If you hope to avoid the leading causes of death in women after 40 -- such as cancer, heart disease, stroke, Alzheimer's disease, respiratory disease, and diabetes -- you'd do well to work on the roots of these problems.
Start with the following behaviors. Each feeds into the leading killers of women in midlife and beyond:
Dieting -- and, um, not dieting
You are what you eat. Unfortunately, many American women don't eat the right things, and their unbalanced diets backfire into obesity, diabetes, high blood pressure, anorexia, heart disease, and other health problems. At one extreme, more women than men exclude even nutritious foods in pursuit of a diet that emphasizes one goal (usually calorie restriction or fat restriction). Others go the other way -- ignoring all sense of food planning, which leads them to over-consume processed foods, animal fats, and sugars.
Oops: More than 60 percent of American women are overweight, according to the National Center for Health Statistics. More than one-third are obese.
Silver lining: The middle ground -- a healthful diet that doesn't skimp on nutrition or overdo empty calories -- doesn't require much planning or thinking and helps stabilize a healthy weight. Nutritionists emphasize focusing on a mainly plant-based diet featuring whole grains, whole fruits and vegetables, healthy oils, and fish -- what's become known as the "Mediterranean diet." Its anti-inflammatory, high-antioxidant benefits include a 33 percent reduced risk of developing metabolic syndrome.
Why Caregiving Stress Can Be a Health Risk
The average caregiver in the U.S. is a woman in her late 40s. Many are "sandwichers," looking after both children and aging parents. With little time or opportunity for adequate self-care, they're prone to caregiving stress syndrome, a condition linked to a medical chart full of health woes, including obesity, diabetes, heart disease, high cholesterol, dementia, and back strain. More than 70 percent of family caregivers show signs of depression.
Men care for loved ones, too, of course. But women tend to have more negative experiences as caregivers than men, who focus more on problem-solving and less on emotional nuances, says I-Fen Lin, a sociologist at Bowling Green State University. Wives caring for husbands report the highest stress load, her research shows.
Oops: Caregivers are twice as likely to manage stress by smoking, according to the American Psychological Foundation's 2012 Stress in America report. And they're 25 times more likely to binge drink. Emotional eating is another common coping strategy that backfires on health.
Silver lining: When stress is managed with good self-care and time off, many caregivers report a deeply enriching experience. Some caregivers even show improved longevity, better memory, and better physical strength, as well as a sense of meaning and purpose, say Boston University researchers.
Why Lousy Sleep -- or Just Not Enough of It -- Can Affect Your Health
Women have more trouble falling asleep than men and get less sleep overall, according to the National Sleep Foundation. Women also suffer more insomnia, more restless leg syndrome, and the sleep disruptions due to menopausal changes. Sleep apnea, which is more common in men, begins increasing in women after age 50; by age 65, it affects one in four women.
Those zzzs matter: Insufficient sleep doubles the risk of hypertension in women, according to a 2007 University of Warwick study, upping the risk of heart disease, diabetes, and obesity. (Men's levels of inflammatory markers didn't change with less sleep.)
Oops: Older women with sleep apnea have an 85 percent greater risk of developing dementia, according to a 2011 JAMA report.
Silver lining: The sweet spot for adding years to your life through sleep is more than 5 hours a night but less than 8.5, according to an analysis of Women's Health Initiative data done at the University of California, San Diego, in 2010.
Why Not Using a Condom (Outside Monogamy) Can Be a Health Risk
Although young adult women are most vulnerable to sexually transmitted diseases (STDs), rates are rising in their mothers' generation as midlife women reenter the dating scene after divorce or widowhood. In fact, the most common STD, trichomoniasis, is more common in women in their 40s and 50s than in younger women, a 2011 Johns Hopkins study found. Untreated, trichomoniasis can lead to pelvic inflammatory disease. Rates of syphilis, gonorrhea, chlamydia, and herpes are up in 45-plussers, too.
Between 6 and 10 percent of HIV infections are in women over age 50, according to estimates, and the number rises to 28 percent of HIV cases in women over age 65. Normal changes due to aging, such as a thinning of vaginal walls and less lubrication, raise the risk of HIV infection, according to the Center for Age Prevention Studies.
Oops: Many older women don't perceive themselves as vulnerable to sexual infections like HIV -- or even know how to protect themselves, CDC researchers say. They also may mistake symptoms of STDs for normal aging-related changes.
Silver lining: Barrier-method contraceptives and regular testing dramatically lower the risk of disease for those reentering the sex scene after a long, monogamous, trustworthy relationship.
Why Sitting (in a Chair, in a Car) Can Be Risky
Women are less likely than men to get at least 30 minutes of moderate exercise a day, according to a 2012 study in Preventive Medicine. (That's the minimum recommended for most adults.) Yet those who do move their bodies for half an hour a day showed a reduced risk of depression and metabolic syndrome (including high cholesterol and obesity). Exercise at midlife also helps protect against osteoporosis, depression, cancer, and being overweight.
Little wonder health advocates refer to exercise as the "wonder drug" -- one of the best prescriptions for physical and mental health.
Oops: Sitting for long stretches (carpool! commutes! computers!) can erase the benefits of daily exercise, warns the American College of Sports Medicine, raising the risk of diabetes and heart disease.
Silver lining: Keeping moving -- even standing up to stretch while you work -- makes a difference. In the Nurses' Health Study, which followed 70,000 women ages 40 to 65 for eight years, those who just walked briskly several hours per week were one-third less likely to develop heart disease. The most active women in the similarly sized Women's Health Initiative developed heart disease half as often as the least active study members.
Why Drinking Too Much Can Be Risky
Women are at greater risk for developing alcohol-related problems, including breast cancer, heart disease, alcoholism, and alcoholic hepatitis. Because women, on average, weigh less than men, pound for pound they have less water in their bodies than men, and water helps dilute the alcohol. Hormone and aging also affect how they metabolize alcohol. More women than men show alcohol-related problems later in life, according to the National Institute on Alcohol Abuse and Alcoholism.
Oops: Older women are less apt to seek help for a drinking problem because of the perceived stigma.
Silver lining: You don't have to be a teetotaler to have good health. The federal Dietary Guidelines for Americans call for one drink per day for women, compared with two drinks per day for men. And red wine is full of recommended antioxidants.
Why Smoking Is a Top Health Risk
Smoking is the leading cause of preventable death in middle age. And the longer you puff, the higher your risk of heart disease, Alzheimer's disease, lung disease, and cancer. Women smokers of normal weight who smoked for 10 to 29 years had a 16 percent higher risk of breast cancer than nonsmokers, according to Women's Health Initiative data on more than 76,000 women. Smoking for more than 50 years results in a startling 62 percent increase in death risk.
Oops: Smoking two packs a day at midlife doubles the odds you'll develop dementia two decades later, found a large Finnish study in 2010, which looked at 50- to 60-year-olds. It echoed earlier research that reached a similar conclusion.
Silver lining: No matter at what age you quit, your risk of added heart damage is halved after one year. The risks of stroke, lung disease, and cancer also drop immediately.