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Understanding the Link Between Prediabetes and Heart Health: A Comprehensive Guide
Prediabetes represents a critical health condition that affects millions of people worldwide, yet it often goes unnoticed and undiagnosed. An estimated 115.2 million U.S. adults have prediabetes as of January 2026, and this intermediate metabolic state serves as a crucial warning sign that the body is struggling to regulate blood sugar effectively. What makes prediabetes particularly concerning is not just its potential to progress to type 2 diabetes, but its significant impact on cardiovascular health. Understanding the intricate relationship between prediabetes and heart disease is essential for prevention, early intervention, and long-term health management.
What Is Prediabetes? Defining the Condition
Prediabetes is a precursor before the diagnosis of diabetes mellitus, where adults often may show no signs or symptoms of diabetes but will have blood sugar levels higher than normal. This intermediate stage occurs when blood glucose levels are elevated beyond the normal range but have not yet reached the threshold for a diabetes diagnosis. The condition represents a critical window of opportunity for intervention and lifestyle modification.
Diagnostic Criteria and Testing Methods
Healthcare providers use several standardized tests to diagnose prediabetes. There are three recommended blood testing methods to identify or diagnose prediabetes: A1C, fasting plasma glucose, and 2-hour post 75 g oral glucose challenge. Each test provides valuable information about how the body processes glucose:
Hemoglobin A1C Test: This test measures the average blood glucose level over the last 2 to 3 months, and if it falls between 5.7% and 6.4%, it is diagnostic of prediabetes. The A1C test offers the advantage of not requiring fasting and provides a comprehensive picture of blood sugar control over an extended period.
Fasting Blood Glucose Test: Blood glucose levels that fall between 100 mg/dL to 125 mg/dL are diagnostic of prediabetes. This test requires an overnight fast of at least eight hours and is typically performed first thing in the morning before breakfast.
Oral Glucose Tolerance Test: This test measures blood glucose levels before and after ingestion of 75 g of glucose solution; if the test shows blood glucose levels that fall between 140 mg/dL to 199 mg/dL, it is diagnostic of prediabetes. This two-hour test evaluates how effectively the body processes a glucose load.
The Silent Nature of Prediabetes
One of the most challenging aspects of prediabetes is its asymptomatic nature. Many people are not aware that they are living with prediabetes, which contributes to delayed diagnosis and intervention. Unlike full-blown diabetes, which may present with classic symptoms such as excessive thirst, frequent urination, and unexplained weight loss, prediabetes typically develops silently. This underscores the importance of regular screening, particularly for individuals with risk factors.
The Cardiovascular Connection: How Prediabetes Affects Heart Health
The relationship between prediabetes and cardiovascular disease is both well-established and concerning. Prediabetes is associated with increased risk of cardiovascular disease and heart failure. Research has consistently demonstrated that individuals with prediabetes face elevated risks for various cardiovascular complications, even before progressing to full diabetes.
Quantifying the Cardiovascular Risk
Large-scale research has provided compelling evidence of the cardiovascular dangers associated with prediabetes. In the general population, prediabetes was associated with an increased risk of all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke. A comprehensive meta-analysis involving over 10 million individuals revealed that prediabetes significantly increases the risk of multiple cardiovascular outcomes.
The absolute risk differences are particularly striking. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36, 8.75, 6.59, and 3.68 per 10 000 person years, respectively. These numbers translate to real-world health consequences affecting thousands of individuals annually.
Mechanisms of Cardiovascular Damage
The pathophysiological mechanisms linking prediabetes to heart disease are complex and multifaceted. Elevated blood sugar levels, even when not yet in the diabetic range, can initiate a cascade of harmful processes throughout the cardiovascular system. These mechanisms include endothelial dysfunction, increased oxidative stress, chronic low-grade inflammation, and accelerated atherosclerosis.
Most patients with prediabetes harbor features of insulin resistance (metabolic) syndrome, including upper-body obesity, hypertriglyceridemia, decreased HDL cholesterol levels and hypertension, among others. This clustering of cardiovascular risk factors creates a particularly dangerous metabolic environment that promotes the development of atherosclerotic cardiovascular disease.
The damage to blood vessels begins early in the prediabetic state. Elevated glucose levels can damage the delicate endothelial lining of blood vessels, impairing their ability to dilate properly and increasing the risk of plaque formation. This vascular damage affects not only the coronary arteries but also blood vessels throughout the body, contributing to complications in multiple organ systems.
Heart Failure Risk in Prediabetes
Recent research has highlighted the specific risk of heart failure in individuals with prediabetes, particularly when combined with other cardiovascular risk factors. Elevated blood biomarkers of subclinical heart injury or stress are linked to an increased risk of heart failure in adults with coexisting high blood pressure and prediabetes. This finding emphasizes the importance of comprehensive cardiovascular risk assessment in prediabetic individuals.
These findings highlight an at-risk group of individuals who could be identified via routine blood work for preventive care before heart failure occurs. The ability to identify high-risk individuals through biomarkers such as high-sensitivity cardiac troponin and NT-proBNP offers new opportunities for targeted prevention strategies.
Stroke and Cerebrovascular Disease
The cardiovascular risks associated with prediabetes extend beyond the heart itself to include cerebrovascular complications. Compared to NGT subjects, individuals with prediabetes have an increased risk of cerebrovascular diseases, including transient ischemic attack, stroke, and recurrent stroke. The elevated blood glucose levels characteristic of prediabetes can damage blood vessels in the brain, increasing the risk of both ischemic and hemorrhagic strokes.
Risk Factors for Developing Prediabetes
Understanding who is at risk for prediabetes is crucial for implementing effective screening and prevention programs. Multiple factors contribute to the development of this condition, ranging from modifiable lifestyle factors to non-modifiable genetic and demographic characteristics.
Obesity and Body Weight
Middle-age adults who are considered overweight or obese with a body mass index (BMI) of 25 or greater are at the highest risk for prediabetes and later developing type 2 diabetes. Excess body weight, particularly when concentrated in the abdominal area, contributes to insulin resistance—the underlying metabolic dysfunction that characterizes prediabetes. Adipose tissue, especially visceral fat, produces inflammatory cytokines and hormones that interfere with insulin signaling and glucose metabolism.
Physical Inactivity
A sedentary lifestyle represents one of the most significant modifiable risk factors for prediabetes. Regular physical activity helps maintain healthy blood sugar levels by improving insulin sensitivity and promoting glucose uptake by muscles. Conversely, lack of exercise contributes to weight gain, insulin resistance, and metabolic dysfunction. The modern lifestyle, characterized by prolonged sitting and minimal physical exertion, has contributed significantly to the rising prevalence of prediabetes worldwide.
Family History and Genetics
Genetic factors play an important role in prediabetes risk. Individuals with a first-degree relative (parent or sibling) who has type 2 diabetes face significantly elevated risk of developing prediabetes themselves. While genetic predisposition cannot be changed, awareness of family history should prompt earlier and more frequent screening, as well as more aggressive lifestyle modification efforts.
Age and Demographic Factors
The risk of prediabetes increases with age, particularly after age 45. However, the condition is increasingly being diagnosed in younger adults and even adolescents, largely due to rising rates of childhood obesity and sedentary behavior. Racial and ethnic minorities, as well as people who are either uninsured or underinsured are also at increased risk. Certain ethnic groups, including African Americans, Hispanic/Latino Americans, Native Americans, Asian Americans, and Pacific Islanders, face disproportionately higher rates of prediabetes and diabetes.
Other Medical Conditions
Several medical conditions increase the risk of developing prediabetes. These include polycystic ovary syndrome (PCOS), gestational diabetes during pregnancy, obstructive sleep apnea, and conditions associated with insulin resistance. Women who have had gestational diabetes face particularly elevated risk and should undergo regular screening for prediabetes and diabetes after delivery.
The Importance of Early Detection and Screening
Given the silent nature of prediabetes and its significant health implications, systematic screening plays a vital role in identifying at-risk individuals before complications develop. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.
Who Should Be Screened?
Current guidelines recommend screening for prediabetes in adults who are overweight or obese and have one or more additional risk factors for diabetes. These risk factors include physical inactivity, first-degree relative with diabetes, high-risk race/ethnicity, history of gestational diabetes, hypertension, HDL cholesterol less than 35 mg/dL, triglyceride level greater than 250 mg/dL, polycystic ovary syndrome, or history of cardiovascular disease.
If screening is negative for prediabetes, repeat screening should be carried out every 3 years as per the United States Preventive Services Task Force. For individuals diagnosed with prediabetes, more frequent monitoring is necessary. Once diagnosed with prediabetes patients should be checked for progression to type 2 diabetes every one to two years.
Screening Methods and Accessibility
Screening for prediabetes can be done as part of routine blood work using a fasting glucose test or a non-fasting hemoglobin A1C test. The convenience of the A1C test, which does not require fasting, makes it particularly practical for routine screening in primary care settings. However, access to screening remains a challenge for some populations, particularly those who are uninsured or underinsured and may not receive regular preventive care.
Lifestyle Interventions: The Foundation of Prediabetes Management
The encouraging news about prediabetes is that it is often reversible through lifestyle modifications. Prediabetes is often reversible with modest weight loss. Research has consistently demonstrated that comprehensive lifestyle interventions can not only prevent or delay progression to type 2 diabetes but also reduce cardiovascular risk.
Weight Loss and Its Impact
Weight reduction represents one of the most effective interventions for managing prediabetes. Research shows that you can lower your risk for type 2 diabetes by 58% by losing 7% of your body weight and exercising moderately 30 minutes a day, five days a week. This level of weight loss is achievable for most individuals and does not require reaching an ideal body weight. Losing even 10 to 15 pounds can make a huge difference.
The mechanisms by which weight loss improves metabolic health are multifaceted. Reducing excess body fat, particularly visceral adipose tissue, decreases inflammation, improves insulin sensitivity, and reduces the burden on pancreatic beta cells. Even modest weight loss can lead to significant improvements in blood glucose control, blood pressure, and lipid profiles.
Physical Activity and Exercise
Regular physical activity is a cornerstone of prediabetes management and cardiovascular health. Exercise improves insulin sensitivity, helps control weight, lowers blood pressure, improves cholesterol levels, and directly benefits cardiovascular function. Both aerobic exercise (such as brisk walking, cycling, or swimming) and resistance training (such as weight lifting) provide metabolic benefits.
The recommended goal is at least 150 minutes of moderate-intensity aerobic activity per week, spread across multiple days. This can be achieved through activities as simple as brisk walking for 30 minutes five days per week. For individuals who have been sedentary, starting with shorter durations and gradually increasing activity levels is a practical approach. Adding resistance training two to three times per week provides additional benefits for muscle mass, metabolism, and bone health.
Dietary Modifications
Nutrition plays a critical role in managing prediabetes and reducing cardiovascular risk. Many studies suggest that a low-carbohydrate diet can help control insulin resistance, blood glucose levels, and weight issues. However, various dietary approaches can be effective, and the best diet is one that an individual can sustain long-term.
Key dietary principles for prediabetes management include:
- Emphasizing whole, unprocessed foods: Vegetables, fruits, whole grains, lean proteins, nuts, and seeds should form the foundation of the diet.
- Limiting refined carbohydrates and added sugars: White bread, pastries, sugary beverages, and processed snacks cause rapid spikes in blood sugar and contribute to insulin resistance.
- Choosing healthy fats: Unsaturated fats from sources like olive oil, avocados, nuts, and fatty fish support cardiovascular health, while saturated and trans fats should be limited.
- Controlling portion sizes: Even healthy foods can contribute to weight gain if consumed in excessive amounts.
- Increasing fiber intake: Fiber slows glucose absorption, promotes satiety, and supports digestive health.
Consuming low sodium at levels less than 1500 mg per day, limiting alcohol to zero or one drink per day, and cutting out added sugar and unhealthy fats will also help prevent prediabetes from developing. These dietary modifications not only improve blood sugar control but also directly benefit cardiovascular health by reducing blood pressure and improving lipid profiles.
Smoking Cessation
Tobacco use significantly increases cardiovascular risk and worsens insulin resistance. For individuals with prediabetes, smoking cessation is essential for reducing the risk of both diabetes progression and cardiovascular complications. Smoking damages blood vessels, increases inflammation, and impairs glucose metabolism. Quitting smoking provides immediate and long-term health benefits, including improved cardiovascular function and better blood sugar control.
Stress Management and Sleep
Chronic stress and poor sleep quality can negatively impact blood sugar control and cardiovascular health. Stress hormones like cortisol can raise blood glucose levels and promote insulin resistance. Similarly, inadequate or poor-quality sleep disrupts metabolic hormones and increases the risk of weight gain and cardiovascular disease. Incorporating stress management techniques such as meditation, yoga, deep breathing exercises, or counseling, along with prioritizing 7-9 hours of quality sleep per night, supports overall metabolic health.
The Power of Prediabetes Remission
Recent landmark research has revealed the profound long-term benefits of achieving prediabetes remission. Reaching prediatbetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalisation for heart failure in diverse populations. This finding represents a paradigm shift in how we understand and approach prediabetes management.
Reaching prediabetes remission by restoring normal glucose regulation has been shown to profoundly reduce future type 2 diabetes risk outlasting the time of lifestyle intervention. The concept of remission—returning blood glucose levels to the normal range—offers hope and motivation for individuals diagnosed with prediabetes. It demonstrates that the metabolic dysfunction characteristic of prediabetes is not necessarily permanent or progressive.
Targeting remission might represent a new approach to cardiovascular prevention. This perspective reframes prediabetes management not merely as diabetes prevention but as an opportunity for comprehensive cardiovascular risk reduction. The decades-long cardiovascular benefits associated with achieving remission underscore the importance of early, aggressive lifestyle intervention.
Long-Term Cardiovascular Benefits
Long term follow-up of the Da Qing study demonstrated that diabetes prevention through lifestyle modification was associated with decreased cardiovascular and all-cause mortality after 23 years. This remarkable finding demonstrates that the benefits of lifestyle intervention extend far beyond the period of active intervention, creating a “legacy effect” that protects cardiovascular health for decades.
Medical Management and Pharmacological Interventions
While lifestyle modification remains the cornerstone of prediabetes management, certain individuals may benefit from pharmacological interventions. Consider metformin for patients under 60 years of age with prediabetes plus other risk factors, such as A1C>6%, hypertension, low HDL cholesterol, elevated triglycerides or family history of diabetes in a first-degree relative and who have obesity.
Metformin, a medication commonly used to treat type 2 diabetes, has been shown to reduce the risk of progression from prediabetes to diabetes, though it is less effective than intensive lifestyle intervention. The decision to use metformin should be individualized based on patient characteristics, preferences, and risk factors. Other medications that may be considered include those targeting cardiovascular risk factors such as hypertension and dyslipidemia.
Managing Coexisting Cardiovascular Risk Factors
Individuals with prediabetes often have multiple cardiovascular risk factors that require management. Hypertension, dyslipidemia, and obesity frequently coexist with prediabetes as components of metabolic syndrome. Comprehensive cardiovascular risk reduction requires addressing all of these factors simultaneously through both lifestyle modification and, when necessary, appropriate medications.
Blood pressure control is particularly important for reducing cardiovascular risk in individuals with prediabetes. Target blood pressure goals should be individualized based on age, comorbidities, and overall cardiovascular risk. Similarly, lipid management through diet, exercise, and potentially statin therapy can significantly reduce the risk of atherosclerotic cardiovascular disease.
The Role of Healthcare Providers and Interprofessional Care
Reversing the prediabetic state is best done in an interprofessional fashion that involves an endocrinologist, bariatric surgeon, dietitian, pharmacists, weight loss nurse, and a physical therapist. Effective prediabetes management requires a team-based approach that addresses the multiple dimensions of metabolic health and cardiovascular risk.
Primary care physicians play a crucial role in screening for prediabetes, providing initial counseling, and coordinating care. Registered dietitians can provide detailed nutritional guidance tailored to individual preferences and cultural backgrounds. Certified diabetes educators offer education on blood glucose monitoring, lifestyle modification, and self-management skills. Exercise physiologists or physical therapists can design safe and effective exercise programs, particularly for individuals with physical limitations or comorbidities.
For individuals struggling with obesity, referral to specialized weight management programs or bariatric surgery evaluation may be appropriate. Mental health professionals can address psychological barriers to lifestyle change, including depression, anxiety, and eating disorders. Pharmacists can optimize medication management and identify potential drug interactions.
Monitoring and Follow-Up
Regular monitoring is essential for individuals with prediabetes to track progress, adjust interventions, and detect progression to diabetes. Follow-up should include periodic measurement of blood glucose or A1C levels, assessment of cardiovascular risk factors, evaluation of lifestyle modification efforts, and screening for diabetes-related complications.
The frequency of follow-up should be individualized based on risk factors and response to interventions. Individuals making significant lifestyle changes may benefit from more frequent visits initially to provide support and reinforcement. Those with additional cardiovascular risk factors or evidence of progression may require closer monitoring and more aggressive interventions.
Special Populations and Considerations
Prediabetes in Older Adults
The prevalence of prediabetes and type 2 diabetes is extraordinarily high in older adults, with nearly 75% of older adults in the U.S. potentially labeled as prediabetic depending on the diagnosis criteria used. However, the clinical significance and management approach for prediabetes in older adults requires special consideration.
Only 5% to 10% of people diagnosed with prediabetes go on to develop type 2 diabetes, and this progression rate may be even lower in older adults. The focus in this population should be on maintaining functional status, preventing cardiovascular complications, and avoiding overly aggressive interventions that may cause harm. Lifestyle modifications remain beneficial but should be tailored to individual capabilities and life expectancy.
Prediabetes in Younger Adults and Children
The increasing prevalence of prediabetes in younger adults and children represents a concerning trend driven largely by rising rates of childhood obesity. Early-onset prediabetes carries particular concern because it provides more years for cardiovascular damage to accumulate. Aggressive lifestyle intervention in younger individuals offers the greatest potential for long-term benefit and prevention of complications.
Women with History of Gestational Diabetes
Women who have had gestational diabetes face significantly elevated lifetime risk of developing prediabetes and type 2 diabetes. These women require lifelong screening and should be counseled about the importance of maintaining a healthy lifestyle. The postpartum period represents a critical window for intervention, as lifestyle modifications during this time may prevent or delay progression to prediabetes and diabetes.
Addressing Health Disparities
Prediabetes and its cardiovascular complications disproportionately affect certain racial and ethnic minority groups and socioeconomically disadvantaged populations. These disparities result from complex interactions between genetic factors, social determinants of health, access to healthcare, and environmental factors.
Addressing these disparities requires multifaceted approaches including improving access to screening and preventive care, developing culturally tailored interventions, addressing food insecurity and limited access to healthy foods, creating safe environments for physical activity, and addressing systemic barriers to healthcare. Community-based programs and partnerships with trusted community organizations can help reach underserved populations and provide support for lifestyle modification.
The Economic Impact and Public Health Implications
The economic burden of prediabetes and its complications is substantial, encompassing direct medical costs, lost productivity, and reduced quality of life. Cardiovascular disease represents one of the most expensive health conditions to treat, with costs including hospitalizations, procedures, medications, and long-term management of complications.
From a public health perspective, preventing progression from prediabetes to diabetes and reducing cardiovascular complications offers tremendous potential for improving population health and reducing healthcare costs. Investments in screening programs, lifestyle intervention programs, and public health initiatives targeting obesity and physical inactivity can yield substantial returns through reduced disease burden and healthcare expenditures.
Emerging Research and Future Directions
Research continues to advance our understanding of prediabetes and its cardiovascular implications. Emerging areas of investigation include the role of the gut microbiome in glucose metabolism, novel biomarkers for cardiovascular risk stratification, precision medicine approaches to tailor interventions based on individual genetic and metabolic profiles, and new pharmacological agents that may prevent diabetes progression while providing cardiovascular benefits.
Technology is also playing an increasing role in prediabetes management, with continuous glucose monitoring devices, smartphone applications for tracking diet and exercise, telemedicine platforms for remote counseling and support, and artificial intelligence algorithms for predicting risk and personalizing interventions. These tools have the potential to make prediabetes management more accessible, engaging, and effective.
Practical Steps for Individuals with Prediabetes
For individuals diagnosed with prediabetes, taking action can feel overwhelming. However, breaking down the process into manageable steps can make lifestyle modification more achievable:
- Get educated: Learn about prediabetes, its implications, and the benefits of lifestyle modification from reliable sources such as the American Diabetes Association (https://www.diabetes.org) or the Centers for Disease Control and Prevention (https://www.cdc.gov/diabetes).
- Set realistic goals: Start with small, achievable changes rather than attempting a complete lifestyle overhaul overnight. Aim for gradual weight loss of 1-2 pounds per week and incremental increases in physical activity.
- Track your progress: Keep records of your weight, physical activity, food intake, and blood glucose levels (if monitoring at home). This helps identify patterns and provides motivation.
- Build a support system: Engage family members, friends, or support groups who can provide encouragement and accountability. Consider joining a structured program like the National Diabetes Prevention Program.
- Work with healthcare providers: Maintain regular follow-up appointments, communicate openly about challenges and barriers, and don’t hesitate to ask for referrals to specialists when needed.
- Focus on sustainable changes: Choose lifestyle modifications that you can maintain long-term rather than extreme diets or exercise regimens that are difficult to sustain.
- Address barriers proactively: Identify obstacles to healthy lifestyle changes and develop strategies to overcome them, whether they involve time constraints, financial limitations, or lack of knowledge.
- Celebrate successes: Acknowledge and reward progress, no matter how small. Positive reinforcement helps maintain motivation for continued lifestyle modification.
The Importance of Prevention
Prevention is the key of prediabetes. For individuals who have not yet developed prediabetes, maintaining a healthy lifestyle throughout life offers the best protection against both prediabetes and its cardiovascular complications. The same lifestyle factors that prevent prediabetes—maintaining a healthy weight, engaging in regular physical activity, eating a nutritious diet, avoiding tobacco, and managing stress—also directly protect cardiovascular health.
Public health initiatives aimed at creating environments that support healthy behaviors can help prevent prediabetes at the population level. These include policies that promote physical activity through urban planning and transportation infrastructure, regulations that improve the nutritional quality of the food supply, programs that increase access to healthy foods in underserved communities, and educational campaigns that raise awareness about diabetes and cardiovascular risk.
Living Well with Prediabetes
Prediabetes is reversible and can only be managed by making significant lifestyle changes. While a prediabetes diagnosis can be concerning, it also represents an opportunity—a chance to make meaningful changes that can prevent diabetes, reduce cardiovascular risk, and improve overall health and quality of life.
The journey from prediabetes to optimal health is not always linear. There will be challenges, setbacks, and obstacles along the way. However, with persistence, support, and the right resources, most individuals can successfully manage prediabetes and significantly reduce their risk of cardiovascular complications. The key is to view prediabetes not as a failure or inevitable progression to disease, but as a wake-up call and an opportunity for positive change.
Conclusion: Taking Action for Heart Health
The link between prediabetes and cardiovascular disease is clear and compelling. Prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. However, this relationship also presents an opportunity for intervention and prevention.
Understanding that prediabetes significantly increases cardiovascular risk should motivate both individuals and healthcare systems to prioritize screening, early intervention, and comprehensive risk factor management. The evidence is overwhelming that lifestyle modifications can reverse prediabetes, prevent diabetes, and dramatically reduce cardiovascular risk. The decades-long cardiovascular benefits associated with achieving prediabetes remission underscore the profound impact that early intervention can have on long-term health outcomes.
For healthcare providers, recognizing prediabetes as a cardiovascular risk factor equivalent to other established risk factors should prompt comprehensive cardiovascular risk assessment and aggressive risk factor modification. For individuals with prediabetes, understanding the cardiovascular implications of this condition should provide motivation for making and sustaining lifestyle changes.
The message is ultimately one of hope: prediabetes is not a life sentence, and cardiovascular complications are not inevitable. With early detection, appropriate intervention, and sustained lifestyle modification, individuals with prediabetes can achieve remission, protect their cardiovascular health, and enjoy long, healthy lives. The time to act is now—every day of improved blood sugar control and healthier lifestyle choices contributes to better cardiovascular outcomes and overall wellbeing.
By addressing prediabetes early and comprehensively, we have the opportunity to prevent not only diabetes but also the cardiovascular complications that represent the greatest threat to health and longevity. This requires commitment from individuals, support from healthcare providers, and investment from public health systems. The rewards—reduced disease burden, improved quality of life, and longer, healthier lives—make this effort worthwhile for everyone involved.