher risk of having a stroke. That is a huge bump in risk.[ix] In keeping with the theme that we ignore that relationships also wire biology, a quick Google of how to prevent stroke did not mention loneliness as one of the risk factors that could be changed. The university medical site mentioned exercise, eating more fruits and vegetables, and cutting down on drinking and smoking.[x] Which are all fine suggestions. But there was nothing about how loneliness is a serious risk factor for stroke, and that being deliberate about connecting with others would reduce your risk.
I always knew that loneliness was a painful condition to experience, but I had no idea that it had such a negative impact on health. When it increases the mortality rate among breast cancer survivors by 51%, the problem is serious. However, now this knowledge gives you another weapon in your struggle against cancer. You can now measure your loneliness and take deliberate steps to increase your connection. If you care for a cancer survivor, you can help weave the threads of social bonds with them, and trap this disease. Our next post will explore this in more detail.
[i] Kraav SL, Lehto SM, Kauhanen J, Hantunen S, Tolmunen T. (2021). Loneliness and social isolation increase cancer incidence in a cohort of Finnish middle-aged men. A longitudinal study. Psychiatry Res. May; 299: 113868. doi: 10.1016/j.psychres.2021.113868. PMID: 33774371
[ii] Wang F, Gao Y, Han Z, Yu Y, Long Z, Jiang X, Wu Y, Pei B, Cao Y, Ye J, Wang M, Zhao Y. (2023). A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav. Aug;7(8):1307-1319. doi: 10.1038/s41562-023-01617-6. PMID: 37337095
[iii] Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspect Psychol Sci. Mar;10(2):227-37. Doi: 10.1177/1745691614568352. PMID: 25910392
[iv] Of course, all details are changed or fabricated to make them unidentifiable. He actually was going to Inuvik, ‘because it was more chill there.’ 😉
[v] https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
[vi] Ruffles All-Dressed potato chips are my favorite salty-crunchy snack. I am willing to do a lot of truly disgusting and shameful things in order to get a bag of those.
[vii] Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res Aging. 26(6):655-672. doi: 10.1177/0164027504268574. PMID: 18504506
[viii] Gao Q, Mak HW, Fancourt D. (2024). Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: A latent growth curve analysis. Soc Psychiatry Psychiatr Epidemiol.. https://doi.org/10.1007/s00127-024-02639-9.
[ix] Soh Y, Kawachi I, Kubzansky LD, Berkman LF, Tiemeier H. (2024). Chronic loneliness and the risk of incident stroke in middle and late adulthood: A longitudinal cohort study of U.S. older adults. EClinicalMedicine. Jun 24;73:102639. doi: 10.1016/j.eclinm.2024.102639. eCollection 2024 Jul. PMID: 39403677
[x] https://ukhealthcare.uky.edu/comprehensive-stroke-center/education-prevention/preventing-stroke/six-ways-prevent-stroke#:~:text=Stroke%20is%20the%20fifth%2Dleading,chances%20of%20avoiding%20a%20stroke.