Living Large and Healthy, but How Long Can It Go On?
By GINA KOLATA
Published: July 30, 2006
Longer life. Less disease. Less disability. The trends have continued for more than a century as humans have become bigger, stronger and healthier. But can they — will they — keep going? Or is there some countertrend, obesity or an overuse of medications, perhaps, that will turn the statistics around?
The questions are serious, but, researchers say, for now there are no easy answers, only lessons in humility as, over and over again in recent years, scientists have seen their best predictions overthrown.
Life expectancy, for example, has been a real surprise, says Eileen M. Crimmins, a professor of gerontology and demographic research at the University of Southern California. “When I came of age as a professional, 25 years ago, basically the idea was three score years and 10 is what you get,” Dr. Crimmins said. Life span was “this rock, and you can’t touch it.”
“But,” she added, “then we started noticing that in fact mortality is plummeting.”
Will it continue much longer?
“It is an extremely controversial area, and the answer is, We don’t know,” said Dr. Richard J. Hodes, director of the National Institute on Aging.
Some worry, for example, that today’s fat children will grow up to be tomorrow’s heart disease and diabetes patients, destroying the nation’s gains in health and well-being.
“It is very legitimate to be concerned about levels of overweight and obesity in kids,” said David Williamson, a senior biomedical research scientist at the Centers for Disease Control and Prevention. “But at the same time, those levels of obesity are overlaid on improvements in health in children, which also affect long-term health and longevity.”
An Uncertain Future
The mixed picture has led to disparate views about what is likely to occur.
S. Jay Olshansky, a professor of epidemiology and biostatistics at the University of Illinois at Chicago, predicted in The New England Journal of Medicine that obesity would lead to so much diabetes and heart disease that life expectancy would “level off or even decline within the first half of this century.”
Dr. Olshansky was countered by Samuel H. Preston, a professor of demography at the University of Pennsylvania. Dr. Preston cited the population’s overall better health, from childhood on, and said that obesity had already been factored into national projections of life spans and that the projections were that life spans would continue to increase.
Dana Goldman, director and corporate chairman of health economics at the RAND Corporation, looked at the obesity question from another perspective: disability. In a recent paper in Health Affairs, Dr. Goldman and his colleagues reported that disability rates among young people had begun to increase, although they continued to decline for the elderly. He suspects it is because of obesity and says it does not auger well.
He said in a telephone interview that the increased number of disabled involved less than 1 percent of young people. That means it is possible that he is seeing a spurious trend resulting from minor changes in reporting practices.
“I think of this as the ‘storm clouds on the horizon’ phenomenon,” Dr. Goldman said.
Others remain circumspect. Perhaps obesity will lead to increased disability, some say. While disability is declining over all, said Dr. Richard M. Suzman, director of the office of behavioral and social research programs at the National Institute on Aging, “if you hadn’t had the increase in obesity, would disability have gone down much faster?”
The problem for now, Dr. Williamson says, is that there is so much concern over obesity that other factors may be ignored.
He tells of a recent episode that illustrates his point, when he went with some Italian colleagues to see a photography exhibit.
“We were looking at pictures of Pennsylvania coal miners in the late 1800’s and early 1900’s,” Dr. Williamson said. “A lot of these people were kids.”
“The Italians said to me, ‘Oh, look. These kids were so thin.’ ”
“I said, ‘Well, hell yes they were thin. But were they healthy?’ ” It is likely that they were poor, malnourished and sick from the coal dust, he added. No wonder they were thin.
“It really got me thinking about, gosh, have we gotten so out of touch?” Dr. Williamson said. Obesity, he said, is a very legitimate concern, but it is not the only health risk. And being thin does not necessarily equate with being healthy.
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