 Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years. Obesity is up, exercise is down, and eating just five servings of fruits and veggies a day dropped like a rock. And we didn't start out that great to begin with. Guess what percentage of Americans of the turn of the century had the following four healthy lifestyle characteristics— not smoking, not overweight, five servings of fruits and veggies, and exercising a half hour a day, at least five days a week—3%. And whether people were wealthy, college educated, no subgroup even remotely met clinical or public health recommendations. Where are people falling down the most? If you look at heart disease risk factors, most people don't smoke, shown here in green, about half are exercising, but check out the healthy diet score, which gives folks points for drinking less than four cups of soda a week, for example. On a scale of 0 to 5, only about 1% score of 4 or 5. So the American Heart Association's aggressive 2020 target to improve that by 20% would bring us up to like 1.2% of men and women. Even that we've known for decades that advanced coronary artery disease may be present by age 20. Coronary atherosclerosis, often even present in young children, is particularly disturbing that healthy lifestyle choices are declining rather than improving in the US. And it shows. In terms of life expectancy, the US is down around 27 or 28 out of the 34 OECD-free market democracies. The people of Slovenia live a year longer than citizens of the United States. Why? Well, according to the most rigorous analysis of risk factors ever published, the number one cause of death and disability in the United States is our diet. What about our diet is so bad? The worst five things about our diet is that we don't eat enough fruit, we don't eat enough nuts and seeds, we eat too much salt, too much bacon, hot dogs, lunch meat, etc., and not enough vegetables. That's based on data like this on diet quality and chronic disease mortality risk, that found that those scoring higher using a variety of different systems that all agreed on more whole-plant foods reduced the risk of dying from heart disease, cancer, and all causes of death combined. There's now overwhelming, an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all cause mortality and preventing chronic diseases, such as coronary heart disease, stroke, diabetes, and cancer. So why do we eat so bad? Are we scared of dying from some of these horrible chronic diseases? It's almost as if we're eating as though our future didn't matter. And there's actually data to back that up. Death row nutrition. The growing macabre fascination with speculating about one's last meal offers a window into one's true consumption desires when one values the future, basically when one's value of the future is discounted close to zero. If the future didn't matter, what would we eat? In contrast to pop culture anecdotes, this group of Cornell researchers actually created a catalog of actual last meals, the final food requests of 247 individuals executed in the United States during a recent five-year period. The most commonly made request, meat, the researchers go out of their way to note, tofu never made the list. And no one asked for vegetarian. In fact, if you compare the last meals to what Americans normally eat, there's not much difference. If we continue to eat as though they were our last meals, eventually they will be.