A recent article in the Washington Post, by Joel Achenbach, came sliding across my feed, interesting (pathologically) because it is backing up with data one of the predictions I’ve made regarding the appalling state of our overall health. That prediction is that our awful diet that excludes saturated fats, and gives a pass to sugar and refined carbs, is combining with epigenetic preloading of insulin resistance and driving obesity in our young people. This earlier expression of insulin resistance, leads to earlier onset of Type II diabetes, and the incumbent Western diseases that flow from that. And that will lead to an increase in All-Cause mortality at younger and younger ages, leading to an enormous public health crisis.

From the article:

The report, published in the Journal of the American Medical Association, was immediately hailed by outside researchers for its comprehensive treatment of a still-enigmatic trend: the reversal of historical patterns in longevity.

Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people age 25 to 64, who should be in the prime of their lives. In contrast, other wealthy nations have generally experienced continued progress in extending longevity. Although earlier research emphasized rising mortality among non-Hispanic whites in the United States, the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people age 25 to 34.

The scientist in me, ever-cautious (really — I know I am fond of far-reaching predictions, but my brain has been trained!) wants to wait for more data. But the systems thinker in me finds all this shocking. According to the article, 1/3 of the accelerated deaths are in a handful of states — Ohio, Indiana, Kentucky and Pennsylvania. One can look at the obesity maps from the CDC and see that the states affected are almost in the bullseye, though there are other states with roughly equivalent obesity rates. Here’s the map.

From the article, it seems like there is little separation between the dark red states and the lighter red states anyway. Why would Ohio, Pennsylvania, Indiana and Kentucky be the worst for youth all-cause mortality? I’d venture that it’s the combo of stress and obesity that are really teaming up in the Midwest. If you’re fat and happy, or really, less stressed, that might provide some marginal differentiation. But when you can’t support yourself, and you’re a step away from homelessness, the cumulative effects just add up

Not surprisingly, it is dominant in working class people, while those with 4 year college degrees are less affected. According to the CDC website, obesity was highest for those with no college degree (~35%) while those with a college degree rang in ~25%. The university community, ever reaching for more dollars, want to claim responsibility for this benefit. I’d argue it IS true that someone with a college education very likely has access to better information on diet, as well as flexible employment potential. But I know for a fact we don’t teach nutrition to all our students at most universities, and if we did, it would very likely be the messed up, low-fat version still prevalent in the nutrition community.

And then there are articles like this one, in the Chronicle for Higher Education, portraying the situation in the impoverished Bootheel of Missouri, that are deeply depressing. They push a narrative that we need more classical education, rather than job training for skills enhancement, customized for the area. What’s really wild is the documentation, through photos, of the obesity and incumbent diabetes crisis. Though obesity is not even discussed, almost all the photos included in the article show people who are morbidly obese. The kicker is the one healthy person in the story resisted his doctor’s advice and put himself on a de facto ketogenic diet. Nothing in this story really points to higher ed. as the answer to any of the immediate problems these people are having.

The Washington Post article highlights a comment by Prof. Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice on the report. The report reveals a broad erosion in health, with no single “smoking gun.”

“There’s something more fundamental about how people are feeling at some level — whether it’s economic, whether it’s stress, whether it’s deterioration of family,” she said. “People are feeling worse about themselves and their futures, and that’s leading them to do things that are self-destructive and not promoting health.”

I’m inclined to cut her some slack for the moralizing, but it still presents the issue as one of moral fiber, instead of a profoundly unhealthy environment. And guns have multiple parts, Prof. Meara.

The article does go on to show a modestly more empathetic view from others inside the academy. Princeton professors Anne Case and Angus Deaton, whose prior research on the issue highlighted increased suicide rates in these areas, characterized the areas as “a sea of despair.” That seems more apropos.

When I originally read this piece, I definitely filled in the blanks with a more contemptuous view of the academics consulted in the piece. Upon re-reading, they are getting some of it right. The viewpoints offered are still siloed, but there is acknowledgement that at least the dominant symptoms are driving all-cause mortality. Prof. S. Jay Olshansky, a professor of public health at the University of Illinois at Chicago, noted the rise in obesity rates among young people, and also said that there would be long-term repercussions. So there is a gradual waking-up that is happening .

But still precious little systems thinking is going on. Each of the experts are on their island in Intellectual Flatland, and aren’t inclined to speculate. I get that — they have professional reputations on the line, and the social structure of the academy, as I’ve written about over and over, is about cautious reliability. And you can’t really tell if the journalist writing the piece knows a lot about the downstream/causal effects of stress and obesity.

Even the basic concept of diet as a metabolic destabilizer — the real phenomenon going on here — is not understood. It’s not surprising. We still count food in terms of meaningless calories, instead of the most powerful medicine we ingest regularly into our systems. The problem with the whole issue of metabolic destabilization is that it drives diseases that are well-recognized, like cancer, with their own pathologies and entire industries set up to treat. Few scientists or physicians are talking about how to prevent cancer in the first place. It’s not that these people are evil — with rare exception (like cigarette smoking) the causal thought just doesn’t occur to them. Like the AIDS virus that destabilized its victims’ immune systems, leading to contracting all sorts of diseases one normally has resistance to, metabolic destabilization runs under the surface of the epidemic. Out of sight, out of mind.

And that, dear readers, is a function of the social structure that is investigating the problem. Medical and dietary research organizations are just not set up to investigate root cause.

While we walk around seemingly perplexed, but safe from an information reliability point of view, stress, obesity, and the insulin resistance that affects it, are locked in a deadly statistical positive feedback loop. We can never run an experiment that can capture with empirical data more than a small snapshot of data. Empiricism is simply not the way to solve this problem — no matter how large the data set.

What is the way to understand this is to posit causal mechanisms, look at case studies, and reward people who look broadly across multiple fields and engage in debate. That is going to require quite a different research organization than currently exists — as well as researchers with broader empathy who can make the complex connections required.

And yeah — there’s probably some of my own confirmation bias in that approach — which is what I do in this piece, linking diet and a growth in authoritarianism. What’s interesting is the author links this to political outcomes as well. The states most affected are swing states looking for reversals of their fortunes, because their people are suffering.

The point of all this is still the same. We better get with dietary modification fast. I thought that it would take until the 2030s to really see some effect. As the data shows, I was wrong. The bell is tolling now. There is no happy note to end this on, either. There is a Perfect Storm scenario in all this that no one is discussing. And it’s this –if younger person effects of all-cause mortality get coupled with the other crisis happening on the other end of the age spectrum — Alzheimers Disease, which some have called Type III diabetes– we will have a compounding civilization-altering event.