Preventative healthcare continues to be at the forefront of many health policies, driving corporate health initiatives, insurance incentives, and wellness programs. While these resources help motivate healthier habits that will work to improve health and lower risks of common chronic diseases, there is still a large percentage of the population choosing not to engage in these opportunities. Far too many individuals continue to live “unhealthy days” in which they knowingly consume unhealthy foods and engage in unhealthy lifestyle choices. It would seem that living “unhealthy days” could be the next new chronic health condition. The question is “why?”

The Centers for Disease Control and Prevention (CDC) developed a questionnaire entitled the “Healthy Days Measures” that allow consumers to rate their physical and mental health each day. The questions are designed to assess the burden of physical and mental health problems that are not disease-specific and often highlights health trends in subpopulations with differences in gender, race or ethnicity, educational level, household income, employment status, marital status, chronic diseases, and disability. In short, the results give an indicator of healthy versus unhealthy days among members of a community or subpopulation. The results point to the fact that voluntary “unhealthy days” are not just a deliberate choice, but often an outcome of mental, emotional, spiritual, and physical factors.

Diet quality is often one indicator of a healthy versus unhealthy day and clinical research also confirms that our dietary choices are closely associated with mental, emotional, spiritual, and physical factors.

Emotions play a large part in fostering “unhealthy days” including a poor-quality diet and depression is a stronger emotional trigger for poor eating. But what usually comes first – the poor diet or the depression? It would seem that there is a bi-directional relationship. A systematic review and dose-response meta-analysis of prospective studies was published in 2018 and sought to investigate the connection between depression and diet quality. A high-quality diet of any kind was associated with a lower risk of depression symptoms. On the other hand, a cross-sectional study of 210 Latinos at risk for type 2 diabetes found that those who had greater symptoms of depression also had a lower quality diet. A causal relationship may be difficult to confirm, but clearly, there is a relationship between feeling low and eating poorly.

Chronic stress affects our mental health as it involves worry, anxiety, memory, perceptions, and awareness. It is another rising health problem that can affect diet quality, leading to “unhealthy days.” Stress often triggers the body’s fight and flight response, activates the corticosteroid pathways, increases insulin, and therefore, influences our dietary choices. Stress over financial constraints or food insecurity heightens the response on food choice. In a cross-sectional study of data collected from 101 women, perceived stress was associated with uncontrolled eating and emotional eating. As with emotional behaviors such as depression, mental health can play a role in influencing poor food choices, but the reverse association is also true – especially for children. Poor dietary habits are consistently associated with mental health problems in adults, adolescents, and children.

Spirituality and religion are not often associated with diet quality, but at least 21 studies have investigated this relationship and found a positive correlation between spirituality and a healthy diet including more fiber, green vegetables, fruit, and fish, as well as a low intake of snacks, processed foods, and unhealthy fats. Spirituality and religion may also lead to positive dietary choices as they promote more positive emotions such as happiness, hope, optimism, and gratefulness and enhance mental health by decreasing stress, worry, and anxiety.

And finally, many physical factors influence dietary choices including financial constraints, food availability, transportation, and mobility.

Rather than continuing to allow “unhealthy days” to overshadow the number of healthy days we experience, perhaps we should also focus our attention on the elements influencing our food choices. Pursue healthy days with by tackling the negative emotions, improving the mental health, giving due attention to spirituality, and seeking ways to overcome any physical deterrents. As these aspects improve, better dietary choices will follow and the number of healthy days will increase so “unhealthy days” doesn’t become the next chronic health condition.