First-hand experience with Chinese air, pro and con

Following this item yesterday, about this article in the current issue on the health effects of living in China, good-news and bad-news reports from American friends with long experience in Asia.

First, the bad news.

"I check the BeijingAir Twitter every time I'm headed there for work. I thought I'd report an anecdote from a friend who has worked in China since the 1970s and lived there for many years (though moved back partly to raise children in a more healthy environment!). She had MRIs performed on her lungs some time ago and they indicated significant scarring and other damage, despite the fact that she has never been a smoker. She has never complained of any symptoms or health problems but clearly some damage was done."

FWIW, I heard similar stories from a variety of people who had been in and out of China since the 1980s, but I don't know of any systematic data. Maybe I'll have another data point two weeks from now, when my appointment with my own doctor for a welcome-home physical exam finally rolls around. Only has taken three months to get on his schedule! Good thing we don't have Canadian-style socialized medicine in this country, what with its long waiting lists and rationing-by-delay etc.

Now, the better news:

"We were back in China for a couple of weeks this past summer to visit my former students in Beijing and then to travel in Hunan for a week or so.  I think the air has improved.  It was mostly blue skies, even in Beijing, which I rarely saw when we lived there for 10 months in 2003-04.  I think you are right to conclude that expats do get over the problems once they leave.  At least we haven't had lasting health problems -- at least not yet."

As a side note, based on my experience anyone who wants to visit Beijing in particular should go in October. Even though the current BeijingAir Twitter reading is deep into the "unhealthy" zone, this seems reliably the nicest time of the year.

Festival of links, part 1

Before an impending "real," as opposed to false-alarm, absence from this site for a while, because of impending "real" writing, a variety of links about things I've meant to mention. Two now, two or three later in the day.

- Everyone on the China-media beat is aware of the turmoil at Caijing, a unique and important magazine in China. The title means "Finance and Economics"; an English site is here. (Disclosure: one of my sons worked there right out of college, during the SARS epidemic, and I know many of the staff.) Caijing has become a powerhouse in both the business and the journalistic sense. It publishes thick issues and holds big, influential conferences -- but it has also been a crucial leader in real business/financial reporting and exposes of financial chicanery, corruption, pollution, and other topics usually hard for the Chinese press to cover. Evan Osnos, who wrote a New Yorker profile of the founder and sparkplug of the magazine, Hu Shuli, has an update on the turmoil here. Other info from the FT here, from the AP here, from the WSJ (subscription wall) here, from the Guardian here, from the NYT here, and from Yahoo news here. None of this is good news.

- In their respective parts of the Atlantic's site, my colleagues Corby Kummer and Megan McArdle make opposite cases about the effects of New York City's calorie-labeling law. McArdle says it hasn't done any good; Kummer argues that it has already done something and, over time, will undoubtedly do much more. Read and judge for yourself, but one part of Kummer's argument seems obviously true and worth underscoring. He stresses (as did the authors of the original study) that calorie labels -- like mileage labels on cars or electric-consumption labels on appliances -- can make a difference even if customers don't think they're paying attention to them. As the original study said:

"Calorie labeling could result in changes that do not rely primarily on alterations in consumers' food choices. Menu labeling regulations may encourage chain restaurants to offer more nutritious or otherwise improved menu offerings, which could be profoundly influential. [italics Kummer's] Public health experts have shown that creating "default" incentives to improve well-being is essential to improving public health. By indirectly influencing restaurants to offer more lower-calorie items, menu labeling regulations could help encourage such default options for consumers."

As Kummer added:

"Yuppie avatar Starbucks immediately changed its default milk from whole to 2 percent, so it wouldn't have to admit that a Frappuccino could amount to practically as many calories as you should eat in a whole day... Just this week, [a NYC official] told me... Burger King began a new ad campaign telling how customers could eat a full meal for 650 calories or less. McDonalds took .7 ounces and 70 calories out of its standard portion of french fries. Dunkin Donuts introduced an egg-white breakfast. KFC put grilled skinless chicken on its menu--not something anyone expected to see at KFC."

Again, decide for yourself, but this corresponds to effects I've seen in other areas over the years. Labeling and disclosure in itself has an influence, in encouraging organizations to offer more of what they think will look "good" and less of what looks "bad."

Emptying the obesity-and-class mailbag

I will say goodbye for now to this topic, which began with an offhand mention that America didn't seem as fat as I "expected" after three years away. An unprecedented amount of mail came in; below and after the jump, samples of some of the themes I hadn't previously gotten to. Thanks for the responses.

Eating as an available pleasure. From a reader in South Dakota:

"An overlooked connection between obesity and class, I believe, stems from varying quantity of personal enjoyment and anticipation of enjoyment.

"It is one thing for a successful, financially comfortable, socially accepted and respected person who has multiple things happening every day that are pleasurable (golf, driving a nice car, nice home, stylish clothing, success at work, interesting social events, kids doing well, planning vacations, etc) to take just one pleasurable aspect of life (overeating) and sacrifice some of that pleasure for the good result of losing weight.

"Now, for people struggling financially and socially, trying to just get through the day and keep their lives together to varying degrees...their meals are often the only consistently happy and pleasurable events they can count on each day. 

"Obviously, a generalization.  But, if one gets up and faces a day with a tedious and unfulfilling job, not much money to spend on anything but necessities, and no "fun" things ahead, how much more difficult it is for that person to also think ahead to a day of denying themselves the pleasure of their mealtimes...."

The processed-food factor:

"I was quite surprised to note the glaring lack of an obvious contributing major factor in your recent post on obesity: processed foods.

"I was first struck by the weight of this factor (pun intended) during a trip to Buenos Aires a couple of years ago. During my stay, I was absolutely astonished to find such a small percentage of fat people given that:

"a) the per-capita consumption of meat (in Argentina) is the highest in the world.

Continue reading "Emptying the obesity-and-class mailbag" »

A whole bunch more on obesity theories

After the jump, an American-style cornucopia of observations and theories about which Americans are overweight and why. I have been fascinated to read this mail and am trying to share some of the most interesting or representative parts.

First, why med students aren't fat, from a fourth-year med student from Indiana:

"1)  From what I've seen, class is a massive factor when it comes to obesity.  For us, it's actually frighteningly easy to quantify class when seeing patients -- we rotate through 4 different hospitals here and the term "Wishard Patient" is a well worn code among students/doctors/nurses/etc.  Typically, it's used in the context of trauma (gun and knife club) but it's depressing how routine it is to see diabetic patients 50/100/150 lbs overweight in the populations that can least afford care.  When working in a clinic for the local indigent population I saw a whole family where I'm certain every member was at least 100 lbs overweight, and a 14 year old girl already weighed over 250 lbs.

2)  For some reason, there are very few fat medical students or residents.  Undoubtedly some of this is class, but the number of overweight students is too low to be attributed solely to that.  This actually kind of surprised me, because I've known my share of fat doctors.  My dad was a physician and could have stood to lose 30-40 lbs for most of his life...  But I'm constantly amazed at how fit my class is.  I can think of maybe 5 people I'd call "overweight" (let alone obese) in a class of 280.  I probably work out less than the mean, and I'm 6'2, 200 lbs, lift/run sporadically but play tennis once a week minimum.  I have friends who literally look like they can bench press trucks.  Some people just never NOT go to the gym, even on their most brutal rotations (sometimes that can mean 100+ hour weeks).  That's really inspiring to me. 

"But the moral of the story is why that's the case?  Undoubtedly some of that is self selection, but I think a lot of it is that the medical hierarchy can be incredibly cruel to the overweight.  I suspect it's much harder than an overweight candidate all else being equal to get admitted to medical school to get admitted (maybe even relative to other professional schools or graduate schools).  I've seen superiors (staff, residents) just blatantly insult the weight of subordinates -- what comes to mind in particular is a staff physician constantly berating an extremely overweight resident to his face.  And honestly, I sometimes wonder how patients would react to an obese physician -- is it tough to tell someone to quit smoking when you're a 100 pounds overweight?  I'm not sure."

Are cars the problem,  or suburbs? A view from Austria:

"Interesting last post about the perils of car culture. I think it's dead on, but I wanted to emphasize that it's not just cities that come out looking good. The lesson is closer to, it's suburbs that are bad.

Continue reading "A whole bunch more on obesity theories" »

Obesity and politics

A reader notes the thematic resemblance between two maps. First, the famous NYT map showing the counties that voted more Republican in the 2008 presidential election than in 2004. The areas in red show where Barack Obama, while winning nationally, got less of the vote than John Kerry did while losing.


What this means, if anything, is hard to say, because of the state-versus-county difference in scale and other anomalies. Still, it's interesting. The reader says:

"You brought up the voting map, but even before I saw your mention of it, it struck me that the obesity/median income map strongly resembled maps that showed percentages of people voting for McCain and Obama. There is a V, with its bottom point in Arkansas and extending an arm NE to West Virginia and NW to Montana, that covers both McCain voters and the poor-and-fat. So the GOP is not just the natural home now of evangelical whites but also the disproportionatlely poor and heavy? Wow. That's a lot of cultural signifiers for rednecks conservatives all rolled up into one.."

Here, also from the NYT, is a map of the states McCain actually carried, showing the reach up toward Montana.

Obesity and class: the "hotness" factor

An additional view on the relationship among education, income, and weight:

"I am currently enrolled in an MBA program in a large city in the South.  On the weekends, I drive 80 miles and work as a paramedic for 48 straight hours for an emergency medical service that covers a bunch of rural small towns.  I am about 50 pounds over my ideal weight.  In my classes and in my neighborhood, which is very "creative class," my weight is definitely irregular.  In a b-school class of 50 or a full trendy neighborhood restaurant, there might be one other person who is more than 20 pounds overweight.  In the more rural area where I work, however, I'm damn close to the median.

"A couple of thoughts:
"1. Very broadly, American culture trends to stereotype those who get good grades as unathletic nerds.  Might be true in engineering, computer sciene and the natural sciences.  But in the professional classes, the same people I went to school with who had the discipline to put in the study time necessary to get into the good law schools, med schools or grab the investment banking or management consulting jobs also had the willpower to put in the time at the gym.  I'd bet that many current 22-year-olds would consider maintaining or obtaining "hotness" as as important as career success.  D.C. is full of these types of successful grads of good schools.

"2. Car culture is terrible for public health.  Again, I'm significantly overweight.  Always trying new exercise and diet programs that never result in sustained weight loss.  What has?  Spent two months in London without car, relying on public transit and walking, no attempt at dieting or exercising.  Weight loss: 22 lbs. Six weeks in NYC without car, relying on public transit and walking, no attempt...  Weight loss: 19 lbs.  D.C. also benefits from this.

"I had a friend from my paramedic job come visit me in the city a couple months back and bring his brother and a few of his brother's friends, who all work physically demanding construction jobs.  The construction guys, who are all stocky but in various stages of growing beer guts, somehow got into a fight with this group of guys who were built like lumberjacks.  It was a draw.  I later found out that the lumberjack guys were all "Big 4" accountants - CPAs who somehow had better arms and fitness levels than those who actually used their bodies for a living."

More in the queue.

From Sudan, the Arctic, Shanghai: last takes on obesity

... at least for a while. Previously here, and with backward-reaching links here. Today's themes:

Role of psychological factors, beyond class and geography:

"Earlier this year, I spent a month in Southern Sudan. Returning to the US has many culture shocks - overpowering media environment being one. But the most striking was the preponderence not only of obese people, but people of all classes who were clearly overweight.

"I live in Rochester, upstate NY which I consider a small midwestern city. The class lines referred to in your post are easily visible and confirmed. But I'd add one other possible obesity factor that likely traverses class lines: depression. No data, but I would guess that people who are depressed or anxious most often turn to food to soothe those beasts. Perhaps there's also a subtle factor of reaction to our Calvinist, repressive cultural history when it comes to sensual pleasure; food is allowed."

The Eskimo angle:

"I live in a predominantly Yup'ik Eskimo part of the world, where education levels are typically lower and the consumption of junk food has led to rapidly increasing rates of diabetes.Overweight and obese are the norm here, and not just among Yup'iks....

"Another indicator from here: the used-clothes boutique has literally tens of feet of rack space for large, large clothes, about one foot or less for what one would consider small sizes.A doctor friend says the medical community has to redefine normal, since official normal does not represent most people...

"I recently took a trip to Kansas City - which appears periodically in those lists generated somewhere of most-obese cities - and was struck by how few overweight people I was seeing. In fact, it was notable to me how fit most people looked, whereas here it is just the opposite. I was surprised."

From a British friend in Shanghai:

"I'm not surprised you are surprised not to see so many obese people. The world is enjoying the conversation about an 'obesity epidemic' and technically America tops the scales which gives the rest of us a chance to enjoy a seeming superiority. Whether or not that situation has changed in America and whether or not the situation for the rest of us has changed (in Europe, China or wherever getting fatter) doesn't matter. It's become a truism that Americans are fatter in greater numbers. This belief is held on to by both a) foreigners who like to have a dig at the US whenever we get a chance and b) ex-pat Americans who take the ex-pat view of all ex-pats that the country they come from has gone to the dogs since they left it. As you've been mixing with both foreigners and ex-pat Americans for several years in China you've probably let your guard down a bit and allowed it all to seep into your consciousness as it sort of seems right. Therefore when you return and are re-immersed in American life your unconscious assumption made while overseas is challenged.

"Or, maybe you just need glasses!

"Seriously though, it is interesting how many myths, stereotypes and assumptions you make about your own society while out of it for even a relatively short time.

"Therefore the question is not really what happened to America's weight, good or bad, but what happened to James Fallows while he was away!"

Ah, that last line opens up some questions that reach far beyond the obesity theme...  For now I'll say that I will return shortly to the ever-pressing boiled frog and slippery slope debates. And I will add, after yesterday's set of obesity maps, that a wonderful site for visualized data in general is FlowingData.com -- eg with this set of charts about making sense of flight delays. Nothing to do with body weight but interesting nonetheless. Thanks to Parker Donham for this lead.

More on obesity, geography, and class

Gary Chapman, of the University of Texas, has created this way of envisioning the relationship between income and obesity. Concept: the shading varies with the obesity rate divided by median household income. This is a not-immediately-obvious way to present the data, in order to highlight one particular phenomenon: The darker the shade, the likelier you are to find people who are both poor and obese. Map created via Datamasher.org.

Continue reading "More on obesity, geography, and class" »

Weight, class, and Wal-Mart

From a friend in Boston, a note that gives an extended version of a theme in many responses I've received. Background here and here. Charts and data on this point shortly. The argument here -- that, along with smoking, obesity has become a class-bound marker and problem in America -- is hardly surprising, but the power of the connection is what many people emphasize.

"i wonder if your seeing fewer overweight people than you expected when you got back to the states might be, at least in part, a function of class. this is a point i'm somewhat uncomfortable making, but it shouldn't be ignored. people who, just as a for instance, run and listen to npr and read (not to mention write for) the atlantic are both likelier to be fit and likelier to associate with people of the same ilk. (as a nation, we've not only gotten fatter but also, as you know, much less likely to mix with people who don't share our educational or cultural background.)

"i remember walking  through harvard yard back in 1986 during the university's celebration of its 350th anniversary. the place was awash in alums, and there was something noticeably different about most of these people. it wasn't that they were expensively dressed or looked like preppies, i realized. it's that almost everyone was so *trim.* none of  these people would likely be found shopping in wal-mart, where waistlines look a lot different.

"as an aside: i've long thought it would be an interesting commentary on the stratification in this society to have political candidates asked during a debate if they'd ever shopped at a wal-mart. i have to think that very few could honestly answer yes--and the higher the office the fewer the yeses. to think that a democracy's leadership class should  have no connection (other than owning stock--or, in hillary clinton's case, being once on its board) to the biggest corporation in the country, how strange! back when the biggest corporation was gm or exxon, even the wealthiest people likely had *some* dealings with it, even only being chauffered in a cadillac."

To answer the last question: I'm not a political candidate, but I have not only shopped in W-Ms around the US but have also been to many outlets inside China. That's a story on its own -- the one in Shanghai has whole pig carcasses suspended by hooks right inside the front door, and tanks full of live carp, which the shopper-housewives let flop around on the floor to see which ones look best for the evening's dinner. No one will ever convince me that W-M doesn't know how to globalize/localize.

But I digress. To sharpen my friend's question: a candidate should be asked when was the most recent time he or she enjoyed Every Day Low Prices.