Best and Worst States for Holiday Health

The holiday season is officially here. It's a time for festivity, relaxation and spending time with loved ones—but it's also when many Americans "fall off the wagon" when it comes to their health.

Whether it's from the extra drinking and eating, spikes in stress, or accidents and exposure to germs during travel, government studies have shown emergency room visits increase during the holiday season, with New York City doctors estimating a 5-12% spike. "Holiday heart attacks" indeed are real and lead to a 4% increase in heart-related deaths, according to a study from the Journal of American Heart Association.

In addition to holiday behaviors that are downright dangerous, preventive behaviors like exercising and eating well also tend to drop off. Meanwhile, Life Extension proprietary sales data shows that health supplement sales were 22.8% lower in December 2021 than they were in January 2022.

So why is it so hard to maintain the commitment to well-being during the holidays – and are there parts of the country where people are more likely to stay healthy year-round?

To determine which states are keeping their bodies and minds the healthiest as we head into the holiday season, we analyzed eight key metrics from the Centers for Disease Control and Prevention spanning nutrition, exercise, smoking and mental health. The results show that while Americans in some states keep up their healthy habits year-round, others are less likely to do so – and therefore, more at risk for heart disease and mental health issues.

Best and worst states

Fortunately, most Americans say their overall health is either good, very good or excellent: 79% in Kentucky are confident in their health status, while up to 88.8% in New Hampshire and Hawaii see themselves as healthy. But when you dive into individual health habits and incidence of physical and mental illness, the numbers tell a somewhat different story, particularly during the holidays…and when you add mental health considerations, things really get complicated!

Case in point: Utah. Averaging out all health factors, the "Land of Pioneers" comes out on top, followed by Massachusetts, Washington, D.C., Connecticut and Maryland. In these top states, adults tend to work out, have low rates of heart disease and smoking, and report being in good health overall. But as anyone who has dealt with depression or anxiety can attest, physical health isn't everything. While nearly 9 in 10 Utahans say they're in good health overall—the state has low rates of heart disease (2.4%), heavy drinking (3.9%) and smoking (7.2%)—just half say they'd had no bad mental health days in the past month. This makes them one of the worst rates in the country in this category.

Source: Centers for Disease Control and Prevention

In contrast, Louisiana landed at the bottom of the list due to its lower exercise rate, high share of smokers and poor nutrition compared with other states. The next four unhealthiest states are located in the Southeast and Appalachia region: Arkansas, West Virginia, Mississippi and Kentucky.

Even so, West Virginians have a below-average rate of heavy drinking (5.4%), and Mississippians are more likely to describe their mental health is good than adults in any state except for Florida and Hawaii.

Diet and exercise

The CDC recommends that every day, adults eat one-and-a-half to two cups of fruit and two to three cups of vegetables; the agency also calls for 150 minutes of moderate intensity exercise a day, with two days per week including muscle-training activity. Unfortunately, most Americans fall short of these guidelines, particularly during the holidays.

At least half of adults in every state said they eat vegetables and fruit on a daily basis, with veggies winning the plate popularity contest. The share of adults who get their greens every day (and yes, that would include from green bean casserole, pumpkin pie and other holiday favorites!) ranged from 74.5% in Louisiana to 86.7% in Maine, while those who eat fruit every day ranged from just from 50.9% in Oklahoma to 67.4% in Washington, D.C.

Meanwhile, about 4 in 5 Americans said they've worked out in the past month, with that share ranging from 69.9% in Mississippi to 83.8% in the District of Columbia and 83.6% in Colorado.

Pro tip: If you feel you've been on the wrong track lately, your doctor can help you make a plan to improve your own physical well-being, whether that's by developing an exercise plan or identifying vitamins and nutrients to help fill nutritional gaps.

Source: Centers for Disease Control and Prevention

Heart health

Over time, poor diet and lack of exercise is a risk factor for heart disease. It's responsible for about 1 in 5 deaths in the U.S., making it the country's leading cause of death. Sadly, that risk increases in the winter months, particularly around the holiday season, according to the American Heart Association.

Some states contain higher populations of cardiac patients than others: at least 5% of adults have heart disease in West Virginia, Kentucky and Mississippi, while Hawaii, Colorado and the District of Columbia have the lowest rates.

Mental health and coping with stress

With all of the hubbub around the holidays, it can be tough to find time to check in with yourself, while others may be reminded of lost loved ones or other difficult family experiences. You're not alone: at survey time, 4.4% of Americans said they'd struggled with their mental health in the past month.

Poor mental health can affect your ability to take care of yourself and socialize with others, and is considered an important indicator of overall health status. Residents of Utah and Vermont were the most likely to say they'd struggled with their mental health lately, while those in Florida and Hawaii were the least likely to say so.

Keep an eye on your mental health around the holidays. To cope with the increased stress, some people turn to unhealthy habits like alcohol or cigarettes. But they're both addictive and carry their own risks, including several types of cancer as well as liver and heart diseases.

Across the country, 16.1% of adults are current smokers (though more than half have tried to quit in the past year) while 6.9% are considered heavy drinkers. And while smoking rates have fallen in the U.S. in recent decades, tobacco remains a major issue in some states, like West Virginia, where 23.6% of adults say they smoke cigarettes.

Meanwhile, rates of heavy drinking – defined as 15 or more drinks per week for men and at least eight drinks per week for women – are highest in coastal states Vermont (9.1%) and Oregon (8.8%).

It's easy to reach for a known coping mechanism, but there are healthier ways to manage when you feel overwhelmed – and a combination of exercise, self-care and stress management nutrients can be a game-changer.

5 Holiday Health Tips

Stress, travel and traditionally big meals are some common obstacles to staying healthy around the holidays – but with some extra planning, you can prioritize your family's well-being during the festive season and beyond.

1. DO enjoy the flavors of the season

   ...but to avoid holiday weight gain and/or bloating after a big meal, watch your portions. Also consider swapping out decadent dishes for "health-ified" ones – for example, oat cookies instead of sugar cookies, or mashed cauliflower instead of mashed potatoes.

2. DON'T get sidelined during the holidays

   – Keep your immune system strong by taking echinacea.

3. DON'T let stress get the upper hand

   – Which is easier said than done during this hectic time of year. Here are 16 vitamins that help with stress.

4. DO avoid burnout

   with legendary herbs like ashwagandha and rhodiola.

5. DON'T skimp on sleep

   . If you're having trouble drifting off to dreamland because you're worried about your to-do list, melatonin can help – just make sure you're taking the right amount.

Conclusion

While the holidays are often billed as "the happiest time of year," they can also be the most stressful for some—leading to increased risk factors for both physical and mental health issues, as well as dangerous coping behaviors such as binge eating and drinking. This is why it is critical for Americans to maintain a healthy lifestyle as much as possible—all year round.

Methodology

We used federal health data to rank the healthiest states as we head into the holiday season. We identified eight key metrics from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, and used a Z-score distribution to scale each age-adjusted, self-reported data point relative to the mean across all 50 states and Washington, D.C. These scores were multiplied by -1 if they were negatively associated with being above the national average, including rates of smoking, heavy drinking and heart disease. A state's overall ranking was calculated using its average Z-score across the eight metrics.

For most states, the data is from 2021. Florida did not report 2021 data, so we relied on the most recently available information, which was from 2019 for fruit and vegetable consumption and 2020 for the remaining six metrics. National-level data is from 2020.

Full metric list

• Fruit consumption

  : The share of adults who say they eat fruit every day

• Vegetable consumption

  : The share of adults who say they eat vegetables every day

• Exercise

  : The share of adults who say they have gotten physical activity in the past month

• Health status

  : The share of adults who say they are in excellent, very good or good health overall

• Mental health

  : The share of adults who say they've had no poor mental health days in the past month

• Heart disease rate

  : The share of adults who say they have ever been told they have coronary heart disease

• Smoking rate

  : The share of adults who say they are current smokers

• Heavy drinking rate

  : The share of adults who are considered heavy drinkers, defined as 15 or more drinks per week for men and at least eight drinks per week for women

References

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• Knight, Josh et al. "Revisiting the "Christmas Holiday Effect" in the Southern Hemisphere." Journal of the American Heart Association, December 2016, https://www.ahajournals.org/doi/10.1161/jaha.116.005098
• "Alcohol and Tobacco." U.S. Department of Health & Human Services, January 2007, https://pubs.niaaa.nih.gov/publications/aa71/aa71.htm
• "BRFSS Prevalence & Trends Data." Centers for Disease Control and Prevention, https://www.cdc.gov/brfss/brfssprevalence/
• "Chronic Disease Indicators." Centers for Disease Control and Prevention, https://nccd.cdc.gov/CDI/rdPage.aspx?rdReport=DPH_CDI.ComparisonReport
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• "Only 1 in 10 Adults Get Enough Fruits or Vegetables." Centers for Disease Control and Prevention, November 2017, https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html