Medical Anthropology (ANG 6737)

A few weeks ago, we discussed a paper published in 2005 showing that people who are defined as overweight (BMI of 25-<30) actually have the lowest risk of mortality. Today, a new paper sheds more light on the association between BMI and mortality by looking at specific causes of death.

It turns out that people who are officially defined as overweight have a lower overall risk of mortality because they are less likely to die from diseases like Alzheimer’s, infections, and lung disease. At the same time, being overweight (but not obese) does not appear significantly to increase the risk of dying from cancer or heart disease.

In a New York Times story about this paper, several observers echoed some of our discussion in class:

Some who studied the relation between weight and health said the nation might want to reconsider what are ideal weights.

“If we use the criteria of mortality, then the term ‘overweight’ is a misnomer,” said Daniel McGee, professor of statistics at Florida State University.

“I believe the data,” said Dr. Elizabeth Barrett-Connor, a professor of family and preventive medicine at the University of California, San Diego. A body mass index of 25 to 30, the so-called overweight range, “may be optimal,” she said.

But as some of you suggested in class, mortality isn’t the only relevant outcome. Others argue that people who are overweight are more likely to develop heart disease, diabetes, and other conditions even if they are not more likely to die prematurely as a result.

On that note, another paper in today’s issue of JAMA examined self-reports of disability among people of varying weights at two points in time. They show that people defined as obese (BMI ? 30) are more likely to be disabled and that the disability gap between people in the obese and normal-weight categories has increased over time. But this finding appears to hold only for the obese category. People with BMIs in the range of 25-30—officially overweight—do not report higher levels of disability.

Causes of Death Are Linked to a Person’s Weight – New York Times

Earlier this month, Paul Farmer delivered a keynote address at the Heller School for Social Policy and Management at Brandeis University. The Heller School has posted a video of Farmer’s speech online, so you can see it too.

The talk focuses on the policy implications of global inequities in health. You will recognize the core arguments from our discussion of Infections and Inequalities, but the examples and evidence come largely from Farmer’s work since that book was published. (Those of you who attended Tracy Kidder’s talk two weeks ago will also recognize some of the photos.)

The best part, if you ask me, is the question and answer period — so hang in there through the end. What aspects of the talk do you find most compelling? In what ways does Farmer draw on his training in anthropology, not just in medicine?

Paul Farmer keynote address at the Heller School

In class this week, we briefly discussed the recent paper by Lauderdale and colleagues, which compared rates of preterm delivery for all births in California during six months before and after September 11, 2001. For women with Arabic names — and only for women with Arabic names — the risk of having a low birth weight baby increased 34% in the six months after 9/11.

Now, a new paper in the journal Human Reproduction reports that the trauma of September 11 also had an impact on the distribution of birthweight in New York City. Eskenazi and colleagues analyzed birth certificate data for all births in NYC and in upstate New York between January 1996 and December 2002. They found an increase in the number of babies born with low birth weights in the week following Sept. 11 in NYC, but not in upstate New York. They also found an increased risk of low birthweight for infants born around the New Year and for those born 33-36 weeks after Sept. 11. The first group would have been in the first or second trimester of gestation on Sept. 11; the second would have been conceived on or around Sept. 11.

The authors interpret these patterns in terms of the stress process. For women living in NYC, the World Trade Center disaster would have been a particularly traumatic event. The physiological response to such an acute stressor may have led to early birth and lower birthweight for some infants. Eskenazi and colleagues are not able to test the hypothesis thoroughly, because they did not have access to high quality data on gestational age. But in the context of other work on the stress process and pregnancy outcomes, the hypothesis is certainly plausible.

Of course, the acute trauma of September 11 is altogether different from the chronic stressors of everyday life. What significance do you think this new study has for our understanding of social inequalities in birth outcomes?

Romantic relationships can fill you with happiness, but these same relationships can also be a significant source of stress in daily life. The results of a new study, recently published in the Archives of Internal Medicine, suggest that relationship difficulties can quite literally break your heart.

In examining data from a long-term cohort study of British civil servants, the authors find that negative interactions in close relationships increase risk for incident coronary heart disease. This relationship exists even when controlling for sociodemographic characteristics, biological and psychosocial factors, and health-related behaviors. The results suggest that negative interactions are more likely to occur in women and lower-income civil servants; however, negative interactions produce similar effects on heart disease regardless of sex or social position.

Does this interaction seem to you like a human universal, a product of our shared evolutionary heritage? Or is this more likely the product of Western society? In light of your recent readings on the interaction of stress, human biology, and culture, how might we examine Western notions of romantic love and the meaning of negative interactions in a cross-cultural comparison to explore these questions?

Thanks to David for bringing my attention to this story about the politics of climate change and health. Yesterday Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention (CDC), testified before the Senate Environment and Public Works Committee. She reportedly told Senators that climate change “is anticipated to have a broad range of impacts on the health of Americans.” But the written testimony she entered into the record contains few details to support that claim. According to the Associated Press, here’s why:

The White House significantly edited testimony prepared for a Senate hearing on the impact of climate change on health, deleting key portions citing diseases that could flourish in a warmer climate, documents obtained by The Associated Press showed Wednesday.

The White House on Wednesday denied that it had “watered down” the congressional testimony that Dr. Julie Gerberding, director of Centers for Disease Control and Prevention, had given the day before to the Senate Environment and Public Works Committee.

But a draft of the testimony submitted for White House review shows that six pages of details about specific disease and other health problems that might flourish if the Earth warms were not delivered at the hearing.

In a Wall Street Journal report, Dr. Gerberding denies that the White House diluted her testimony, calling such allegations “ridiculous.” It’s hard to know what really happened, but at least the media coverage of this controversy highlights the political context of scientific debates.

The New York Times recently ran an article describing a U.S. Department of Defense program that embeds groups of anthropologists and other social scientists with combat brigades deployed to Afghanistan and Iraq. This article suggests that combat operations, and civilian casualties, have dramatically decreased since the arrival of anthropologists, leaving the military more time for security, peacekeeping, and reconstruction efforts.

Anthropologists have always worked in some capacity with the U.S. government, which has led to numerous ethical crises within the discipline in the last century. Franz Boas, considered a founder of American anthropology, was famously censured by the American Anthropological Association for writing a letter to political journal The Nation in 1919 exposing the spying activities of anthropologists in the field. Anthropologist David Price describes the story behind Boas’s censure, anthropology’s role in the history of American intelligence activities, and the state of contemporary anthropological ethics on this matter.

However, the anthropologists described in the New York Times piece are presumably not pretending to conduct research while actually spying for clandestine services. The article describes some of the ways that anthropologists have contributed to military goals by investigating the problems (poverty, land disputes) facing communities caught in a war zone.

What are the ethical decisions related to working under the aegis of U.S. Army brigades in a combat environment? What if your training contributes to the death and injury of others, but contributes to the military’s success? What if your insights are responsible for decreasing the need for combat operations? How might medical anthropology serve the good of all in a war zone?

You may have noticed that activity on the blog has been fairly sparse. That’s not due to any shortage of issues related to medical anthropology in the news. Rather, it’s mainly because I’ve been busy with other things—like grading your essay exams.

So today I’m happy to introduce a new contributor to the blog, Brian Tyler. Brian is a doctoral student in anthropology. His dissertation research focuses on culture, trauma, and health in contemporary Guatemala. As he puts it:

Researchers across disciplines recognize that exposure to traumatic events can have serious consequences to both biological and psychological health. My research explores the sociocultural correlates of psychosocial stress and health, the nature of social suffering following decades of civil war, and the cultural mediation of individual and collective response to war-related traumatic experience. I am particularly interested in the social and cultural factors that mediate the impact of traumatic experience on individual mental and physical health outcomes.

Given these interests, it is fitting that Brian’s first post deals with the current controversy over the role of anthropologists in the U.S. military. In what’s left of the semester, you can look forward to hearing more from Brian about new research and current events related to the themes of the course.

Via the Well blog at the New York Times, I just learned about the Illustrated BMI Categories Project on Flickr. As of today, the Flickr photoset includes photographs of 80 women, along with their height, weight, and BMI category, based on CDC guidelines (I haven’t verified the BMI calculations). Do the CDC categories fit your idea of who is overweight or obese? And what do you make of the fact that only women are featured in the photos?

Be sure to check out the comments on the original post at the Well blog, too. They give you a good sense of how people react to controversy over the meaning of BMI.

A few weeks ago in class, I recommended Zotero, a free tool for managing references and producing bibliographies. Yesterday, Inside Higher Ed published a detailed review of Zotero that will help you decide if it’s right for you. The best part about the review is that the author, Scott McLemee, is a self-proclaimed newbie with no particular technical expertise. He identifies the key strengths and weaknesses of Zotero and gives a good sense for how you would get started using it.

Whether it’s Zotero or something else, I encourage you to develop a system for managing references. It will save you time and headaches later on.

Yesterday we discussed the question that Wayt Gibbs posed in a recent issue of Scientific American: Is obesity an overblown epidemic? This question is also the focus of a three-part debate that took place last week in the Los Angeles Times. The LA Times pits Kelly D. Brownell, a professor of psychology and public health at Yale, against Paul F. Campos, a professor of law at the University of Colorado. Campos is featured in the Gibbs article you read, too.

This debate has also played out recently in the scholarly literature. For example, see the series of point and counterpoint articles in the February 2006 issue of the International Journal of Epidemiology. What do you make of this debate?