Big in the Big Apple

Visiting the States is always a learning experience. With the regime very much at the front of my mind - and how to possibly maintain it when spending a week in New York – I took particular interest in the country’s relationship with health.

America’s marketing machine is, of course, dominated by food and fitness. It has to be big and it has to be beautiful. Only here can I watch an advertisement for life-size cartwheel pizza (buy one, get the wagon free) followed by the latest pharmaceutical advances in slimming aids – complete with obligatory verbal small print (“side effects may include nausea, irritability...suicidal tendencies and even death. Please consult a physician if you experience any abnormal symptoms”).

The fitness industry is burgeoning. It employs over half a billion people, and its $24 billion in revenues last year surpassed the GDP of 96 nations. Growth in online fitness services is particularly strong, evidenced, for example by John Stone’s exponential rise from personal blog to mega forum. My Manhattan hotel tv was hard-pedalling this package, that comes complete with its own pig-latin by prefixing every noun with ‘insane’: insane workouts to ‘dig deeper’ for that insane body. Digging deep seems to be the mantra here, and the manic adrenalin-glares of the showcase 'winners' do challenge the office platitude ‘you don’t have to be insane to work here...’

I made my contribution to the industry via the hotel gym, a newly refurbished suite of rooms direct from the set of the Starship Enterprise. Each machine was accompanied with a personal tv so I could monitor Congress’ objections to Obama’s health reform bill, punctuated by advertisements for ice cream and Texas burgers, whilst biking up a virtual Mont Blanc. One news feature that particularly caught my interest followed a new salmon breeding technique that claimed to produce fish twice the size in half the time. Asked whether we should be concerned about eating creatures raised in a soup of growth hormones, a biochemist replied, “we all exist in a wash of growth hormones, it’s just the quantities that are different” – how reassuring. This method is yet to be approved by the US regulatory authorities, but if given the green light, producers would not be obligated to indicate how the fish was raised. If it’s big, be concerned.

With big food come big bodies. America’s obesity rates (second, by proportion of population, only to Mexico) are renowned. Some 70% of the population is overweight (defined by BMI), and the prevalence of obesity exceeds 30% across most age and sex groups. Interestingly, smoothed frequency distributions suggest that rapid increases in obesity rates are slowing. But they also show you're more likely to bump into someone with grade 3 obesity (BMI>40) than spy an underweight waif (BMI<18).   

  

Flagel et al 2010, Prevalence and Trends in Obesity Among US Adults, 1999-2008

But that also partly depends on where you are. Mississippi has topped the state obesity rankings for the last five years, with rates of over 35%. It’s also been the poorest state for the last 5 years. In fact, cross-referencing against per capita state incomes reveals some stark correlations between obesity and poverty: the 8 fattest states are among the 10 poorest, with the remaining two just outside. This all links closely with ethnicity – you’re much more likely to be obese if you’re non-white (particularly non-Hispanic black). Will the economic crisis reverse the observed obesity slow-down? If so, the human and economic consequences may reach far further than is currently being estimated.

These regional differences are perhaps understandable, driven by historical patterns of economic growth and politics of ethnicity. More disturbing is how such patterns are replicated in the microcosm of New York City. Walking around Manhattan everyone seemed in pretty good shape. This reflects recent research that finds the more affluent areas, such as Upper East Side, Chelsea and West Village, with low obesity rates – around 8%. By contrast, several poor neighbourhoods such as East Harlem and the Bronx suffer rates over 30%. Limited health and fitness facilities together with a narrow range of food outlets have been suggested as one reason for the difference – independent of age, race and education levels. But perhaps it’s more of a downward cycle: healthy food comes at a premium in the US, and such companies are going to follow the money. I wonder how the density of M&S food outlets in Glasgow compares with Chelsea?