A startling development

By Lorenzo

One of the things that has been strongly associated with the modern age is increasing life expectancies.

So, it is startling to discover that life expectancies for low-educated whites in the US are declining.

It is apparently not clear why, but the effect is clear, particularly for low-educated white women:

The steepest declines were for white women without a high school diploma, who lost five years of life between 1990 and 2008, said S. Jay Olshansky, a public health professor at the University of Illinois at Chicago and the lead investigator on the study, published last month in Health Affairs. By 2008, life expectancy for black women without a high school diploma had surpassed that of white women of the same education level, the study found.

I have always scoffed at suggestions about how “unhealthy” modern living was on the basis of increasing life expectancies.  Clearly, the story is now more complicated.

Perhaps not coincidentally, President Obama — he of Obamacare — is polling well among working class white women.

45 Comments

  1. Posted October 4, 2012 at 12:20 pm | Permalink

    Lowering of support and increasing exploitation resulting in poorer outcomes is hardly surprising. A key factor in this outcome is the increasing capacity and willingness to manipulate people into self harming behaviour in order to make a profit.

  2. Posted October 4, 2012 at 5:17 pm | Permalink

    [email protected] What lowering of support? There is also the difficulty that the life expectancy of black women has continued to increase. The picture is clearly complicated.

  3. conrad
    Posted October 4, 2012 at 7:33 pm | Permalink

    That is a pretty odd find (the white vs. black interaction, not the decrease). Do you know if it is reliable?

    Also, I haven’t read the whole article (will look at work if I get time), but the abstract is biased — it appears to compare the worst group now with the average of the 1950s, which is hardly a valid comparison.

  4. Posted October 4, 2012 at 8:21 pm | Permalink

    [email protected] I thought that the point was the worst group had not shared in the overall gains since the 1950s. And I have no independent basis for judging the reliability, but it is certainly a striking finding.

  5. Ben
    Posted October 5, 2012 at 1:15 am | Permalink

    Conrad is correct that there is too much bias for this statistic to be useful. This measure is comparing maybe average of society to the the very bottom of society. Because of the way averages work the very bottom could be better off now but it wouldn’t show up in this statistic.

  6. Posted October 5, 2012 at 5:59 am | Permalink

    [email protected] Well yes, but the pertinent finding is the lowering in life-expectancies for low-educated whites, particularly white women, since 1990.

  7. Mel
    Posted October 5, 2012 at 1:41 pm | Permalink

    From the NYT article:

    The five-year decline for white women rivals the catastrophic seven-year drop for Russian men in the years after the collapse of the Soviet Union, said Michael Marmot, director of the Institute of Health Equity in London.” (my bold)

    Wow.

    I imagine the libertarian response to this would be to

    (a) deny further funding to research bodies, in the name of small government,

    (b) declare the issue to be one of personal responsibility, thus placing the blame and the onus for action solely at the foot of the unfortunate women.

  8. kvd
    Posted October 5, 2012 at 3:25 pm | Permalink

    Lorenzo I was struck by the pic you chose to illustrate your post? As far as I can see from the brief abstract of the linked article, it makes no mention of diet or kids; rather, from the heading, it is more directed to some apparent connection to race and education levels.

    So I searched the image you used, and it goes back well before March 2006; in fact in December 2006 I found an article referring to it as “the most widely used ‘fat kid’ image on the web”.

    The image seems to be used for a variety of purposes – healthy diet, ‘funnies’, lambasting McDonalds, consumption, America, etc. – and has been photoshopped so many times that it is difficult to see what really might have been the ‘point’ of its original use.

    But I’m just asking you – how/why you decided to use this particular image to illustrate a post about declining life expectancy – when the abstract itself makes no mention of anything one might take from that image?

  9. John H.
    Posted October 5, 2012 at 3:39 pm | Permalink

    Americans lacking a high school diploma found disturbingly sharp drops in life expectancy for whites in this group. Experts not involved in the new research said its findings were persuasive.

    Group with highest unemployment. Great way to die young. The smoking issue is also very relevant because lower incomes do smoke much more than higher up.

  10. Mel
    Posted October 5, 2012 at 5:35 pm | Permalink

    FFS, kvd. From the NYT article linked to in the OP:

    “The reasons for the decline [ in life expectancy for the least educated] remain unclear, but researchers offered possible explanations, including a spike in prescription drug overdoses among young whites, higher rates of smoking among less educated white women, rising obesity, and a steady increase in the number of the least educated Americans who lack health insurance.”

    As an aside, life expectancy may fall some more and extend to the wealthier and educated classes if this type of “I’m big, fat, healthy and beautiful” attitude becomes a new social norm. The capacity for human self-delusion is truly spectacular.

  11. kvd
    Posted October 5, 2012 at 6:47 pm | Permalink

    Yes Mel, I read that link. I read about some speculation, loosely connected to the study. But your problem is, the study simply notes a decline in life expectancy in a particular educational, and racial, subgroup – with females of that subgroup affected worst.

    But let’s forget all that; let’s prejudge the issue, and jump on the latest bandwagon. Oh, and let’s have a whack at HAT while we’re at it. As you say: ffs.

  12. Mel
    Posted October 5, 2012 at 7:25 pm | Permalink

    Stop babbling nonsensically, kvd.

    The link between obesity, socio-economic status (which is largely analogous to education levels), longevity and social norms is well studied. No one has to prejudge anything.

    My comments are entirely and soundly evidence based. Here is an abstract from a study done one-quarter of a century ago:

    “A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity . They include dietary restraint, physical activity, social mobility, and inheritance.

    Dozens of studies have found the same set of relationships since the 144 reviewed by the above paper and this is surely well known to anyone with at least a moderate level of intelligence and some interest in public affairs.

    IT is not taking an unfair whack at Hoyden About Clown to point out the bleedingly fucking obvious.

  13. Posted October 5, 2012 at 7:34 pm | Permalink

    Kvd: I used that image because, after trying various Google image searches, it seemed to nicely encapsulate behaviours associated with low-education levels that might depress life expectancy.

  14. Posted October 5, 2012 at 7:35 pm | Permalink

    [email protected] But African-Americans have a higher unemployment rate. And, until 2008, the US had had low unemployment for quite some years.

  15. Mel
    Posted October 5, 2012 at 7:39 pm | Permalink

    Denialism over at Scienceblogs reviews a meta-analysis involving a lazy 900,000 cases that, shock horror (for kvd at least), finds a clear and obvious link between being fat and mortality.

  16. Mel
    Posted October 5, 2012 at 8:06 pm | Permalink

    Further, if kvd had bothered to go beyond the abstract of the study Lorenzo cites he would know that the lead researcher, Jay Olshansky, clearly, specifically and repeatedly draws a link between obesity, including childhood obesity, and longevity. See here for example.

  17. Mel
    Posted October 5, 2012 at 11:29 pm | Permalink

    LE,

    It is one thing for M**** to be happy with her own obesity (she says she tips the scales at 110 kg 242 pounds) but it is something else entirely to use a well read blog as a platform to irresponsibly spruik some bullshit message about obesity being OK.

    A moderate amount of public shaming of people (other than children) who engage in risk taking behaviours, be that piling on the pounds, smoking or drag racing on public roads, may well be an imperfect yet still useful prophylactic against undesirable behaviours.

    The fact that a small number of fat people have a medical reason for being fat or that an hysterical obsession with thinness may cause anorexia are red herrings and no reason to dilute the message. I mean, possibly the best prophylactic against Parkinson’s disease is cigarette smoking but I suspect even you would could bullshit on a Benson and Hedges sponsored Smokers Pride March based on this factoid. And then there’s the vitamin D deficiency/ reduced bone density versus skin cancer trade off re sun exposure.

    Finally, I’m about 10 kgs overweight myself. A modest amount of internalised self-disgust and a liberal amount of public and wifely shaming are possibly the only things that keep me from eating a cheese cake each night (yum yum) and becoming a complete porker.

  18. Posted October 6, 2012 at 12:14 am | Permalink

    I wonder whose “just calories in and calories out” blog post that could have been?

  19. kvd
    Posted October 6, 2012 at 4:45 am | Permalink

    [email protected] thank you for the link ‘beyond the abstract’ – something I attempted to do but came up against a paywall. It makes interesting reading, but doesn’t really answer my simple point that potential obesity is but one of the possible factors noted in your very own [email protected]

    In your link is a small graphic which seems to suggest a present ‘adverse effect’ amounting to between 0.30 and 1.08 years for those born in 2000, then moves to suggesting that this ‘adverse effect’ may increase to 2-5 years ‘at birth between now and 2050’.

    This is all good stuff, and one hopes something comes of it in terms of public health planning, but what I don’t get is the almost rabid reaction this sort of study seems to generate.

    Meanwhile, I shall go walk one of my dogs – studies of said activity suggest this will increase my life expectancy and general wellbeing far more than 0.30 years. And if I should start putting on weight, I shall get another dog 😉

  20. John H.
    Posted October 6, 2012 at 7:20 am | Permalink

    spruik some bullshit message about obesity being OK.

    Obesity in and of itself does not necessarily lead to poor biomarkers. Studies now suggest that for some people at least being a little overweight is nothing to worry about, with a few studies suggesting this might even be beneficial. Think about it, how the hell do we know what is optimal nutrition and optimal weight? Guessing. Good guessing but still guessing. People can be obese and be healthy. Thinks that pardoxical, I see paradoxes everywhere in that game.

  21. Posted October 6, 2012 at 7:21 am | Permalink

    Anorexia seems to be strongly linked to the effect of photography on body image.

    Part of the problem is that we lack good metrics. BMI is notoriously unreliable (being mildly overweight by its measurement is apparently healthier than being “correct weight”). And it would rate George Clooney as “obese”.

    That being said, as Mel points out, there is a lot of evidence that genuine obesity is bad for you. (I know Mel hates his work, but Taubes is very clear about what the evidence says on that point.)

    I have managed to lose a significant amount of weight through exercise and shifting diet — generally avoiding starch, grains and sweets. Indeed, I find avoiding starch in particular makes it easier to avoid sweets, as it makes sweet things less attractive.

  22. John H.
    Posted October 6, 2012 at 8:44 am | Permalink

    (probably more so than some skinny friends).

    Yes, there is data to support that. One interesting thing I noted which helps explain rising obesity is that cooked foods provide many more calories than uncooked. Processed foods are cooked twice over … . As to the fish, make sure it is not fried, that is actually worse for your health than no fish. Oven bake or steamed is great. The heat of pan oxidises the fats. If losing weight is a problem eat more raw unprocessed foods.

  23. Mel
    Posted October 6, 2012 at 11:32 am | Permalink

    The fact that some folk who are clearly not obese end up being rated obese by BMI means that studies that use BMI will actually underestimate the longevity effects.

    LE @23:

    “And there’s no way I’d ever shame her – I happen to know she’s been shamed throughout her life, and I think enough is enough (we’ve been friends since we were 10 or 11).”

    Nor should you, yet I would argue that the instinctive sense of disgust and revulsion aroused in many people (including myself, I must admit) when confronted by grotesquely obese people is functional and adaptive social norm. The “collateral damage” (your friend for example) is real, unfortunate but possibly unavoidable. Or rather, if norms change and fatness becomes acceptable, the consequences would be far worse than the collateral damage.

    I remember talking to a social worker in Alice Springs many years ago about the hideous drunkenness and alcoholism that was evident among the local indigenous population. He pointed out that one of the causal factors is the absence of shame and guilt in indigenous culture regarding alcohol abuse. This made perfect sense to me.

  24. Posted October 6, 2012 at 11:50 am | Permalink

    Two things about BMI.

    First, most people who are considered overweight, obese, etc by BMI are also overweight, obese etc by other measures. In fact BMI potentially underestimates the prevalence of obesity.

    Secondly, because most people are not fitness models, strength athletes or folks with unusually dense bones, the number of people for whom the BMI is not at least weakly informative is low. There are few outliers. This makes BMI very useful for population studies, modulo the study linked to above.

  25. Mel
    Posted October 6, 2012 at 12:28 pm | Permalink

    LE:

    “But sometimes shaming actually produces perverse results. It all depends upon the person.”

    Well, no, actually. You wouldn’t make the same argument regarding cigarettes so why make it in this case?

    SL has described the law as a blunt instrument and the same observation applies to social norms. Neither can be otherwise, because rules and norms are universal by there very nature. Rules and norms are not invalidated by hard cases or rare exceptions. The perfect is the enemy of the good, as they say.

    Let’s be frank, your arguing technique and use of factoids perfectly mirrors the tactics of the anti-vaccination crowd. “But my friend … adverse reaction … autism …”.

    It is worth highlighting this graph again. At an aggregate level, there is a clear dose-response relationship between obesity and mortality.

    Thanks Jacques for introducing some common sense and scientific thinking into the discussion.

  26. Posted October 6, 2012 at 2:57 pm | Permalink

    I think that the one thing that most people get wrong is crash dieting, for two reasons.

    The first is that fat is more easily created than lean tissue. Protein synthesis requires more energy and much more complex biochemistry than lipogenesis. Putting it another way: to create new muscle fibre requires breaking down some ingested source of protein into amino acids, shuttling them into cells, and then burning a bunch of energy rearranging them according to the person’s DNA. Lipogenesis is substantially simpler and cheaper: pull glucose out of the bloodstream, do a few relatively simple biochemical reactions, deposit fat. Done.

    Way back in WW2 the Minnesota Starvation Experiment was conducted to see what conditions in Europe were like. The subjects were so severely starved on a diet composed mostly of bread and potatoes that their hearts shrank. As in, they were breaking down vital lean tissue to stay alive. In the second part of the study they were given a variety of different refeeding plans. Result? Lean tissue came back slowly. Most of the regained weight was fat.

    This is because, as I said, building lean tissue takes much longer than building fat. If you crash diet and then resume eating at your previous rate, you will gain weight.

    The second thing people get wrong is usually to cut too deeply into protein. Protein is the master macronutrient for dieting. A diet sufficiently high in protein shows substantial protective effects for lean tissue during periods of caloric deficit, which is the basis of the major medical fasting technique, Protein-Sparing Modified Fasts (PSMFs). I’ve tried PSMFs. It is hell, not recommended for normal folk, but it works pretty much as advertised.

    The other thing to do to protect lean tissue is lift weights. Lifting weights sets in train a complex sequence of reactions that can largely offset the reactions caused by caloric deficit. Eat plenty of protein at an overall caloric deficit, lift weights frequently, and you will lose weight. I’m down 25kg in the past year.

    All this having being said, I am ambivalent about shaming people for being fat.

    What irks me is not that people are fat. I understand exactly how that can happen, I spent 30 years getting fatter.

    What irks me is people who are in denial about the causes. Who hide behind excuses. It really gets up my delicate nostrils.

    There are outliers, people for whom it is more difficult than others. But genetics? No. It’s not as though in the past 40 years the distribution of DNA has magically altered. Thyroid conditions? Ditto.

    What has changed is the total population-wide consumption of calories per person. It tracks population BMI with almost perfect exactitude. I’m talking correlation of .95 and above over N=millions.

    This stuff is not mysterious.

  27. Posted October 6, 2012 at 9:30 pm | Permalink

    Basically the purpose of fat is to store energy.

    Like I pointed out in my notorious blog post, without fat, warm-blooded, higher animals simply could not have evolved.

    And humans in particular. Our brains are caloric monsters. No matter whether we think hard or just had a day watching the soapies, it accounts for about 20% of our daily BMR. Without the ability to store and release energy, such an energy hog simply couldn’t have evolved in the face of variable energy availability.

    As Lorenzo points out, statistics show that being very lean has a slightly higher morbidity than carrying a slight (I emphasise slight) bit of squishiness, particularly for women.

    Insofar as people think they can look like fitness models or bodybuilders during a contest, they are deluded. Those people are on steroids, dehydrated and running pretty close to immediate-trip-hospital levels of bodyfat (2-3% for men). It’s simply not possible to look like that day to day. Humans do not work that way, good night.

  28. Mel
    Posted October 6, 2012 at 9:36 pm | Permalink

    LE:

    “I wonder if obesity is a genetic condition designed to deal with periodic starvation that most people would have suffered throughout history?”

    I’m sure it is. As I understand, our ancestors experienced feast and famine and it was the energy-efficient fatties who survived the famine. This may be why bigger sized women were once highly valued.

    If I put on more weight maybe I should get a t-shirt that reads “I’m not fat, I’m just prepared for a famine” 🙂

  29. Mel
    Posted October 7, 2012 at 10:54 am | Permalink

    LE:

    My sister has a policy that no one is ever to mention the weight issue around her two young daughters. I think that is a great idea.

    On shaming, what I think may be valuable in relation to the overweight (although crude) is reduced value in the dating game, less smiles and hellos from strangers etc… This happens already, and I do wonder what would happen if these mild sanctions disappeared. Wouldn’t a significant proportion of us throw in the towel and eat without restraint? Again I’m thinking about the Aboriginal relationship with alcohol and the example that sets.

    Having said all that, shaming in the form of teasing and humiliating folk is clearly unacceptable and it isn’t what I mean by moderate shaming.

  30. kvd
    Posted October 7, 2012 at 11:32 am | Permalink

    [email protected] I stopped commenting on this thread once concepts of guilt, shame, and even ‘self disgust’ appeared because I think those terms are totally inappropriate and can be very damaging.

    I’m sorry but I just cannot see how you can say on the one [email protected] “I’m sure it’s genetic” and on the other suggest that even ‘moderate shaming’ (whatever the hell that is) is a worthwhile response.

    The thing is, we are all different, and even the base idea of setting up some sort of notional standard to which we must aspire to is damaging enough – and pointless. Somewhere in Lorenzo’s post, and repeated by Jasques, was the thought that the vague usefulness of BMI was in population-wide research and actions. To apply it otherwise is to misrepresent that specific usefulness.

  31. kvd
    Posted October 7, 2012 at 11:44 am | Permalink

    Further to my 36 (in which I wrongly typed 38, meant 35 – apologies) the reason this sort of thing gets my goat is that to this day I vividly remember my teenage years during which I suffered quite badly from acne. I cannot adequately describe just how that affected my life for eight or nine years, but I can honestly state that no amount of shaming, jibing, or smart-arse commentary would have made my life one whit more bearable.

    It is one thing to take a human condition and measure it on a society-wide scale, and maybe react to it; it is quite another to even gently call another human being ‘porky’ or ‘scabs’ or ‘insert your own epithet here’.

  32. Mel
    Posted October 7, 2012 at 3:47 pm | Permalink

    Perhaps the utility of shame and guilt is best illustrated using a taboo example. Picture this apparently not uncommon scenario: step-dad finds himself sexually attracted to step-daughter as she enters her teenage years. Despite his best efforts, step-dad finds himself occasionally fantasizing about her but guilt prevents him from acting on his fantasies. I would argue that in this case, the inhibiting effect of guilt and any associated self-disgust is functional.

    Anthropologists often talk about the utility of shame and guilt. I’m surprised that folk here think that these two emotion states are always and in every case bad.

  33. kvd
    Posted October 7, 2012 at 4:17 pm | Permalink

    I’m surprised that folk here think that these two emotion states are always and in every case bad.

    Who said that? And what does it have to do with the discussion you seem intent upon having about how to ‘fix’ obesity.

    Your example: someone ‘controls himself’ through the shame and guilt associated with his potential transgression.

    The discussion: it is somehow a good thing to use ‘moderate shaming’ to force people to lose weight.

    You lost me.

  34. Posted October 7, 2012 at 6:15 pm | Permalink

    I regret that acne and cerebral palsy are broken analogies. So too appeals to sexism, racism and so on.

    None of these involve an element of personal choice.

    Weight, for almost everyone, does. Not a single big choice. Just lots of little choices that add up.

  35. John H.
    Posted October 7, 2012 at 8:40 pm | Permalink

    And humans in particular. Our brains are caloric monsters.

    The problem there Jacques is we cannot convert fat into sugar, which is the only realistic source of energy for neurons. The counterpoint is that humans will, with exercise, rapidly release cortisol to induce lipolysis, the implication being that this ensures plasma glucose is saved for the astrocyte-neuron interaction that allows sugar uptake with fatty acid metabolism, which some assert is the primary energy source for the heart, serving the body during these times. Our brains are sugar monsters, which is not the same as caloric monsters.

    That does mean more sugar is good. Nonetheless while many people are aware of the long term threats by high sugar loading, few appreciate that hypoglycemia is bad for brains. The extremely worrying aspect of the obesity and type 2 diabetes epidemic is some neuroscientists think of alzheimers as “type 3 diabetes” because insulin resistance in the brain is a common factor in Alz. Even more perversely, some antidepressants and antipsychotics are clearly risk factors for insulin resistance. Go figure because I can’t.

  36. Mel
    Posted October 7, 2012 at 9:01 pm | Permalink

    Jacques @42:

    There is no such thing as a free lunch choice.

    – Mel Friedman.

    Nonetheless, I’m convinced “just do it” attitudes such as yours do indeed spur on some people in the same way that Lorenzo’s Taubian placebo has helped him win (for now) the battle of the bulging waistline.

  37. John H.
    Posted October 9, 2012 at 9:03 am | Permalink

    This article highlights how the challenge of obesity is extending beyond mere individual considerations. From endocrine disruptors to sleep deprivation, many factors affect our metabolism and we are largely unaware of it.

    As it happens I just read another article about Brain Derived Neurotrophic Factor, which also plays a factor in regulating appetite. Guess what, stress, anxiety, and depression, are great at reducing BDNF levels. The implications of this go far beyond obesity because low BDNF is a regular feature in neuropathologies ranging from schizophrenia to depression to dementia.

    People still think about behavior as what they choose to do. But as Schopenhauer quipped: can I will what I will?

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