Detail from Death and the Miser

Obesity, Despair, and Mortality in the U.S.

We’ve only just begun. That was once a hopeful refrain. But now, it applies to a worrisome trend. Working age people in the U.S. are dying at rates that are unprecedented among wealthy countries. This finding comes from a stunning, comprehensive study of a reversal in U.S. life expectancy. Because it’s now in its third year, it’s more than just a blip. Steven Woolf and Heidi Schoomaker published their analysis yesterday in JAMA. Obesity, despair, and mortality link to this trend.

The Link to Obesity

Back in 2005, Jay Olshansky foresaw this. He and colleagues wrote in the New England Journal of Medicine:

Unless effective population-level interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth of today may, on average, live less healthy and possibly even shorter lives than their parents.

In fact, that’s exactly what’s happening now. And Olshansky says this is only the beginning:

Kids are acquiring obesity in their early teen years, sometimes under the age of 10. When they get up into their 20s, 30s and 40s, they’re carrying the risk factors of obesity that were acquired when they were children. We didn’t see that in previous generations.

This isn’t a one-time phenomenon. It’s going to echo through time.

Disparities and Despair

Anne Case and Angus Deaton have woven a compelling narrative about “deaths of despair” to describe some of these trends. Suicide and drug overdoses are big contributors. However, to fully explain how people are dying in mid-life, you have to look further. Improvements in cardiovascular death rates have stopped and reversed. That’s big. Deaths linked to diabetes are rising, too.

In parallel with all of these trends is the fact of rising disparities. Economic disparities yield disparities in health and mortality. A loss of relative social status seems to be playing a role, too.

More of Same Will Not Work

In an editorial alongside this new research in JAMA, Howard Koh, Anand Parekh, and John Park call for action. Their call for more of same – soda taxes and healthy food initiatives – is not terribly impressive. It’s boilerplate that hasn’t yielded any results to date. Preaching about healthy eating has flourished while obesity has risen and life expectancy has taken a dive.

What does impress is their call for curiosity. We must come to terms with the effect of income inequality, unstable employment, public policy, and social dimensions on health and mortality. Healthy food is great, but only if it matches up with healthy prospects for life and well-being. And that is simply not going to happen on a wage of $7.25 an hour.

America can do much better than this.

Click here for the analysis in JAMA and here for the editorial. For further perspective, click here and here.

Detail from Death and the Miser, painting by Hieronymus Bosch / WikiArt

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November 27, 2019

4 Responses to “Obesity, Despair, and Mortality in the U.S.”

  1. November 27, 2019 at 9:03 am, Mary-Jo said:

    ‘We must come to terms with the effect of income inequality, unstable employment, public policy, and social dimensions on health and mortality.’ Truth. I lived in Russia in the early 2000s and life expectancy for men was 58 y.o., for women 71 y.o., highly based on the harsh conditions re: all factors in that statement. It’s better now.

    Say what you want about Putin, but at least the STABILITY he brings to Russia has increased life expectancy and quality of life years there. I’m not saying I agree with autocracy. My point is, I disagree with anarchy which is what we are seeing in the West, especially the USA, today.

    To me, it’s a lesson to be on the side of whatever candidates and parties will bring back stability to the USA, UK, and Europe so that policies can strive toward and reflect again more equality, stable increased dignified employment, thus improved societal dimensions for all. These constant scandals and breaking news alerts and bitter divisions and polarizations of wealth, parties, ideologies is taking a toll on health and mortality.

  2. November 27, 2019 at 12:48 pm, Richard Atkinson said:

    I hate to introduce politics into a column on obesity and nutrition, but the above column and comment by Mary-Jo deserve examination. First, the suggestion that “equality” is going to do anything for obesity is fanciful. There has always been inequality and likely there always will be (even Jesus said there will always be poor people).

    The reference above to “rising disparities” is a Conscienhealth column of January 27, 2016 that points out that income status is not the critical factor in “inequality” – the perception that others have it better is paramount (in other words, envy). The graph in that column shows the income of the 95 percentile has tripled since 1950 while the income of the 20th percentile has only doubled. Even people in the lower portion of the “poverty level” today live far better than many of the middle class and even rich did in 1950, yet there is more dissatisfaction due to “equality.” Millionaires perhaps envy billionaires today – the logical consequences of “perception.” Perception is influenced by our communication technology and media that allow everyone to see how “the rich and powerful” live.

    Next is the fallacy of the minimum wage. The Washington Post (quite liberal) and the Cato Institute (right of center – Libertarian) both agree that the minimum wage has major adverse consequences (WP – Only 5% of employees are poor single mothers and potentially raising the minimum wage might help some of them. Most minimum wage earners are not living in poverty. Artificially increasing the price of things means there will be less of them, including labor (more robots, fewer jobs, especially for the unskilled).

    As salaries rise, prices rise, inflation rises, so a vicious cycle ensues with no real change in “equality.” Finally, Mary-Jo’s comment about Russia possibly may be correct about stability – one could argue that people were happier under Sadam Hussein and Tito because their societies were “stable” (but people certainly were not equal). Russia has the highest “inequality” in the world (

    Mary-Jo would argue that the standard of living has increased and there is stability. However, “equality” raises its ugly head and the Russian population is getting angry. So, throughout the world the problem is that envy has blossomed. Good luck with fixing that. Let’s all go back to government enforced “equality” – like Venezuela. That worked out so well. Perhaps if we all lived by the 10th Commandment we would be happier and healthier.

    • November 28, 2019 at 6:33 am, Ted said:

      Thanks, Mary-Jo and Richard for taking the time to respond thoughtfully. As you’ve each noted in your own way, these difficult problems have no easy solutions. Nonetheless, I will persist in thinking we can do better.

      And, Richard, you’re right for not wanting to inject politics. Debating politics and religion on this site is not my preference, either.

  3. November 28, 2019 at 9:45 am, John DiTraglia said:

    Richard, as you point out it’s complicated like obesity. And income inequality is increasing everywhere and under very different systems. And it’s not anybody’s fault. But I think that we need to try and fix really big inequality. Even rich people will be harmed. If we don’t, violence and instabilities that affect us all will increase. Maybe trying to talk people out of envy will help but maybe not and not so much if it gets worse. I don’t have as many references at my fingertips as you – or solutions except maybe except for this very intriguing one
    Maybe rich people can think of some answers.