Loneliness is a complex psychological state characterised by a sense of social isolation and lack of meaningful relationships with others. It has been associated with various adverse health outcomes, including malnutrition. Malnutrition is a condition that results from a deficiency, excess, or imbalance of essential nutrients, which can lead to serious health consequences and the development of immune and metabolic disturbances.
Loneliness it seems is as bad for you as smoking 15 cigarettes a day, and is more damaging for health than obesity and physical inactivity according to a top US health official, as he warned that America faces an “epidemic of loneliness and isolation”[i].
Dr Vivek Murthy, the US surgeon general, has called for growing social isolation to be treated as a public health threat as serious as obesity or drug abuse. Murthy said medical studies had found that about half of all American adults were affected by loneliness, with the crisis exacerbated by the Covid-19 pandemic.
Here in the UK loneliness is also a significant issue with increased association of greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. Some 45% of UK adults say they feel occasionally, sometimes or often lonely in England. This equates to twenty five million people. Whilst people over the age of 50 and female tend to record the highest levels of loneliness, it also affects younger people as well.
Middle Aged or Older?
Lonely middle-aged and older adults are more prone to be physically inactive and to have an inadequate diet in terms of daily consumption of fruit and vegetables and may continue the patterns of adverse adolescent nutrition, or diverge from prior good nutrition due to extenuating circumstances.
Studies undertaken across the EU in Switzerland, England, Czech Republic and Poland show that socially isolated individuals have high risk of poor or inadequate diet, not consuming the desirable quantities of fruit and vegetables and so fall short of essential micronutrients and in many cases macro nutrients, with an excess of refined and processed foods and all of the associated risks[ii],[iii].
Does it affect the young?
Adolescence is a particularly salient time for understanding the health consequences of loneliness because youth at this stage in their lives are experiencing various developmental transitions, from biological (i.e. pubertal onset) to social (e.g. transitioning from primary to secondary school)[iv].
During this developmental stage, they are also transitioning from their parents to their friends as primary socialising and performative agents.
In the words of Dan Pena:
Show Me Your Friends and I’ll Show You Your Future
Such a range of transitions can lead to both friendship instability and emotional distress, which can lead to a cascade of health risks over time. Food choices at this time, without suitable guidance tend to be variable in quality and can if not corrected, compound future physical and mental health problems if not addressed in these formative years.
College or university students in a 2022 study showed that loneliness was related to altered diet quality and physical inactivity. The authors indicated that interventions to reduce loneliness may have a positive effect on health promotion in this population[v].
Interestingly, George Osborne, the former chancellor of the exchequer, stated at the Time Health Commission (May 5th 2023) that smoking should be banned in the UK, as per New Zealand and orange juice and milk shakes taxed. Calling for sweeping public health interventions to reduce obesity and cancer, the former chancellor insisted that “anti-nanny state Conservatives” are “not worth listening to”. He should have pushed for this whilst in office of course and as recently explained by Henry Dimbleby current leadership are also unlikely to be so bold.
Taken together, these papers suggest that loneliness can be a risk factor for malnutrition, and complex immune related outcomes, attributed to inadequate nutrition, particularly among older adults and young adults. To address this issue, there are a number of potential solutions that could be implemented.
First, increasing social support and social connections among lonely individuals could help to improve their nutritional status. This could involve programs that connect lonely individuals with others who share similar interests, or programs that encourage social activities and events. For older adults, this could include local community centres that offer meals and social activities, while for young adults, this could include social clubs or sports teams.
Second, addressing emotional eating and unhealthy eating behaviours could also help to improve nutritional status among lonely individuals. This could involve programs that teach healthy eating habits and provide support for individuals struggling with emotional eating or binge eating. For example, cognitive-behavioural therapy (CBT) and other psychological therapies have shown to be effective in reducing emotional eating and binge eating among individuals with eating disorders, and could be adapted for use with lonely individuals who are at risk of malnutrition[vi].
Third, addressing the underlying causes of loneliness could also help to improve nutritional status. This could involve addressing mental health issues such as depression or anxiety, which are often associated with loneliness and micronutrient deficiency. It could also involve addressing social isolation and lack of social support, which can contribute to feelings of loneliness. On a bigger scale, reduction in poverty, enhanced schooling, and stable home life are also key determinants for the resolution of loneliness. Addressing these underlying causes could help to improve overall health and wellbeing, including nutritional status.
Loneliness has been found to be associated with poor health behaviours, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycaemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. In effect loneliness is an immunometabolic syndrome with multifaceted pathologies and needs close attention and practical resolution.[vii]
In conclusion, loneliness can be a risk factor for malnutrition and associated metabolic/immune dysfunction, particularly among older and young adults. To address this issue, it is important to increase social and family support and social connections, address emotional eating and unhealthy eating behaviours, and address the underlying causes of loneliness and supplement nutrients as required.
The most common nutrients missing from the diet will be those associated with vitamin and mineral rich fruits and vegetables, supplementing a B vitamin and a multi mineral complex will meet many of the essential needs, but further evaluations on specific requirements will be essential.
[i] Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517-530.
[ii] Boulos C, Salameh P, Barberger-Gateau P. Social isolation and risk for malnutrition among older people. Geriatr Gerontol Int. 2017;17(2):286–94. [cited 2019 Oct 10].
[iii] Sahyoun N, Zhang X, Serdula M. Barriers to the Consumption of Fruits and Vegetables Among Older Adults. J Nutr Elder. 2006;24(4):5–21. [cited 2019 Jul 18].
[iv] Goosby BJ, Bellatorre A, Walsemann KM, Cheadle JE. Adolescent Loneliness and Health in Early Adulthood. Sociol Inq. 2013 Nov 1;83(4):10.1111/soin.12018.
[v] Jiang L, Cheskin LJ, Frankenfeld CL, Rana ZH, de Jonge L. Loneliness is associated with unhealthful dietary behaviors and physical inactivity among US college students. J Am Coll Health. 2022 Nov 17:1-6.
[vi] Iacovino JM, Gredysa DM, Altman M, Wilfley DE. Psychological treatments for binge eating disorder. Curr Psychiatry Rep. 2012 Aug;14(4):432-46.
[vii] Pourriyahi H, Yazdanpanah N, Saghazadeh A, Rezaei N. Loneliness: An Immunometabolic Syndrome. Int J Environ Res Public Health. 2021 Nov 19;18(22):12162.