Obesity and longevity

[Guest guest]

Hi All,

Here is a series of short comments article on previous papers on obesity and

longevity. Where full-texts are indicated, PDFs can be provided for the

references.

Whitehouse FW.

Obesity and longevity.

N Engl J Med. 2005 Jun 16;352(24):2555; author reply 2556-7. No abstract

available.

PMID: 15958816

To the Editor: Preston's editorial (March 17 issue)1 on obesity and its

influence on

longevity, which accompanies the report by Olshansky et al.,2 focused my

thinking on

morbidity versus mortality. Preston wrote that " the current life expectancy at

birth

in the United States would be one third to three quarters of a year higher if

all

overweight adults were to attain their ideal weight. " This goal is unlikely to

be

achieved, and even if it were, the gain in life expectancy would be minuscule.

As a

clinician, however, I see daily the terrible morbidity that obese patients have

—

complications from diabetes, dyslipidemia and hypertension, wear and tear on the

knees and hips, legs swollen from venous insufficiency, backache, and a winding

down

of physical activity. It seems to me that an emphasis on morbid states that

could be

averted with the elimination of some (not all) excess weight would permit an

educable patient to sit up, take notice, and act. The gain in life expectancy is

too

small to sell to any patient. The avoidance of suffering is worth the effort.

References

1. Preston SH. Deadweight? -- the influence of obesity on longevity. N Engl J

Med

2005;352:1135-1137. [Full Text]

2. Olshansky SJ, Passaro DJ, Hershaw RC, et al. A potential decline in life

expectancy in the United States in the 21st century. N Engl J Med

2005;352:1138-1145. [Abstract/Full Text]

--------------------------------------------------------------------------------

A. Simon, M. Frye

To the Editor: In providing examples of population shifts toward healthier

lifestyles, Dr. Preston states incorrectly that " primarily because of behavioral

changes, the incidence of AIDS has fallen by nearly 50 percent since 1992. " The

observed decline in the incidence of AIDS from 1992 to 1994 was an artifact of

the

change in the surveillance case definition for AIDS that was implemented in

January

1993.1 A substantial decline was then observed in the years 1995 through 1998

after

the introduction of highly active antiretroviral therapy for human

immunodeficiency

virus (HIV) infection.2 Since 1998, the incidence of AIDS has remained

relatively

stable.2 To suggest a shift toward " healthier lifestyles " in the context of HIV

infection is particularly misleading, given recent reports of increased levels

of

unsafe sexual behavior among gay and bisexual men in urban centers throughout

the

United States, Canada, and Western Europe.3 These reports highlight the critical

need for continued efforts to identify and implement more effective strategies

of

HIV prevention.

References

1. Update: acquired immunodeficiency syndrome -- United States, 1994. MMWR Morb

Mortal Wkly Rep 1995;44:64-67. [Medline]

2. Advancing HIV prevention: new strategies for a changing epidemic -- United

States, 2003. MMWR Morb Mortal Wkly Rep 2003;52:329-332. [Medline]

3. Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old

problem.

JAMA 2003;290:1510-1514. [Full Text]

--------------------------------------------------------------------------------

Bradford M. Blanchard

To the Editor: Preston states, regarding obesity, that " the U.S. population has

already shown the ability to shift to healthier lifestyles. " There are few

recent

data to support his statement. During the past 15 years, the percentage of

adults

who smoke has decreased by only 1 percent.1 The number of new cases of AIDS has

remained unchanged, at 40,000 per year.2 The modest reduction in the number of

fatal

vehicular crashes reflects improved safety equipment and better emergency

medical

care, not fewer drunk drivers.3 The incidence of obesity has doubled, dietary

fat

intake has increased, and serum cholesterol levels have not decreased

significantly

(from 205 to 203 mg per deciliter).4

An antiobesity campaign should focus sharply on creating new social policies

that

encourage weight loss (e.g., adjustments in insurance premiums, compulsory

exercise

for students from elementary school through college, and health-friendly food

choices in cafeterias).

References

1. Freid VM, Prager K, MacKay AP, Xia H. Health, United States, 2003: with

chartbook

on trends in the health of Americans. Hyattsville, Md.: National Center for

Health

Statistics, 2003:169, 212, 228. (DHHS publication no. 2003-1232.)

2. Jaffe H. Whatever happened to the U.S. AIDS epidemic? Science

2004;305:1243-1244.

[Abstract/Full Text]

Cutler DM. Behavioral health interventions: what works and why? In: NB,

3. Bulatao RA, Cohen B, eds. Critical perspectives on racial and ethnic

differences

in health in late life. Washington, D.C.: National Academies Press, 2004:643-74.

4. Health, United States, 2004: with chartbook on trends in the health of

Americans.

Hyattsville, Md.: National Center for Health Statistics, 2004:240. (DHHS

publication

no. 2004-1232.)

--------------------------------------------------------------------------------

Arielle H. Carpenter

To the Editor: I became alarmed when I observed what my peers were eating at my

public high school. In 2003, I began a campaign as a teen advocate for healthful

eating. Olshansky and colleagues' forecast for my generation is distressing.

Businesses should not be allowed to market unhealthful products to children.

They

undermine our own personal responsibility to make choices by flooding the

marketplace with unhealthful choices. We should educate children and adolescents

so

that they can make informed choices. It definitely takes more time, effort, and

money to eat more healthfully. This " obesity tsunami " can be stopped through

education and by subsidizing more nutritious food sources and granting schools

an

adequate budget to provide nutritious meals.

--------------------------------------------------------------------------------

Paolo M. Suter, Moser

To the Editor: Olshansky et al. highlight once more the fundamental impact of

weight

control on the risk of disease and, thus, longevity. We all know that weight

control

is vital for the longevity of each person and for our health care system. A

central

question regarding increased life expectancy is often insufficiently addressed1:

What are we going to do during the years gained? At present, the most likely

answer

would be eating and gaining weight.

References

1. Nass R, Thorner MO. Life extension versus improving quality of life. Best

Pract

Res Clin Endocrinol Metab 2004;18:381-391. [CrossRef][iSI][Medline]

--------------------------------------------------------------------------------

H. Preston

Dr. Preston replies: Dr. Whitehouse is surely correct that the consequences of

obesity in terms of morbidity are significant and that reductions in obesity

would

improve both levels of fitness and longevity. It is important to recognize that

the

estimated loss of one third to three fourths of a year of life expectancy that

results from obesity patterns is a national average across all body types; the

loss

of life expectancy for obese people themselves is considerably greater.

Dr. Blanchard argues that behavioral trends during the past 15 years are not as

benign as those that I cite, but his citations to data and references are

seriously

flawed. The source that he refers to for smoking patterns does not show a 1

percent

decline during the latest available 15-year interval. Rather, the percentage of

adults who are current cigarette smokers declined from 30.1 percent in 1985 to

23.3

percent in 2000.1 The reference that he and I cite with regard to fatal crashes

involving drunk drivers attributes the decline in mortality not to improvements

in

safety equipment and better medical care but rather to two campaigns fostered by

Mothers against Drunk Driving. One focused on legislative change to discourage

drunk

driving, and the other on assigning designated drivers.2

Dr. Blanchard also argues that the incidence of AIDS has not declined in the

past 15

years. In their letter, Drs. Simon and Frye point out correctly that the

incidence

of AIDS has declined since 1995. With adjustment for reporting delays resulting

from

a 1993 expansion of the definition of AIDS, the number of AIDS cases declined

from

62,200 in 1995 to 42,156 in 2000 and has remained roughly constant since that

time.3,4 As Drs. Simon and Frye suggest, this decline probably had more to do

with

changes in treatment regimens than with behavioral change. However, an earlier

decline in the incidence of AIDS " almost certainly reflects prevention efforts

within gay communities. " 5 Improving health behaviors is not easy, but there is

solid

evidence that it can be done.

References

1. Freid VM, Prager K, MacKay AP, Xia H. Health, United States, 2003: with

chartbook

on trends in the health of Americans. Hyattsville, Md.: National Center for

Health

Statistics, 2003:212. (DHHS publication no. 2003-1232.)

2. Cutler DM. Behavioral health interventions: what works and why? In:

NB,

Bulatao RA, Cohen B, eds. Critical perspectives on racial and ethnic differences

in

health in late life. Washington, D.C.: National Academies Press, 2004:643-74.

3. HIV/AIDS surveillance report. Vol. 8. No. 2. Atlanta: Centers for Disease

Control

and Prevention, 1996:28.

4. HIV/AIDS surveillance report. Vol. 15. Atlanta: Centers for Disease Control

and

Prevention, 2003:12.

Jaffe H. Whatever happened to the U.S. AIDS epidemic? Science

2004;305:1243-1244.

[Abstract/Full Text]

Al Pater, PhD; email: old542000@...

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