[Acb-diabetics] interesting article

[Patricia LaFrance-Wolf]

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http://www.nytimes.com/2009/10/18/magazine/18fob-essay-t.html?_r=1&partner=r
ss&emc=rss&pagewanted=all

By DANIEL ENGBER

Published: October 15, 2009 

At nearly 6 feet 2 inches

 and about 175 pounds, 

Barack Obama

 may be the slimmest president since the Civil War. His body-mass index
hovers near 23, well within the healthy range and somewhat to the left on
the bell

curve of American bodies. Perhaps he has some credibility, then, when he
encourages the rest of us to shed a few pounds. During the presidential
campaign,

Obama suggested that rolling back 

 rates would save a trillion dollars for 

. 

Sophia Martineck

 

He's right that there is a connection between excess fat and public health.
Obesity is associated with a higher risk of 

, 

, cardiovascular disease and other problems. If we could somehow slenderize
the fattest people in America all at once, we would prevent an estimated
112,000

deaths a year, according to the 

. But girth shouldn't be the only dimension in the health care debate.
There's at least one more bodily attribute that's eating away at the
Medicare budget:

shortness.

We've long known that stature can serve as a crude measure of public health.
If everyone came from a perfect home, the average height across the
population

would be a function of our genes alone. (There would still be tall people
and short people, but we would all have grown as much as we possibly could.)

Anything less than an ideal standard of living, though, tends to stunt a
child's growth. 

Many problems associated with being overweight correspond to being
"underheight." The shorter you are in America, the more likely your chances
to develop

 

, diabetes or stroke. Fat people and short people lead briefer lives, and
they put an increased burden on the health care system. Economists estimate
that

excess weight alone accounts for 9 percent of the country's medical
spending. There's no such figure for insufficient height, but we do know
that obesity

and shortness play out in similar ways across the socioeconomic landscape.

In the labor market, the effects of height and weight tend to run in
parallel. A 2004 study by John Cawley of 

 found that severely obese white women who weigh more than two standard
deviations above average - women who weigh, for example, more than 212
pounds if

they're 5 feet 4 inches tall - are paid up to 9 percent less for their work.
Likewise, a decrease in a man's height to the 25th percentile from the 75th

- roughly to 5 feet 8 inches from 6 feet- is associated with, on average, a
dip in earnings of 6 to 10 percent. 

And like obese people, short people are less likely to finish college than
those of average weight. A paper from the July issue of the journal
Economics

and Human Biology used survey data from more than 450,000 adults to conclude
that male college graduates are, on average, more than an inch taller than

men who never finished high school.

Moreover, just as a buildup of abdominal fat increases the risk of chronic
illness, so can 

 have a direct impact on physiology. Smaller people, for example, have
smaller lungs - and reduced lung capacity is a risk factor for death from
cardiovascular

disease. Shorter people also have narrower coronary arteries, which may be
more susceptible to 

. 

Whatever the cause, higher weight and lower height are associated with
chronic disease, low wages and poor educational attainment. And while we are
getting

fatter, we may be getting shorter too. The economist John Komlos has shown
that the United States is losing height relative to other developed nations,

and some American demographic groups are even shrinking in absolute terms.
Yet we tend to discount shortness as a mere byproduct of 

 and early-life experience, while treating the obesity epidemic as if it
were a grave danger to public health. Why can't our campaign to reshape the
American

body have two fronts? If we really want to make our country healthier, let's
have a war on shortness too.

You're excused for scoffing. You probably think of weight as a problem we
can fix, while height seems beyond our control. We could try to make people
thin

by taxing junk food or by raising their insurance premiums unless they go on
a 

. But what kind of policy could make someone taller? 

Controlling our country's height may be just as plausible - or implausible -
as controlling its weight. It's true that someone who is fat can lose weight

on purpose, while a short adult can't do anything to gain height. Yet
instances of radical, lasting weight loss are exceedingly rare. Diet and
exercise

schemes tend to yield only minor effects over the long term. While lesser
changes to your weight may be associated with modest health benefits, they
won't

help all those obese adults to become slender. For most of us, changes in
body size follow a long, slow pattern across our adult lives. Every year, we

lose a tiny bit of height and gain a pound or two of weight until, in our
older years, we shrink in both measurements.

Given how hard it can be to lose weight, a realistic war on obesity starts
to look a lot like a war on shortness. In both cases, we're dealing with a
complex

function of genetics, social class and poor health in childhood. 

Early-life experiences play an important role in the development and
consequences of body size. Exposure to 

, infectious disease, chronic 

 and poverty stunta child's development and seem to explain many of the
long-term problems associated with short stature. Environmental factors may
promote

obesity, too: lack of 

, bad nutrition, chronic stress and poverty have all been associated with
early weight gain and a higher risk of health problems down the road.

A range of sensible interventions could address both problems at once. To
win a war on shortness, we might promote the consumption of fruits,
vegetables

and other foods that are low in 

 and high in micronutrients. Or we could invest in education as a means of
alleviating poverty and environmental stress. Better access to doctors for
children

and their parents would improve prenatal and postnatal care and stave off
the stunting effects of childhood disease. 

None of these policies treat body size as an end in itself. We would never
just prescribe growth hormones and bariatric surgery to every child who
doesn't

fit a tall, slender mold. Obesity and shortness are society-wide
measurements, not reflections of individual virtue or good health. To that
end, our goal

should be to improve the quality of life for children. If we can manage
that, they just might end up a little taller - and thinner too. 

Daniel Engber is a senior editor at Slate. 

A version of this article appeared in print on October 18, 2009, on page
MM23 of the New York edition.   

http://www.nytimes.com/2009/10/18/magazine/18fob-essay-t.html?_r=1&partner=r
ss&emc=rss&pagewanted=all

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