Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108AGING IN THE 21S T CENTURY 72 The Role of Lifestyle and Health Behaviors Lifestyle and health behavior risk factors — such as smoking, physical inactivity and obesity — have a large impact on health and disability in old age. Both the prevalence of these factors and their impact vary across developed countries with the prevalence of obesity and inactivity generally higher in the US and England compared to Europe. A number of studies explore these differences as a possible mechanism to explain cross-national differences in health and mortali- ty. Another set of studies examines differences in behavioral risks in Mexico and the US. Steptoe and Wikman (2010) use comparable data from the second wave of ELSA in 2004, wave two of SHARE (2004-2007), and the seventh wave of HRS in 2004 on the frequency, duration and intensity of physical activity. Vigorous activity includes things like cycling, digging, running, jogging or swimming. Examples of moderate activities are dancing, gardening or walking. Light activity includes home repairs and laundry. Figure 4-3 shows the proportion of adults over age 50 who report doing moderate or vigorous physical activity at least once a week, ranging from a low of 56% in Poland to a high of 83% in Sweden. The prevalence of weekly moderate to vigorous activity in the US is 69% and nearly 75% in England. Americans report the highest levels of inactivity at 22%. Physical inactivity is associated with self-reported poor health and diabetes. Obesity is another important risk factor for disease that varies across countries (Michaud et al. 2007). Figure 4-4 shows the obesity rate — indicated by a body mass index, or BMI, greater than or equal to 30 — for the US, Austria, Germany, Sweden, The Netherlands, Spain, Italy, France, Denmark and Greece. The US obesity rate of 30% for men and 36% for women is almost 10% higher than the next highest country, Spain. The overall obesity rate for the European countries is 17.6% for men and 24.2% for women. The study also considers rates of severe obesity, indicated by a BMI greater than 35. The difference between the US and these European countries is even greater at the higher end with 9.2% of American men severely obese (16.5% of wom- en), but only 3.3% for men (6.7% for women) in Europe as a whole. Waist circumference at all levels of BMI is higher in the US compared to the UK, accounting for a large degree of the cross-country differences in diabetes risk (Banks et al. 2012). 0% 10% 20% 30% 40% 50% 60% 70% 80% Moderate or vigorous activity Inactive Poland Czech Republic Austria Italy France G reece Spain United States Belgium England G erm any N etherlands D enm ark Sw itzerland Sw eden FIGURE 4-3  Percent reporting moderate or vigorous activity in the last week and percent reporting inactivity in Europe and the US: 2004 Source: Steptoe and Wikman (2010).