Obesity and Longevity
http://www.100md.com
《新英格兰医药杂志》
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.
Fred W. Whitehouse, M.D.
Henry Ford Hospital
Detroit, MI 48202
fwhiteh1@hfhs.org
References
Preston SH. Deadweight? -- the influence of obesity on longevity. N Engl J Med 2005;352:1135-1137.
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.
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.
Paul A. Simon, M.D., M.P.H.
Douglas M. Frye, M.D., M.P.H.
Los Angeles County Department of Health Services
Los Angeles, CA 90012
psimon@ladhs.org
References
Update: acquired immunodeficiency syndrome -- United States, 1994. MMWR Morb Mortal Wkly Rep 1995;44:64-67.
Advancing HIV prevention: new strategies for a changing epidemic -- United States, 2003. MMWR Morb Mortal Wkly Rep 2003;52:329-332.
Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA 2003;290:1510-1514.
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).
Bradford M. Blanchard, M.D.
Hartford Hospital
Hartford, CT 06106
lblanc@comcast.net
References
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.)
Jaffe H. Whatever happened to the U.S. AIDS epidemic? Science 2004;305:1243-1244.
Cutler DM. Behavioral health interventions: what works and why? In: Anderson 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.
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.)
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.
Arielle H. Carpenter
2818 Banyan Blvd. Cir. NW
Boca Raton, FL 33431
ahc119@bellsouth.net
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.
Paolo M. Suter, M.D.
Catherine Moser, M.D.
University Hospital Zürich
8091 Zurich, Switzerland
paolo.suter@usz.ch
References
Nass R, Thorner MO. Life extension versus improving quality of life. Best Pract Res Clin Endocrinol Metab 2004;18:381-391.
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.
Samuel H. Preston, Ph.D.
University of Pennsylvania
Philadelphia, PA 19104
References
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.)
Cutler DM. Behavioral health interventions: what works and why? In: Anderson 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.
HIV/AIDS surveillance report. Vol. 8. No. 2. Atlanta: Centers for Disease Control and Prevention, 1996:28.
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.
Fred W. Whitehouse, M.D.
Henry Ford Hospital
Detroit, MI 48202
fwhiteh1@hfhs.org
References
Preston SH. Deadweight? -- the influence of obesity on longevity. N Engl J Med 2005;352:1135-1137.
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.
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.
Paul A. Simon, M.D., M.P.H.
Douglas M. Frye, M.D., M.P.H.
Los Angeles County Department of Health Services
Los Angeles, CA 90012
psimon@ladhs.org
References
Update: acquired immunodeficiency syndrome -- United States, 1994. MMWR Morb Mortal Wkly Rep 1995;44:64-67.
Advancing HIV prevention: new strategies for a changing epidemic -- United States, 2003. MMWR Morb Mortal Wkly Rep 2003;52:329-332.
Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA 2003;290:1510-1514.
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).
Bradford M. Blanchard, M.D.
Hartford Hospital
Hartford, CT 06106
lblanc@comcast.net
References
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.)
Jaffe H. Whatever happened to the U.S. AIDS epidemic? Science 2004;305:1243-1244.
Cutler DM. Behavioral health interventions: what works and why? In: Anderson 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.
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.)
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.
Arielle H. Carpenter
2818 Banyan Blvd. Cir. NW
Boca Raton, FL 33431
ahc119@bellsouth.net
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.
Paolo M. Suter, M.D.
Catherine Moser, M.D.
University Hospital Zürich
8091 Zurich, Switzerland
paolo.suter@usz.ch
References
Nass R, Thorner MO. Life extension versus improving quality of life. Best Pract Res Clin Endocrinol Metab 2004;18:381-391.
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.
Samuel H. Preston, Ph.D.
University of Pennsylvania
Philadelphia, PA 19104
References
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.)
Cutler DM. Behavioral health interventions: what works and why? In: Anderson 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.
HIV/AIDS surveillance report. Vol. 8. No. 2. Atlanta: Centers for Disease Control and Prevention, 1996:28.
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.