Last week, Gallup released the results from its Healthways Well-Being Index survey. Telephone interviews were conducted from January 1-June 23, 2014 with a random sample of almost 85,000 adults, aged 18 and older from all over the United States.

The results of the survey indicate that obese and underweight Americans are less likely to be socially “thriving” and more likely to be socially “suffering” than Americans that are a normal weight or are overweight, but not obese. When it comes to Americans at weight extremes, the quality of their social life is lacking.

Further, those with high social well-being were also found to be consuming greater amounts of fruits and vegetables per week and exercising more frequently than those who are suffering socially. Of Americans who ate fruits and vegetables between four to seven days a week, 66.4 percent of them were socially thriving, compared to 44.3 percent of Americans socially suffering. Similarly, 57.9 percent of Americans who exercised for at least thirty minutes a day at least three times a week were socially thriving, compared to 40.2 percent of people socially suffering.

Every ten years, the U.S. Department of Health and Human Services releases its Healthy People plan for improving the health of all Americans over that decade. In Healthy People 2020, the social determinants of health were emphasized as a critical component of the greater goal. Social determinants of health are defined by Healthy People as the “conditions in the environments in which people are born, live, learn, work, plan, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

There are both social and physical determinants of the environment that can affect the health of individuals and communities. Some examples of social determinants include: exposure to crime and violence, the availability of resources to meet daily needs, social norms and attitudes, and public safety. Physical determinants include the conditions of the natural environment (plants, weather, climate change), built environment (buildings and transportation), homes, schools, worksites, and exposure to toxic substances.

Although obesity and low social well-being has been well documented, the results from this survey indicate that people who are underweight also suffer from similar social insufficiencies. Body Mass Index (BMI) scores were based on the respondents’ self-reported height and weight. A BMI less than 18.5 is underweight, between 18.5 and 24.9 is normal weight, between 25.0 and 29.9 is overweight, and a BMI of 30 or above is considered obese. Almost two-thirds of the American population is either overweight or obese (35.3% and 27.7% respectively) and 2.1 percent are underweight, leaving only about one-third (34.9%) of the American population being a normal weight.

The social and physical determinants of health can contribute to these findings. The results of the survey raise several questions regarding the direction of the relationships among these findings. Does being overweight or obese lead to low social well-being or does suffering socially lead to being overweight, obese or underweight? Are people self-conscious of their weight and therefore do not socialize or are they struggling to form relationships with others and are, therefore, more prone to eating too much or too little leading to problems with weight? Similar questions are raised regarding the direction of the relationship between social well-being and the frequency of exercise and produce consumption.

Further research needs to be done to figure out more about these relationships and in which direction they function. Overweight Americans do not seem to suffer from a lower social well-being, therefore, it is evident that the social suffering is primarily experienced by Americans at weight extremes. The social determinants of health are having a strong impact on the social well-being of individuals. It is imperative that policies set in place to achieve the goals of Healthy People 2020 are targeted at the structural and social determinants of health that are leading to the health outcomes we are witnessing in our society today.