
U.S. Women Are Dying Younger Than Their Mothers, and No One Knows Why - aelaguiz
http://www.theatlantic.com/health/archive/2013/10/us-women-are-dying-younger-than-their-mothers-and-no-one-knows-why/280259/
======
DanBC
Why people say "obese" they either mean the everyday use of the word "really
fat", or they mean (as here) the formal definition of "BMI > 30". There are
problems with BMI - we hear about the trained athlete with high muscle mass
and very little body fat who has a BMI of 38. Luckily most people are nothing
like that trained athlete so BMI is handy for this kind of mass population
stuff.

As Mikeb85 says, the map posted by elwell starts at 13.7%, and that lowest
band goes up to nearly a quarter of the population at 23.3%!

NHBLI have a nice chart here.
[http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm](http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm)

The average American man is 69 inches tall. He'd have to be 203 pounds to have
a BMI of 30. The average American woman is 64 inches. She'd weigh 174 pounds.

Fat shaming is bad, and stupid, and shouldn't be tolerated. But there is a
problem with people's shifting perceptions of what "fat" and "obese" mean.
People who would have been called fat are now called "shapely" or "curvy".

People do not recognise obesity any more.

~~~
huttbutt
>fat shaming is bad, and stupid

No, it's not. Obesity is unhealthy and usually the result of bad habits. All
the ex-fatties I know think this "fat acceptance" crusade is bad and stupid.

~~~
aznjons
Fat shaming actually increases risk of becoming or staying obese. So although
obesity is unhealthy, fat shaming is still bad and stupid since it does not
help, and actually hurts.

There are better ways to help people become healthy.

>The present research demonstrates that, in addition to poorer mental health
outcomes, weight discrimination has implications for obesity. Rather than
motivating individuals to lose weight, weight discrimination increases risk
for obesity.

Source:
[http://www.plosone.org/article/info:doi/10.1371/journal.pone...](http://www.plosone.org/article/info:doi/10.1371/journal.pone.0070048)

~~~
randyrand
1) You cant say that unilaterally - Fat shaming may very well also prevent
skinny people from becoming fat. You can't just look at already fat people. 2)
These self reported "weight discrimination" studies have so many biases you
really shouldn't take them as fact. 3) The usual correlation =/= causation
speech. It could very well be that amount of discrimination also varies with
weight (duh) and that those that get a lot of discrimination are already past
the point of motivation to change (just one of many alternative theories. This
specific example isn't the best by any stretch).

All in all, it just does not make as much intuitive sense that fat jokes
(among other things) encourage people to stay fat and this little study is
definitely not enough to override occams razor in my opinion.

~~~
aznjons
Did you bother to read the abstract of the source provided? It directly
refutes pretty much all of your points including a control group. For your
convenience, I've italicized the relevant text:

>Participants were drawn from the Health and Retirement Study, a _nationally
representative_ longitudinal survey of community-dwelling US residents. A
total of 6,157 participants (58.6% female) completed the discrimination
measure and had weight and height available from the 2006 and 2010
assessments. Participants who experienced weight discrimination were
approximately 2.5 times _more likely_ to _become obese_ by follow-up (OR =
2.54, 95% CI = 1.58–4.08) and participants _who were obese at baseline_ were
three times more likely to remain obese at follow up (OR = 3.20, 95% CI =
2.06–4.97) _than those who had not experienced such discrimination_. These
effects held when _controlling for demographic factors (age, sex, ethnicity,
education) and when baseline BMI was included as a covariate._

------
flexie
Obesity and lack of activity. It's easy to see for us outsiders that are used
to other sizes. Where I am in Europe, a typical woman has a body not that far
from the fashion world's ideals which Americans often call skinny bitches,
"anorectic" or similar derogatory terms. Look at pictures of Americans 40
years ago. Most were slender. Now, many if not most could use different eating
habits.

~~~
atlanticus
Apparently you are not in northern Europe.

~~~
flexie
No, but used to be. There we have the same obesity problems, though still on a
smaller scale.

------
mynewwork
Title: "No one knows why" Article: "female obesity and drug abuse have risen
dramatically over the past two decades"

~~~
bdcravens
1 in 4 women die of heart disease. 1 in 36 die of breast cancer. Which one
receives more attention?

~~~
VLM
You need years of life lost stats not just lifetime frequency. My
grandmother's heart didn't get her until she was in her 80s. If she had a
miracle perfect heart well maybe she would have made a couple more years at
most till the kidneys, or the liver, or something else got her. Unfortunately
I know of too many women, practically girls really, who get cancer in their
20s or maybe 30s. Without the cancer they'd probably have had another 50
healthy years before the heart disease got em.

Edited to add you hear a lot about people dying of heart disease when they're
30 because its shockingly unusual, usually heart problems kill bluehairs. But
cancer always seems to strike someone like my kids friends mom who's only
30something, that unfortunately seems normal for cancer?

~~~
bdcravens
Good points. Though I'm thinking the 80 year old dying of heart disease is
less common than the 30 year old obese person who is buying death on
installment plan

------
varelse
At the risk of losing some of the karma I've built up every time I deconstruct
Google's hiring practices, here goes:

High Fructose corn syrup and subsidizing horrible nutritional choices is at
least partially to blame for the obesity epidemic. However, there is an
element of personal choice and free will here. Ironically, one side of the
political fence here will not acknowledge the former and the other side
refuses to acknowledge the latter.

If you choose to squander what little free time you have from your minimum
wage job on sitting in front of a TV instead of burning an extra 500-1000
calories per day, you will get fat, and you will most likely die young, and
that's the cost of watching TV instead of exercising. For god's sake, at least
squander that time on Khan Academy or coursera.

That said, this is a valid choice IMO. It's easy to forget how much life sucks
for the bottom 80% when you're earning a salary in the top 5%. I can
completely understand why someone with no perceived prospects for life ever
getting any better would choose to numb themselves with food, TV, and alcohol.
And that is a national disgrace.

But from my perspective, I always had a burning motivation to prove myself and
stand out from the people who dismissed me as not worth the effort. Similarly,
I am regularly astounded at the different outcomes I see from immigrants who
arrive here with nothing, and become millionaires within a generation. The
solution IMO (and there may not be one) is to figure out how to instill that
kind of passion in a higher proportion of the population (and that may not be
what the corporatocracy really wants because then they might start asking some
really uncomfortable questions).

~~~
DanielStraight
You are greatly oversimplifying people's decisions about how to spend their
time.

I am not trying to defend laziness. I am just drawing to draw your attention
to some of the factors you are not considering here.

People often watch TV while doing things like cooking dinner or housework,
which aren't compatible with serious exercise.

People often watch TV at hours of the day where outdoor exercise is
impractical or at least inconvenient.

The decision of how to spend time isn't binary: TV or exercise. People with
many family responsibilities have less free time. People who can't afford to
buy time by paying for their oil changes, plumbing, etc. have less free time.

It should be telling that many people who do get regular exercise get up very
early to exercise before starting their normal daily activities. Even people
who make exercise a priority have a hard time fitting it into a normal
schedule.

~~~
VLM
You two are going to get really confused at the net results of my treadmill
being in front of the TV, just far enough back to not affect the use of the
kinect. Although I acknowledge that's probably so weird it makes "standing
desks" look mainstream. Do I want to watch Dr Phil today? Well, is it Really
worth a 3 mile walk? It certainly cuts down on casual TV watching.

One datapoint that might help you both is minimum wage jobs are often
physically exhausting. While I was a starving student I stacked 80 pound bags
of water softener salt on pallets... four hours per day. Even for a big
weightlifter dude thats pretty rough. When I went home to do homework I
(correctly) felt no need for further exercise. But even a retail clerk drone
is at least standing 8 hours per day, even if not lifting much. At another
drone job I figured I walked (pretty fast) at 4 mph about half the 8 hour
shift, that's 16 miles of walking every day.

There probably are minimum wage jobs where you sit all day, but
stereotypically sitting around is a problem for highly paid workers. At this
instant the only minimum wage / entry level job I can think of involving
sitting all day is call center, and those are organized around churn and burn
them to get an annual turnover ratio exceeding 1.0 to keep labor costs low
(fire everyone before annual review day, and not only do you get to skip
giving reviews, but you never have to pay over starting wage).

~~~
varelse
Confused? Not at all. I personally watch really godawful action movies on my
spin bike on a regular basis. And if you're on your feet all day, by all
means, eat what you want, you're going to need it! But don't lump yourself in
with the couch potatoes. Physics doesn't lie.

I wear a fitbit and I can burn ~3,000 calories a day just walking around the
office and doing household chores. If I exercise on top of that, it's 3,500 to
4,500 calories.

------
pg
That map looks remarkably like this one:
[http://www.cdc.gov/physicalactivity/data/facts.html](http://www.cdc.gov/physicalactivity/data/facts.html)

~~~
8_hours_ago
And kind of like this map!
[http://www.startribune.com/177786361.html](http://www.startribune.com/177786361.html)
There's a government conspiracy to kill Republicans!

I'm not saying that exercise isn't the cause of shorter life-spans, and there
is certainly data to support it, but comparing maps alone is kind of silly.
There are a lot of maps that look like that.

~~~
pg
Comparing maps is no sillier than looking for correlations between any two
data sets.

And indeed, I suspect the resemblance between your map and mine is not a
coincidence either.

~~~
8_hours_ago
"Silly" was perhaps a strong word. My point was that there are a lot of heat
maps of the US that have a similar distribution, and those similarities could
very well be due to a spurious relationship.

------
rayiner
> The most shocking study, published in August 2012 by the journal Health
> Affairs, found that life expectancy for white female high-school dropouts
> has fallen dramatically over the past 18 years. These women are now expected
> to die five years earlier than the generation before them—a radical decline
> that is virtually unheard of in the world of modern medicine.

High school graduation rates are up substantially over that time period,
especially for women, so the category of "high school dropouts" probably
represents a narrower pool of women today than 18 years ago.

------
smokey42
As some suggested a correlation with obesity, I'd like to highlight another
correlation.

Recent findings showed that obesity can be an side-effect of stress. [There is
a genetic component to it, such that people who can compensate detrimental
effects of stress to the brain, become obese as a side-effect. People who
can't, don't become obese but have detrimental effects to their brain. They're
fucked both ways. :-( But this is merely a second hand recitation of what I
heard a scientist say. Grain of salt, blah blah.]

Nevertheless, the biggest source of stress is socio-economic stress. It's way
more stressful than any "direct" stress.

Trying to find some of the relevant resources:

* [http://www.cdc.gov/nchs/data/databriefs/db50.htm](http://www.cdc.gov/nchs/data/databriefs/db50.htm) shows correlation between socio-economic status and obesity

* [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158/)

Linkage between obesity and some dopamine pathways are also known since 2001.

My own speculation: The location where mortality of women is highest produce
the highest socio-economic stress to women.

Additional speculation: This ought to happen in high or in low income areas
and may be linked with income inequality within the community.

------
hacknat
Because they're more obese.

~~~
elwell
Yeah, overlay that map with this one: [http://www.stratasan.com/wp-
content/uploads/2012/04/Obese_po...](http://www.stratasan.com/wp-
content/uploads/2012/04/Obese_population_by_county.png)

~~~
colanderman
The correlation seems to break down in Appalachia -- low obesity; high
mortality rate.

(Aside -- the stark contrast in obesity between Colorado and Kansas is
surprising.)

~~~
Patrick_Devine
I'd love to have access to the raw data to feed it into R. I'm fairly positive
even with Appalachia included there is still going to be a strong positive
correlation.

~~~
gohrt
That's not really how averages work, though. You can't just smash two modes of
a bimodal distribution together and treat it like a unimodal distribution. I
mean, you can, but it generates garbage results.

~~~
Patrick_Devine
It's hard to draw that conclusion without knowing what's in either data set.
I'm fairly certain that the obesity data would have gender as one of its
attributes, and it's also probable that any death statistics would include
other vital stats such as height and weight at time of death.

But you're right, it's certainly possible that all of the women in those
states are of normal weight and it's only the men who are obese. I'm being a
little glib though, it's hard to know without seeing the data.

------
croisciutto
Perhaps dying younger is simply that being educated and joining the workforce
entails _thinking_ more. Low grade, high-volume thinking requires persistent
states of arousal, not dissimilar from stress, and ultimately causing stress.
The symptoms are reduced immune activity, increased blood pressure, poor
digestion, etc. The health risks of chronic overwork (heart attack, stroke) do
seem to be the same as those of excess hedonism (heart attack, stroke). The
double whammy is that people who work too hard tend to 'play hard' during
their off-duty hours. They think of it as necessary and well-earned
_relaxation_ , which is why they do it, but it isn't quite the same thing.
Drinking, smoking and other drugs merely produce more arousal, though it is
interpreted as being pleasant because the ego is not threatened. I think the
foregoing ideas are why some religious traditions have specified a day of
complete rest, which breaks the cycle somewhat

------
forgottenpaswrd
Yes we know.

Ladies now smoke as much as men do. In my country young women smoke now more
than men. You don't smoke to be a man anymore(stupid male reason), now you
smoke for getting slim, or looking "sophisticated" or any other stupid female
reason.

Females now work as hard as men. In the past they had to raise the family
only, now they raise the family and work with all the crap of working(stress),
they eat the same fast food shit that males do(obesity), they sleep as bad as
men do.

Females now use hormones for not getting pregnant, breast and ovary's cancer
incidence has gone up.(they survive more years through).

~~~
taejo
> Females now use hormones for not getting pregnant, breast and ovary's cancer
> incidence has gone up.

It seems that hormonal birth control slightly elevates the risk of breast
cancer, but _reduces_ the risk of ovarian cancer by a larger percentage
([https://en.wikipedia.org/wiki/Hormonal_contraception#Effects...](https://en.wikipedia.org/wiki/Hormonal_contraception#Effects_on_rates_of_cancers)).

------
Mikeb85
My own opinion on things like diet, weight, exercise, is pretty simple.

1) Eat relative to your activity level. If you're sedentary, eat less. If
you're active or an athlete, eat more.

2) Eat good food. If you don't recognize it as something that comes out of the
ground or directly from an animal, don't eat it. There are a few exceptions
(oils, vinegar, fermented products). Either way, you should know where it's
coming from and how it's handled.

If you do these two things, you should be alright. And IMO, the only things
you should be drinking are: water (lots), beer (slightly less), wine (even
less), milk (a little), juice (a little less).

Any time I see people drinking pop as a 'beverage' and not a treat I just
shake my head...

------
tekalon
I read somewhere (long ago and I can't remember where) that the rate of heart
disease increased in women the same time more women worked outside their
homes. Add that to obesity, education and all the other options the article
and commenters have mentioned. Issues like this isn't often one or two things,
its many that build up.

------
dpweb
"And No One Knows Why" Nauseating..

Health is a mess, and we're further advanced than ever in history. Education
is a mess, and every person has all the knowledge of the world literally in
their pocket.

Personal responsibility.

------
niels_olson
Can someone correlate this data with red-blue voting distribution at the same
level (counties)? Because, by my eye, they are in lock step.

~~~
VLM
The hard statistical challenge is your voting theory is pretty much a proxy
for urban/rural. So you'd need some sneaky statistics to find the rare areas
where you can separate the two closely matched data sources. Rephrased, I bet
if you ran correlation coeff for urban/rural ratio vs both voting and death
rates I bet they'd match up about the same and the coeff between urban/rural
and death would be higher. Or I could be totally wrong and you're right. But
what I am pretty sure I'm correct about, is this experiment would be the
logical second step after your theory.

------
ck2
Is it just me or are areas of the map that show "improvements" where you would
more likely find immigration?

Just a very casual observation, may be completely wrong.

~~~
VLM
Looks closer to percent urbanization. Migrant farm worker land not looking
very blue. My pasty white state matches pretty well with urbanization, not so
well with racial variation. This explanation doesn't seem to hold in other
areas.

I wonder how well it corresponds to grain related pesticide and insecticide
use per county. This seems to work, Los Vegas is not exactly a legendary
wheatfield. CA has a lot of agribusiness but not as much grain as Iowa or
Montana. Ahh the waving cornfields of Manhattan Island NYC. It seems to match
up...

~~~
ck2
Agriculture is far from the only immigration job.

Everything from construction to tech.

------
drakaal
No one knows why....

Obesity is up. As we move away from a labor economy fewer people work on farms
and factory, we eat the same number of calories, or more, and do less.

More women are in the work place, and that's stressful... Job related stress
shortens lives. Sure in the old nuclear family where mom stayed home and
raised the kids that was stressful too, but with nannies and day care we still
have people in that role, and now you have more single moms doing work and
home on their own.

Ethnic diversity due to an increase in the number of immigrants from
developing nations. We have a lot more people from countries that had much
shorter life spans than the US. Enough to move the numbers. Like it or not
while Asia has people who live the longest the average is much shorter than
those from Europe, and Mexico and Central America are much shorter still.

~~~
VLM
There's a chronological problem with your theoretically logical idea where the
farm worker collapse started near the turn of the last century (1900) and
smoothly over the decades pretty much anyone who was leaving the farm had left
by 1970 but fatness indicators like number of diagnosed diabetes patients
didn't start expanding (sorry for pun) until late 1990s (about 20 years after
an explosion in corn syrup consumption in the USA, surely just a coincidence).
So there is a 90 to 20 year gap depending how you want to run the numbers to
explain, why the workers are already gone but not sick yet.

There's also a numerical hole where at peak we're talking about 10 million or
so american farm workers leaving the farm over the 1900s, but 1/3 or so of 400
million aka over 100 million getting fat. If 10 million changed jobs and 10
million got fat, even if we don't have data to prove its the same 10 mil my
spidey sense would tingle, but you're off by a factor of ten.

Also the point of the article graph is rural Montana is not the place to be if
you're a woman aspiring to be old, but rural Montana never had quite the same
industrial production as NYC or the WWII aircraft plants in WA. So thats a
geographic issue.

The problem with your theory about short lived Mexicans is my general lifetime
knowledge about where you'll find illegals living maps pretty decently with
where people are actually living longer. Its as though immigrants were not
exposed to certain industrial or agricultural toxins in the 3rd world that we
expose our own kids to. For example no one in New Mexico (well, there's an
accurate name) can speak English anymore, but the article map show's they're
ridiculously healthy compared to, say, pasty white rural northern Wisconsin
where I'm pretty sure they have a hunting season for illegals. Which is
interesting.

(edited to add, I liked your post a lot, because it used logical thinking to
come up with apparently reasonable falsifiable hypothesis, which is awesome,
keep on doing it. Problems need theoreticians and experimentalists to solve
them, just one isn't going to do it alone. Theoreticians do need thick skin
since 90% of their theories aren't going to work and its nothing personal)

~~~
drakaal
I said farm and Factory. We also drive more and walk less, we are a much less
active people than we were.

I didn't say illegals, but people of Indo and Asian descent have shorter lives
for the most part compared to Caucasians.

I'm not saying my presentation of facts was perfect, but I can dig around
there are plenty of studies (and I hate studies as opposed to experiments)
that these observations were pulled from.

My point was really that there are lots of reasons, and likely it isn't "just
one", but they aren't "unknown".

------
001sky
This is a flaw in their statistics. Just eyeball the map, and you can see the
red counties are in areas of remote/economic depravation. Over the course of
100 years, you are getting "the thin end of the gene pool" as others move out.
So, your baseline samples are not the same. Also the gene-pool will be more
startified by education as time goes on (ie, its more "common" to have edu
degrees), so as the weaker become educated again only the weakest do not. So
their is instability in the relationship between the proxy variables for
"class" and success and the genetic ones. This article is a good example why
researchers (and reporters) need to be boots on the ground and understand what
they are dealing with. None of this would be surprising to anyone who hase
been to many of the remote rural areas flagged in red here.

