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You may think of millennials as outdoorsy types with healthy attitudes about work-life balance, plant-based diets, and the importance of things like biking, meditation, and yoga. But despite those progressive 21st-century pursuits, a new study by Blue Cross Blue Shield shows some surprising findings. Namely that millennials aren’t actually as healthy as you might think they are: In fact, they’re even less healthy in several areas than Gen Xers were at the same age.

The report states that “nearly 73 million people in the U.S. are millennials—people born between 1981 and 1996 and who were 21 to 36 years old in 2017,” the year of the study, which focused on “the 55 million millennial Americans that are commercially insured.” The study’s main finding, listed at the top of the report, is that “older millennials (age 34-36) have higher prevalence rates for nearly all of the top 10 conditions than did Generation X members when they were in the same age range.” Of the 10 conditions, six were behavioral (affecting mental health), while four were physical.

The study found that millennials experience a steep downturn in health conditions after age 27. The main conditions affecting them include major depression, hyperactivity, and type II diabetes, which all had significant growth in prevalence for millennials between 2014 and 2017. The least healthy millennials could be found in southern states like Alabama, West Virginia, and Louisiana, with western-state millennials in California, Arizona, Nevada, and Colorado are the healthiest. 

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While 83% of millennials considered themselves healthy, notably only 68% had a primary-care physician, and it’s definitely possible that lack of insurance or other financial strains could be adversely affecting the health of this generation. As Time pointed out when discussing the study, “Many millennials also do not see primary care doctors and struggle to pay for health care.” Also, “Part of the recorded rise in depression among millennials may also be because they are more likely than older generations to talk about and address mental health issues through therapy… which could result in an increase in identifying and diagnosing mental health issues.”

Millennials will soon become the largest generation of Americans in the workforce. The BCBS report concludes: “The health status of millennials will likely have substantial effects on the American economy over the next two decades—including workplace productivity and healthcare costs.”

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