How to avoid a midlife health crisis

It’s a snapshot that provides an unpleasant reality check. In midlife, 34 per cent have multiple chronic health problems — “multimorbidities” has a ring to it — with over a quarter (26 per cent) engaging in high-risk drinking, 21 per cent reporting recurrent back problems, and 19 per cent experiencing mental health problems. In addition, 16 per cent had high blood pressure, 12 per cent were suffering from asthma or bronchitis, 8 per cent had arthritis and 5 per cent had diabetes.

“There’s a lot going on in midlife,” says the study’s lead author Dr Dawid Gondek, a research fellow of UCL’s Research Department of Epidemiology and Public Health. There really is. When he cites the World Health Organisation definition of health — “A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” — I struggle to think of a friend of mine who would qualify.

Spend less time in front of a screen

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Mind the health gap
Gondek says that he was surprised to find that such a high proportion of the midlife generation had at least two serious health issues, and that the 1970 cohort had relatively more problems than those from a previous study of people born in 1958. “There are several risk factors which you could speculate might have contributed, such as smoking and alcohol consumption, yet some of these things improved over time,” he says. Well, quite — most midlifers quit smoking decades ago. Our parents puffed away with dedication for half a century. Still, today I worked (in my gym gear) for 14 hours at my desk and popped painkillers, which may be a clue.

“Less people smoke on average, but we do eat worse, processed food and our lifestyles have changed. We spend more time in front of computers; we have more sitting jobs; we tend to spend our free time sitting rather than moving around,” he says. Obesity has ballooned. “We see a higher BMI in this generation than in previous generations.” Gondek, a whippersnapper of 31, says his generation have nothing to be smug about since they have an even higher BMI than the 1970 cohort. “I’ve got a few years to change my lifestyle,” he says.

Another recent UCL study compared depression and anxiety in the 1958 and 1970 cohorts and found that the mental health of those in midlife is worse too. UCL researchers suspect a significant contributor is that it was tougher for 1970 babies to “start adult life” thanks to higher unemployment and house prices. They believe that social changes such as a rise in the divorce rate also factored. “The differences emerge quite early on. The guys born in 1970 had worse mental health already in their twenties.”

So the unhealthy habit of bottling everything up was at least in part mitigated by socioeconomics — whereas trying to prioritise your wellbeing was frankly no match for the profound stresses of struggle and continual uncertainty. (Midlifers from the poorest families had triple the risk of bad mental health and high blood pressure.) I feel sad for us, but it makes my blood run cold for millennials and Generation Z. And Gondek says, “There’s less stigma around mental health, but there’s still a lot of work to do.”

Regular movement can help with back pain

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The bad back epidemic
The Yorkshire-based GP Dr Amir Khan, the author of The Doctor Will See You Now (Ebury), isn’t surprised that Gondek’s study found back pain to be one of the main issues affecting those in middle age. He feels that “lifestyle” factor doesn’t quite cover it, as noted in the study. “There’s an increased risk of these things when you live in poorer communities or have a lower birth weight — things you have no control over,” he says.

Yet we do have some control. The key to easing off the mechanical muscular back pain that affects so many of us, Khan says, is “to live as mobile and active a life as possible, to get your weight down, but also to keep moving. What particularly lower back pain needs is movement. When I’m treating it, we might help patients get out of pain with a short course of medication, but the focus should be on movement, even physiotherapy for people who’ve had it for a long time.”

Stick to two alcohol-free nights a week

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The boozing generation
And what of this generation’s tricky relationship with booze? According to Alcohol Change UK, people aged 55-64 are more likely to drink at higher risk levels. Or, as one midlife friend said to me of his drinking habit, you just put out the posh olives and Italian ham and call yourself a foodie.

Khan agrees. “There’s a lifestyle sold with it, but we’ve got to be very clear that alcohol is an addictive substance. And if you’re having a glass every night, there’s a chance that will slowly increase. Because once you open a bottle, it’s a slippery slope for a lot of people.”

“Chronic full-blown alcoholics” are relatively uncommon, he says. Rather, “we see a lot of this insidious increase in alcohol intake among midlife people because they’ve got into this habit of having a drink most nights”. When told that their intake is excessive, “they’re really surprised because they don’t think a glass of wine or a beer every night is an issue, but it all adds up”.

At the least, he advises two alcohol-free days in the week, and ”if you feel guilty about the way you drink, or get upset or angry at anyone who asks you how much you’re drinking, or if you’re getting cravings for alcohol”, he says, seek help from your GP.

Yet is it surprising that many rely on alcohol to take the edge off? Reconciling yourself to the ageing process can be tough. And as Khan says, “This is the age where you might lose a parent and become bereft, or children may be leaving home — all sorts of issues add to the pressure, stress and anxiety.” Common mental health problems in his midlife patients are based around “relationship breakdowns, problems at work”.

One positive to come out of his research, Gondek says, is that alcohol consumption may have peaked. “We just asked a few simple questions about when you drink, how much you drink, and how it affects your functioning,” he says. And there is some relatively good news. “At least at the moment, alcohol consumption is decreasing, so hopefully conditions related to that will decline.”

It’s never too late to change
Dr Lucy Pollock, a consultant geriatrician and the author of The Book About Getting Older (Michael Joseph), isn’t up for self-pity. “Yup, yup, yup,” she says as I dramatically list the dreary consequences of our louche, boozy, junk-eating ways. “And the good thing about that is that those are all things we can change. We’re not doomed on this one.”

There are, she concedes, “great big” societal changes required “to make it easier for people to make good choices” — addressing the grotesque dominance of ultra-processed food springs to mind — “but actually as individuals we can make good choices as well. And midlife is a really good moment to take stock.” See the “little warning signs” as a prompt “to say, ‘What can I do to make this little engine of mine last out the next 30, 40, 50 years?’ Suddenly realising you’re not immortal is quite a useful thing.”

Number one — a bit of a curveball — get off the toilet. “About a third of UK adults take very, very little exercise. An awful lot of people spend more time on the loo than they do exercising.” Twice as much in fact, Pollock notes. Quitting smoking and cutting drinking are obvious moves and she recommends the Drinkaware app to keep tabs on your intake, but “activity is probably the single most important. When I look at older people who’ve been active, they are strides ahead in health terms. And often in happiness as well.” Plus, “Exercise is really good for your mental health and for warding off dementia as well as heart problems.”

It’s important to resist an all-or-nothing mindset, though — don’t think along the lines of, “I’ll never run a marathon so I might as well eat crisps.” “Modest changes make a real difference, especially if they’re sustainable,” Pollock says. “If you make small changes that you do every single day, or routinely three times a week, that will stand you in good stead. I love the Couch to 5K. The first week you run for one minute.”

Instigating positive change isn’t easy — it does take grit and determination — but, she says, “We can all do a little bit more than we think we can.”

Gondek also believes the outlook is sunnier than it might appear. “Midlife is when health starts to deteriorate,” he says, but “you still have time to implement changes to your lifestyle. Try to live more healthily because that will impact on your ageing. This is a good time to worry about it.”