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For research purposes, loneliness is typically measured on a continuum that ranges from not at all lonely (i.e., socially connected) to very lonely. It is informative, however, to get a sense of the prevalence of loneliness when assessed as present or absent. Loneliness is a common experience; as many as 80 percent of people under 18 years of age and 30 percent of people over 65 years of age report being lonely at least sometimes. For most people, feelings of loneliness are situational and transient (e.g., geographic relocation). For as many as 15-30% of the general population, however, loneliness is a chronic state, and it is among these individuals that loneliness wreaks its greatest havoc. In a study of children followed through young adulthood, those who were highly lonely at each of three measurement occasions (i.e., childhood, adolescence, and at 26 years of age) exhibited a significantly greater number of standard health risks. The chronically lonely individuals were more likely to have higher body mass index (BMI), elevated blood pressure, higher levels of total cholesterol, lower levels of “good” HDL cholesterol, greater concentrations of glycosylated hemoglobin (an index of impaired glucose metabolism), and poorer respiratory fitness than those who were lonely at only two or one of the measurement occasions.² In a study of older adults, loneliness predicted mortality over a 3-year period, and increased mortality was explained by the fact that lonely individuals had more chronic diseases and functional limitations.³ Higher rates of mortality in lonely individuals do not appear to be attributable to inadequate healthcare utilization: even after accounting for the presence and severity of chronic illness,

lonely individuals are actually more likely than nonlonely individuals to make use of health facilities and physicians.⁴
Most chronic diseases (e.g., hypertension, coronary artery disease, diabetes) are the result of the interactive influences of genetic, environmental, and behavioral factors on physiological functioning. How do feelings of loneliness penetrate to a level that affects disease risk? Plausible pathways include poor health behaviors, stress-related processes, restorative “anti-stress” processes, and even differences in patterns of gene activity. In general, physiological systems exhibit redundancies and compensatory processes that minimize the immediate health effects of adverse heritable, environmental, and behavioral factors. However, subtle changes in these predisease pathways can be detected prior to the onset of manifest disease and may indicate the beginnings of a steeper downward trajectory in resilience.⁵
Take health behaviors, for instance. Major risk factors for disease in Western society include high-calorie, high-fat diets, and sedentary lifestyles, each of which contribute to being overweight or obese. Feelings of loneliness have been associated with greater incidence of these predominantly lifestyle risk factors. In a large cross-sectional survey of adults 18 years and older, the lonely group had a higher mean BMI and a greater proportion of overweight/obese individuals than did the nonlonely group. Loneliness has been associated with lower levels of physical activity in every age group from grade school to middle-age adults. In the latter study, lonely individuals were also more likely to become inactive over time. Changes in health status also

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