Wellness Defined: The Ultimate Guide to Health and Happiness
T he year 2017 will no doubt go down in history as one that shone a spotlight on areas that directly threaten women's wellness. From attacks on reproductive rights, limited access to safe and affordable birth control,?gag rules on physicians who specialize in women's and children's health, and emerging horror stories about sexual harassment and abuse in Hollywood, politics, and the culture at large, women's health is in the news — but rarely for positive reasons.
As we begin to take a long, hard, and much overdue look at areas where we have big problems with wellness,?Everyday Health saw a unique opportunity to explore how women actually define what makes them well or unwell. The picture is much more complex and more layered than we think. What we do know for sure: At the end of the day, how any woman — of any age, race, or ethnicity; single or married; with or without children; and living in a city, suburb, or rural area — defines wellness goes well beyond asking the question "Am I healthy?" or "Am I disease-free?"
We set out to ask women what factors — including things like financial health and sex — influenced their personal wellness. In October 2017, we surveyed a diverse group of 3,000 American women?[download survey data]?— millennials, Gen Xers, and baby boomers — to ask what wellness means to them. Respondents included married and single women, some with children and some without, from different races and ethnic backgrounds, including those living in cities, suburbs, and rural areas.
We then checked these findings with top experts on women's health, and gleaned insightful analyses to advance future research. What's standing in the way of women's wellness, health, and happiness? What would it take to enable them to feel empowered and inspired to live their best lives and achieve their highest level of wellness?
Key Survey and Research Findings
The top 5 women's wellness?definers?of 2017, in order of importance, were:?stress, sleep, exercise, eating healthy, and anxiety.
The top 6 women's wellness?influences that "matter most to my overall wellness goals" were: financial security, being as healthy as possible, feeling supported/loved, having confidence in myself, the ability to feel energized and passionate, and optimism and balance.
The top 8 women's wellness?bummers of 2017 were, from greatest to least: stress and anxiety, weight/BMI/waist size, body- and self-image, financial security, emotional and mental state, work-life balance, medical challenges, and fitness.
The top 5 wellness?boosters?of 2017 were, survey said: fitness, social life and trusted relationships, relationship status, financial security, and career and professional satisfaction.
The top wellness?priorities by geography?were:
From the West: "What's on the inside counts more than what's on the outside." From the Midwest: "Feeling supported and loved by others." From the Northeast: "Finding enough me time." And from the South: "Having a healthy and satisfying sex life."
The top write-in wellness?influences, in no particular order, were: relationship conflicts (neighbors, coworkers, family), caregiving to a loved one (person or pet), spirituality (nondenominational), medical issues, Trump and politics.
The top 5 wellness?fears?were, in order: cancer, bad debt, living in pain, no health insurance, and mental illness.
The biggest?shocker:?One-third of women are more afraid of loneliness than a cancer diagnosis.
The Meh News?
Nearly three-fourths of the women who responded to the wellness survey were neither satisfied nor dissatisfied with their wellness.
The Good News?
Almost half of all the women surveyed reported feeling "loved, cherished, supported, or special to someone else." Furthermore, they also reported that weekly, if not daily, they are heartily?laughing out loud?— for real, #IRL. Their priorities for where they prefer to spend their precious time and hard-earned money appear to be the very things that will help them achieve greater wellness goals:?vacation, cooking, spending time with friends and family, education, and self-awareness.
The Stress of Anxiety
When ranking specific wellness challenges, respondents cited managing an illness or disease, and "stressing about my life" as the top challenges, while mental health and feelings of low self-esteem ranked at the bottom of the list. In prioritizing values that affect wellness goals, the survey takers ranked having financial security as the highest and having a healthy, satisfying sex life as the lowest concern.
When asked which factors are currently affecting their personal wellness, respondents cited weight, body mass index, waist size (51 percent), and stress and anxiety (50 percent) at the top of the list. On the other end of the spectrum, respondents cited less concern about the perceptions of others (14 percent) and medical challenges (23 percent).
In the ranking of wellness challenges, 80 percent among those who said that stressing about life was a challenge indicated that "stressing about my life" is the top, second, or third most significant wellness challenge. Fears about cancer and finances also trigger our stress and anxiety.
It's clear that stress and anxiety about life in general is widespread. Yet we all know that stress is here to stay. So how do we make stress work for us instead of us against us? "The number one thing women need to ask themselves is, 'How do I deal with stress?'" says Mikhail Varshavski, DO (aka Doctor Mike), a New York–based family medicine physician who will join the staff at Atlantic Health System Overlook Medical Center in Summit, New Jersey, this coming January. "If you view stress as your enemy, then it's time to turn the tables to see where you can start to view stress as your ally." This simple shift, he says, can go a long way toward improving wellness.
Doctor Mike's go-to recommendation for seeing stress in a more positive light? "What's most important is carving out time for yourself each day to spend time thinking. This doesn't have to mean meditation with your legs crossed, forefinger touching thumbs — this is simply a period of time to be introspective and set some goals that are attainable." These regular check-ins are a great way to recalibrate and begin to see stress in a new light, he says. (Doctor Mike also likes to write his patients a prescription that says "take a walk, once daily.")
Stress as a positive? Sounds good to us. But for women, actually carving out the time to recalibrate might be easier said than done. Three-fourths of women in the survey said they are likely to put themselves "last" rather than "first" if given the option. This selflessness worries many women's health experts, including Laura Berman, PhD, a world-renowned sex and relationship educator and therapist, popular TV, radio, and internet host, a New York Times bestselling author, and an assistant clinical professor of ob-gyn and psychiatry at the Feinberg School of Medicine at Northwestern University in Chicago. Because women make 80 percent of health and healthcare decisions in the home, when women aren't healthy, it can backfire on the whole family.
"It's second nature for women to put everyone else ahead of [us], but when we do that, our own health suffers. We can't be our best selves if we are tired, cranky, and miserable. Self-care is our responsibility and our right as human beings," Dr. Berman says.
Generational differences also factored into the survey results. Millennials cited "stress and anxiety" as a primary factor negatively affecting their wellness goals, and cited "work-life balance" and "career and personal satisfaction" as other stressors. In contrast, baby boomers responded that "age and not being able to do what they used to do" were significant obstacles in achieving their wellness goals. Women of all ages worried about "weight, BMI, and waist size," but they weren't as concerned about "being single" and sleep deprivation.
For example, many women report feeling anxiety about their body, but don't seem concerned about what others think about them.
And what makes us feel good? According to the survey, women would much rather splurge on a vacation, spa day, or gym membership than a cosmetic procedure. Women feel more secure having a "rocking bank account" than a "rocking body," and are more likely to stress out over choosing to take time to calm themselves.
The number one wellness influence revealed in our survey when women answered the question "What matters most to your overall wellness goals?" was financial security. That was followed by, in order of importance: health, feeling supported, confidence, ability to feel energized and passionate, and optimism and balance. Hmm … now, what could threaten that?
As women learned this year about one story after another of claims of sexual harassment in the workplace, by people in a position of authority who were accused of taking advantage of and abusing this authority — Matt Lauer, Al Franken, Mario Batali, Charlie Rose, Garrison Keillor, Harvey Weinstein, and Louis C.K., among others — conversations about #metoo online and offline left us stressing and anxious about our own safety as well as the safety of the people we care about and the women who are speaking up.
"Women themselves — their bodies, their lives, their experiences — have been in the battlefields for quite some time, but this past year they are so directly under assault in such clear, stark ways," says?Jennifer Weiss-Wolfe, a New York City–based writer, activist, feminist, the author of?Periods Gone Public: Making a Stand for Menstrual Equity, and the vice president of the Brennan Center for Justice at New York University School of Law.
"I see a lot of despair and sadness and a lot of deep, complicated emotion," said?Ann Shoket, the New York City-based former editor in chief of?Seventeen?magazine and the author of?The Big Life: Embrace the Mess, Work Your Side Hustle, Find a Monumental Relationship and Become the Badass Babe You Were Meant to Be. And yet there is reason to hope. "I am inspired by this transparency and that women are willing to share their stories. Women are owning the fact that they are angry and they are not willing to be diminished."
Social media has allowed and empowered women to speak up and own the narratives instead of letting the conversation be diluted or solely framed by the mainstream media, experts say. "Knowledge is power and women should speak up," says?Gloria Allred, the women's rights attorney currently representing Summer Zervos in her defamation case against President Donald Trump as well as the accuser in the Roy Moore sexual harassment case. "Women are feeling that there's safety in numbers, so many are stepping up and speaking out."
"The thing that feels exciting right now, or perhaps a new line we've crossed, is that women are really beyond ready to have our voices heard," says Weiss-Wolfe.
While speaking up is laudable and healthy for many women, making a public disclosure or filing a police report is a very personal decision that deserves caution and deliberation.
"If someone is able to disclose their experience without coercion, that's wonderful and can be a part of their healing," says?Kristen Slesar, a licensed clinical social worker who has a private practice in New York City specializing in psychotherapy for teen and adult survivors of trauma. However, given the negative response that victims often receive from others after coming forward, she cautions that publicly disclosing sexual assault or abuse can be physically dangerous, and ultimately emotionally and psychologically damaging to victims, as well as retraumatizing. "The victim can have flashbacks, intrusive thoughts, nightmares, return of symptoms of depression and anxiety, increase in substance abuse, eating disorders, and sleep disturbance."
Whether or not you publicly disclose sexual assault or file a police report, talking about your experience in a safe and therapeutic environment can be a key to recovery, says Slesar.
Sexual Health and STDs
Nearly 20 percent of women reported having never had satisfying sex in the past year. And, perhaps surprisingly, most respondents (73 percent) admitted they would choose an amazing meal over amazing sex. That's because "amazing food" is more of a sure thing, says?Lauren Streicher, MD, an associate clinical professor of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine and the medical director of the Center for Sexual Health and the Center for Menopause in Chicago. "Frankly, a lot of people don't have amazing sex. Ice cream sundae versus amazing sex? They're gonna take the ice cream."
Whomever you're partnering with in the bedroom, when it comes to personal wellness, protecting yourself against sexually transmitted diseases needs to be a top priority. In September 2017, the?Centers for Disease Control and Prevention (CDC)?reported that more than two million cases of?chlamydia,?gonorrhea, and?syphilis?were reported in the United States in 2016, the highest number ever. The majority of these new diagnoses (1.6 million) were cases of chlamydia, and nearly half of these infections were in young women.
"STD awareness is important for women of all ages, but what millennials do now with regards to their health may be with them for many decades to come," says?Todd Ellerin, MD, an infectious disease specialist at South Shore Hospital in Weymouth, Massachusetts.
"Untreated chlamydia can lead to infertility, pelvic inflammatory disease, and chronic pelvic pain. That's serious business. I want to encourage all women, including younger women, to be empowered, and when they're having sex, to think about ways to protect themselves from potential STDs," says Dr. Ellerin.
Ellerin says that includes using safer sex practices, condoms, avoiding sex if you think that your partner has an active STD — and it means avoiding concurrent, multiple sex partners. "Given that many sexually transmitted infections are asymptomatic, it's important that women who are at increased risk for sexually transmitted infections speak to their medical care providers about getting screened."
OK, so we need to be vigilant about safe sex practices. Intellectually we know this. But could a woman's wellness status sabotage her clear thinking?
In 2015, research data from two separate studies published in scientific journals by the National Institutes of Health (NIH) and CDC respectively looked at contributing factors to the rise in STDs. The data revealed that societal norms and perceptions about how we believe we are supposed to look and act is a contributing factor to the rise in STDs.
Specifically, the NIH study, published in the journal?Body Image?in January 2015, found a correlation for both women and men between "body dissatisfaction" and condom use. The authors concluded that "as body dissatisfaction increases, one's self-efficacy regarding the use of condoms diminishes." The authors wrote that "integrating interventions to decrease body dissatisfaction and sexual risk behaviors may prove to be an effective strategy to decrease STIs." "Decreasing body dissatisfaction" may be a big ask in today's world of readily accessible aesthetic procedures for physical enhancements, "medi-spas," "anti-aging miracles," "body sculpting," and even social media photo filters, but there is some hope. The emergence of body positivity and diversity, along with the recent movement in the beauty industry to strike the word "anti-aging" from the advertising and editorial vernacular, and the entrance of "plus-size beauties" into media outlets where thin once reigned supreme over fit, may ultimately turn the tide back toward condom use to prevent the spread of STDs.
The connection between self-image and STD protection may be just as complicated for men, according to CDC research revealed in the journal?Archives of Sexual Behavior?in February 2016. The authors stated that their research results "indicated that men who believe they are less masculine than the typical man (i.e., gender role discrepancy) and experience distress stemming from this discrepancy (i.e., discrepancy stress) engage in high-risk sexual behavior and are subsequently diagnosed with more STDs." That may mean that if a woman is feeling "dissatisfied" with her body and her male partner is experiencing "discrepancy stress," chances are no one's reaching for the condom.
Sleep and Wellness
When it comes to sleep, 81 percent of us aren't getting good sleep. Dr. Streicher says she sees similar patterns in her own clinical practice and research.
Like many medical experts interviewed for this article, Streicher thinks that women are making a huge mistake by not prioritizing sleep — and that they're fooling themselves if they don't think lack of sleep is causing some of their other health and wellness challenges.
"Insomnia is epidemic, and in every aspect of a woman's life, people do not function if they do not sleep," she says. When she meets women who are concerned about their weight, their libido, menopause, or?depression, she says, "My approach is: First we fix the sleep. Then we fix the libido. Weight gain is often also caused by lack of sleep."
"Too little sleep and lack of energy" (in the last 12 months) ranked as the most prevalent wellness setback among respondents. On the other end of the spectrum, respondents did not feel that being single or "lacking partners with shared wellness goals" was negatively affecting their wellness.
We know that stress is a blanket category affecting women's wellness, but the survey indicated that millennial women feel stress and anxiety most acutely. That doesn't surprise?Stephanie Faubion, MD, the director of the women's health clinic and office of women's health at the Mayo Clinic in Rochester, Minnesota, and a parent of three millennial daughters. "They are called the ‘Stressed Generation' for a reason," she says. "Millennials are under intense pressure to get a job, pay back college loans, to do everything, and they are not prepared for it. It's like they had everything laid out for them before they graduated from college, then suddenly it's ‘Now you have to leave and be an adult.'"
In his coaching sessions with women,?Daris Wilson, a certified personal trainer and the owner of the Jersey City, New Jersey–based JCF Health and Fitness, a workout and nutrition membership group predominantly for women, says he has discovered that many of his clients feel better once they are able to break down what is real versus perceived stress.
"After talking, we're able to process what really matters and what certain concerns aren't really as pressing," he says.
Willow Jarosh, RD, the co-owner of C&J Nutrition, a New York City– and Washington, DC–based nutrition consulting, communications, and workplace wellness company, and the coauthor of?Healthy, Happy Pregnancy Cookbook, says that many of her clients stress about work and money, including having to work longer hours to make more money or to keep their job.
Wilson hears during coaching sessions that many worry about putting themselves first and not leaving their families or careers behind.
"It's the stress of balancing obligations with personal happiness," says Wilson.
Finances, Financial Security, and Money Matters
In prioritizing values that affect wellness goals, the survey takers ranked financial security highest.
A rocking banking account is worth celebrating, as respondents let us know. But when dealing with financial lack, 26 percent of respondents reported that this negatively impacted personal wellness. "The number one cause of money stress is the feeling that you are one disaster away from financial ruin," says?Diane Harris, the former editor in chief of?Money?and?Money.com, and currently a financial wellness columnist for PBS's digital media platform?Next Avenue. "Most people do not have enough money saved to cover a $4,000 emergency, and emergencies happen all the time."
Kelley Holland, a financial coach and founder of Own Your Destiny Coaching in Montclair, New Jersey, adds that women's financial stress isn't surprising when you consider the gender pay gap. "Women overall earn 80 cents for every dollar a man brings home, according to the National Partnership for Women & Families, and it's even worse for women of color: African-American women earn just 63 cents, and Hispanic women earn only 54 cents for every dollar a white, non-Hispanic man makes," she says. "At the same time, women tend to have lower confidence in their ability to manage their money. So not only do women earn less, they also feel less comfortable making the most of what does get into their paychecks. It’s a double whammy."
Whatever age you are right now, you should be prioritizing your finances, advises Harris. "I have seen research on people who are under financial strain who put off going to the doctor and taking meds they are supposed to take. Stress about money is also connected to headaches and high blood pressure and a variety of other ailments." Taking steps to prioritize your financial wellness can set you up for better overall wellness.
Work-Life Balance: Health, Family, Friends, and Me Time
"Women feel guilty for not being home when they are at work and they feel guilty at home because they are not working," says?Christiane Northrup, MD, an obstetrician-gynecologist in Yarmouth, Maine, who is a leading advocate for women's health and wellness. "It's ridiculous."
"I'm amazed that younger women and older women are so resigned to the fact of the stress, and worry about this idea of the work-life balance. I think balance is a sham," says Shoket, commenting on the survey results. "The idea of balance magnifies anxiety around this idea. It is all work all the time. It is all life all the time. The more we try to imagine balance, the harder it is to reach."
When respondents were asked if they were likely to put their own needs first, only 24 percent responded that they would.
More than half of survey respondents indicated that taking time off (or "me time") is the greatest factor in helping them achieve wellness. Ranking lowest (19 percent) on the choices for what provides the biggest boost to wellness are efforts such as diets, detoxes, and weight-loss programs.
Northrup recalled that even though both she and her ex-husband were surgeons, she felt guilty about spending money on taking care of herself, and felt compelled to ask him for permission.
Body Image and BMI
When asked which factors are currently affecting their personal wellness, respondents cited weight, body mass index, waist size (51 percent), and stress and anxiety (50 percent) at the top of the list. The fact that body image and body mass index ranked at the top of concerns among those surveyed is no surprise, says Northrup. She cautioned that stress about the body could cause even more of a challenge in overall wellness.
"No woman who is stressed is going to lose weight," Northrup says, citing the fact that your body is receiving signals to hold on to "every molecule of fat" when it is subjected to stress. "True self-care, true health begins with the courage to truly take care of yourself."
Jarosh echoed Northrup's assertion that managing stress can be an overarching determinant in the ability to achieve wellness goals.
Achieving a healthier body image means resetting how you view your body, experts say. In large part, this means moving away from cultural norms that tell us we need a "perfect swimsuit body" or "rocking abs," and that until we achieve these things we have somehow failed.
"You don't have to love your body, but you do need to make peace with it. Appreciate your body for what it can do," says Shoket. "The more we obsess over what our bodies look like, the more we sabotage other areas in our life. You can't go into the room and crush it at a business presentation if you keep pulling at your sweater because you think your sweater is too tight. It's a complicated relationship, but you have to make peace with your body."
Making peace with your body is also one of the goals Wilson sets forth with his clients.
"I hear a lot of hang-ups about nutrition, what to eat, and how much to eat," says Wilson, addressing survey results that showed that 47 percent would rather eat less than work out more. "And there are many women who tend to focus on eating less without thinking about how much that can affect your metabolism."
Northrup believes that with the advent of digital photography and its integration with social media, women are becoming more focused on their outward appearance.
"They are living their lives disconnected from their inner self," she says. "They are looking at the outer reflection thinking that is the self."
With smartphone cameras, women are taking photos and deleting ones they don't like, which disconnects them from their inner selves.
While stress and anxiety affect physical health, the inverse relationship also matters.?Sean McCaffrey, MD, the founder of the McCaffrey Family Health Center in Springfield, Illinois, and a women's health advocate, also notes that mental and emotional health factors are inherently tied to ones that can be physically controlled.
"Rather than giving in to pressures that stem largely from the media and advertising, focus on self-care," says Dr. McCaffrey. "Taking care of yourself emotionally, physically, and nutritionally will help you have a more positive mind-set, because you will feel better in all those aspects. When the body is healthy, it is also happy.
"If you can balance your nutrition and improve the functioning of your adrenal glands, you will be more in control of your anxiety and depression," he says. "You will then gain a foothold and will be more prepared to combat the emotional and physical stress. You will be armed with the ability to gain control over all aspects of your life."
McCaffrey advises women to plan, make more time for self-care, and view restoring physical function as a foundation.
"Our body reacts the same whether it is emotional, mechanical, or nutritional stress. Under stress our bodies react in two ways. Adrenaline gets you going, and your body also releases slower, longer-lasting stress hormones called glucocorticoids to get the body used to stress," he says.
Almost half (46 percent) of the respondents indicated that on a daily basis they felt "loved, cherished, supported, or special to someone else." The power of the shared experience has helped many of our survey respondents manage their wellness. Only 13 percent of survey takers expressed that social life and trusted relationships have a positive effect on their health, and stress and anxiety (43 percent) have a negative effect on their health. Millennials surveyed indicated they sought wellness advice and information more from their family or friends or online resources, whereas boomers stated a higher dependence on medical professionals.
"We can gain inspiration and become part of that tribe, and that's the power of social media," says Shoket. "We are so connected all the time, we're all liking the same stories and sharing the same stories."
Social media has allowed women to find like-minded women to connect with — even if people who feel the same way they do are not physically around, Shoket says.
"I think it makes your romantic relationships better when you have strength in your other relationships," says Shoket, whose newsletter Badass Babes started from her hosting dinner parties with women to spark conversation around the challenges of being a woman today. "This is your squad. You need a tribe of women around you who are endlessly devoted to helping you succeed. There's power in that."
Says Dr. Faubion, sharing stories is one of the best ways to feel empowered. "There was a time when women were grouped as a 'minority,' as in, 'women and other minorities.' But we are not a minority, and we all have powerful stories to tell."
Additional Contributors: Amy O'Connor, Dakila Divina, Maura Corrigan, Elizabeth DeVita Raeburn, Denise Maher, George Vernadakis, Ingrid Strauch, Melinda Carstensen, Sarah DiGiulio, Amy Kraft, Pharyl Knight, Maile Dyer, Gwen Petro, Beth Silvestri, Bethany Rouslin, and Jeanie Davis
"Beyond the Rhetoric: The Real-World Attack on Planned Parenthood and Title X," Guttmacher Institute, August 3, 2017
"Trump Administration Rolls Back Birth Control Mandate," The New York Times, October 6, 2017
"After Weinstein: 42 Men Accused of Sexual Misconduct and Their Fall From Power," The New York Times, December 12, 2017
Infographics by Everyday Health. Photos by Getty Images.