Diseases of Modern Life Flashcards
1
Q
A. Kleinman: disease vs illness
Timmermann, C., ‘Chronic Disease and Illness History
A
‘illness’ is the experience
‘disease’ is an ‘identifiable entity’
2
Q
Chronic diseases in the longue duree
Timmermann, C., ‘Chronic Disease and Illness History
A
- ‘chronic, incurable illness, leading to slow but apparently inevitable deaths, has a history that long precedes the twentieth century and has been blamed on civilisation by many past commentators’
3
Q
How were chronic diseases viewed in the immediate post-war?
Timmermann, C., ‘Chronic Disease and Illness History
A
- synonymous with non-communicable
- preceded by long, symptom free periods, even dormancy, and triggered by various forms of stress
- similar to consumption
4
Q
Susan Sontag on parallels between consumption, TB and cancer?
Timmermann, C., ‘Chronic Disease and Illness History
A
- Consumption ‘not a distinct disease entity’ as it was not exclusively TB, and sometimes other conditions were labelled consumption, too. Sometimes scurvy, cancer
- Susan Sontag, Illness as Metaphor
5
Q
Parallels between consumption ajd AIDS?
Timmermann, C., ‘Chronic Disease and Illness History
A
‘Chronic illness signalled a weak constitution irreparably damaged by a life lived
carelessly or under unfavourable conditions’
6
Q
Case study: Dropsy
Evidence of changing diagnosis
Timmermann, C., ‘Chronic Disease and Illness History
A
- associated with cold and heavy drinking, caused fluid buildup
- like consumption, diagnosis based on symptom manifestation, causes found in biography/lifestyle
- Richard Bright (1789-1858)’s urine test meant patients could be diagnosed with ‘Bright’s Disease’ with no symptoms
- Triumph for pathological anatomy
7
Q
Case Study: Diabetes
A Modern disease, but why?
Timmermann, C., ‘Chronic Disease and Illness History
A
- outlook for Diabetes patients changed with isolation of the insulin hormone in 1921 - a triumph for experimental physiology
- Insulin was isolated in Toronto in 1921, and was medically available in Britain in 1923
- not a cure, but made diabetes manageable
- became ‘a model for the long-term management of other conditions being identified as chronic diseases.’
8
Q
TB in the 20th century
Timmermann, C., ‘Chronic Disease and Illness History
A
- ‘remained a chronic, incurable disease until the mid 20th century’
- Had declined in incidence by 1950s (Mckeown controversy)
9
Q
Mortality and morbidity in 20th century Britain
Timmermann, C., ‘Chronic Disease and Illness History
A
- Deaths in childhood/adolescence had declined rapidly
- More people living past middle age, so cancer, heart disease, stroke, become far more visible
- By 1950s, mortality rates for TB lower than cancer
- New fears (lung cancer, cardiovascular disease, hypertension, blood cholesterol)
- lung cancer sole contributor to increase in cancer deaths: work by R. Doll (1912-2005) and A. B. Hill (1897-1991)
- Development of geriatrics as a specialism
10
Q
New conceptions of epidemiologic transitions in the modern world
Timmermann, C., ‘Chronic Disease and Illness History
A
J. Michael Gaziano, ‘Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity
J. Olshansky and A. B. Ault, ‘The Fourth Stage of the Epidemiologic Transition:
The Age of Delayed Degenerative Diseases’
11
Q
‘Diseases of civilisation’ - Roy Porter
Porter, R., ‘Diseases of Civilisation’
A
- ‘it has been a fact of history - at least until recent times -
that disease incidence runs in direct ratio to settlement density.’ - Excessive consumption of fine foods and alcohol, and lack of exercise combined to obstruct the nervous fibres, impeding communications between the brain, the vital organs, and the extremities, and leading to pains, inflammation, stoppage , and habitual sensations of lethargy and lassitude unknown
to strapping peasants.
12
Q
The development of theories of ‘modern’ diseases in the 19th century
A Socio-pathological view?
Porter, R., ‘Diseases of Civilisation’
A
The manifestations of insanity had traditionally been understood to be either supernatural in origin (visitations of God or the Devil) or essentially organic, provoked by an excess of black bile (melancholy), or yellow bile (choler), or by some brain defect. Now a socio-pathological account achieved popularity. Madness was increasingly seen as in the mind,
a disorder of the imagination or understanding.
It was, in other words,
psychological, and the realm of the psyche was viewed as being significantly
programmed by the ensemble of linguistic, literary, and intellectual signals in
cultural circulation (for example Methodism, Romanticism)
13
Q
Social Medicine
Porter, R., ‘Diseases of Civilisation’
A
- Epidemiology had to move
beyond the pathology laboratory and into society as a whole. - sickness trends were functions of social variables
such as class, income, status, occupation (or, commonly, unemployment),
family size, housing standards, educational achievement, and so forth. - life-styles and environments
(in one case, the pressures upon the business person; in the other, the
alienation of the young mother in run-down inner-city accommodation or on
the council estate).
—> what was psycho-socially triggered could not
adequately be treated by pharmaceutical or surgical interventions alone.
14
Q
Have infectious diseases been superseded by ‘modern diseases’?
Porter, R., ‘Diseases of Civilisation’
A
- as the airborne and water-home infections
classically associated with high-density living (typhoid, diphtheria, tuberculosis,
etc.) have been vanquished, new classes of diseases have gained in prominence:
cardiovascular disorders, degenerative conditions of the nervous system, hypertension, diabetes mellitus, cirrhosis of the liver, the cancers, Alzheimer's disease, depression, chronic fatigue syndrome
15
Q
Questions to challenge the notion of ‘diseases of modern life’
Porter, R., ‘Diseases of Civilisation’
A
Might not the apparent escalation of
these complaints largely be, in reality, an optical illusion?
Are not more
people dying today of disorders that their forebears never lived long enough to
contract?
Are not superior diagnostic techniques and more intense screening resulting in the showing-up of a far higher proportion of cancers and degenerative neurological conditions than could have been identified in earlier centuries?
16
Q
A few causes of diseases of modern life?
Porter, R., ‘Diseases of Civilisation’
A
atmospheric carcinogens, obesity,
cigarette moking, addictions,
17
Q
Diseases of modern life and class?
Porter, R., ‘Diseases of Civilisation’
A
it appears likely that today’s so-called diseases of civilization are not in any
straightforward sense the products of affluence, but rather diseases disproportionately afflicting the less privileged members of advanced societies. In
this light, it is highly significant that cancers, heart conditions, respiratory diseases, and so forth are rapidly worsening amongst the masses of the
Third World, evidently spread by industrial toxins, dietary dislocation, and by
cigarette smoking.
18
Q
Modern medicine as a ‘disease of modern life’ (?!)
Porter, R., ‘Diseases of Civilisation’
A
Ivan Illich, argues that modem medicine is one
of the prime diseases of civilization, not only spreading iatrogenic disorders,
but orchestrating a disabling ‘expropriation of health’. Illich has commended
the health and disease cultures of simpler times and peoples.
19
Q
Berridge on chronic diseases in modern Britain
A
‘The key to the new post-war public health would be a revised epidemiology which dealt with chronic rather than infectious disease’
20
Q
Berridge on ‘changing patterns of disease’
A
- The traditional focus on public health had been the outbreak of epidemic…but this pattern of disease and disease-related mortality began to change in the middle of the twentieth century.
- As the population lived longer, so non-infectious causes of death such as heart disease, strokes and cancer grew in importance.
21
Q
Decline of infectious diseases and its impact on death rates
A
1840s-1971, 75% of mortality rate reduction due to decline of infectious disease
22
Q
NEURASTHENIA
NEURASTHENIA: Who invented the term ‘neurasthenia’?
A
- George Beard, Boston Medical and Surgical Journal 1869
- ## Van Deusen also used the term that year
23
Q
NEURASTHENIA
Primary source: the fashionability of neurasthenia
A
- ‘everything could be explained by neurasthenia: suicide, decadent art, dress and adultery’
24
Q
NEURASTHENIA
What was neurasthenia?
A
- ‘a disease of the nervous system…characterised by enfeeblement of the nervous force.’
- ‘nervous exhaustion, characterised by undue fatigue and muscular weakness’
An exceptionally broad church:
1) male hysteria
2) chronic fatigue
3) depression
4) prototype and foundational for other diseases
25
NEURASTHENIA
The Social Paradigm of Neurasthenia
- overwork, nervous exhaustion
| - 'modern civilisation': 'wireless telegraphy, science, steam power, newspapers, the education of women'
26
NEURASTHENIA
Problems of measuring fatigue?
- 'It was doubted if neurasthenia really was 'a disease of modern life (Schofield, 1908)
- we had become more tender in our ills - Dubois, 1909
27
OBESITY
Why does obesity occur in the 21st century?
GILMAN
- we live longer, have less physically stressful occupations, and have easier access to food
- a mental illness on the spectrum with anorexia nervosa
- access to poor food
- addiction
- genetic: an 'ob-gene'
28
OBESITY?
Counter argument to premise that obesity is a disease of modern life: the ob-gene
GILMAN
Jeffrey M. Friedman discovered the ob-gene,
Working with a special strain of mice, he set out to identify the hormone that normal animals use to control their appetite - a molecule that was missing in the plump rodents. After eight years he found it
The OB gene encodes leptin, a hormone that inhibits hunger
29
OBESITY?
Counter argument to premise that obesity is a disease of modern life: anti-medicalisation
GILMAN
'One social product of the stigmatisation of the obese by the 1960s was the appearance of advocacy groups of overweight individuals who argued not only that their bodily status should not be stigmatised but also that they were happy and proud to be fat.'
NAAFA (1969): to 'eliminate discrimination based on body size'. Later splintered into offshoot groups
--> obesity 'a natural state or a disease process'?
30
OBESITY
Statistics on OBESITY in the uk now
GILMAN
- As of 2013, UK had the highest obesity level in Europe
- 24.5% of uk obesity
- By 2050, could be 50%
SOURCE: NHS Live well
- more commonly lower socioeconomic and socially disadvantaged
groups
31
OBESITY
Infectious obesity?
GILMAN
For all of the desire to stop the image of the obese being at fault for their own misery, the idea of infectobesity provided yet one more level to the anxiety about the obesity epidemic.
32
OBESITY:
Longue-duree perspective on Obesity:
A. V. Cornaro, Discorsa della vita sobria (1558)
GILMAN
- claims his gluttony 'kills every year'
- physicians encourage Cornaro to diet
was certainly ill with many of the diseases attributed to obesity in the Galenic tradition: “I had pains in the stomach, frequent pains in the side, symptoms of gout, and, still worse, a low fever that was almost continuous; but I suffered especially from disorder of the stomach, and from an unquenchable thirst.”3 But he also lost his ability to reject temp- tation, having become addicted to eating and drinking.
33
OBESITY
A history of weight monitoring from the renaissance to BMI
GILMAN
- S. Sanctorius (1561-1636): weigh body to promote losing excess weight
- 19th Century: Adolphe Quelet, ‘l’homme moyen’—average man—by the mean values of
measured variables having a normal distribution!
- Keys proposed in this 1972 article that the index
devised by Quetelet, the ratio of weight over height
squared, now be called the ‘body mass index’ (BMI)
34
Keys (BMI guy)'s attitudes to obesity
Commentary: Origins
and evolution of body mass
index (BMI): continuing saga
Henry Blackburn* and David Jacobs Jr†
GILMAN
He maintained that obesity was ‘ugly but does not itself cause CHD’,12 and was not necessarily dangerous
for mortality risk in the average working man in the
traditional populations we studied in mid century
- Writing around 1949-1950, aware of potential for obesity epidemic in affluent societies
35
OBESITY
Victorian attitudes to Obese women
GILMAN
In his 1897 book, The Female Offender, author Cesare Lombroso
“This greater weight among prostitutes is confirmed by the notorious fact of the obesity of those who grow old in their vile trade, and who gradually become positive monsters of adipose tissue.”
36
OBESITY
Victorian psychological attitudes to obesity
GILMAN
“Obesity always carries with it physical and often mental weakness…”
37
Obesity as a disease, or as a contributor to disease?
Obesity as a disease
Roland T Jung
The Diabetic Centre, Nineusells Hospital, Dundee, UK
Obesity is not just a health risk but a disease. Estimates of the genetic
contribution to weight gain in susceptible families range from 25—40%
Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the
disease category
Mortality rates affected, link with CHD
Associated with 45 diseases inc. gout, several cancers, heart disease, t2 diabetes
38
Etiology of obesity
Rippe, Crossley, Ringer, 'Obesity as a Chronic Disease'
'Obesity is a chronic disease with a multifactorial etiology including genetics, environment, metabolism, lifestyle, and behavioural components'
Treatments include lifestyle changes and medical interventions
39
How is obesity a chronic disease?
Rippe, Crossley, Ringer, 'Obesity as a Chronic Disease'
- Many cannot easily return/shift to a healthy weight
- For many the transition to being obese is very slow, over several years
- Many go through cycles, returning to a healthy weight before relapsing into obesity again
- Most effectively managed not just with intervention but with management: pharmaceutical, surgical, lifestyle changes
40
Lifestyle vs heredity?
- Probably 30-40% hereditability
- 'Clearly, genetic shifts represent an implausible argument for the recent dramatic surge in the prevelance of obesity. Lifestyle factors such as overconsumption of energy and decreases in physical activity offer more reasonable explanations.'
- food intake, esp. high fat, does contribute
- plentiful energy-dense food
41
Petrie, Wesseley, Modern worries, new technology, and medicine New technologies mean new health complaints
Modernity and illness?
Normal everyday
symptoms such as headache and fatigue are now
more easily interpreted as signs of disease or ill health.
Attributions made by patients about the cause of their
illness often involve environmental pollution, and they see the effects of modern life as undermining the effectiveness
of their immune system.
The rapid introduction of new technologies,
while improving the quality of life of millions of
people, has been accompanied by important adverse effects in the way people make sense of illness and present with health complaints.
42
Obesity: historical development of scientific and cultural ideas.
Author(s) : Bray, G. A.
Obesity as a modern idea?
It is concluded that most of the concepts which are the basis for research in obesity had their origin in the 19th century and often earlier.
43
Obesity in Ancient History
D. Haslam, The treatment of obesity: Past, present
and future
Obesity has existed ever since civilisation has
been recorded.
- The Venus of Hohle Fels, a crude statuette of a naked obese woman, is estimated
to be 35 000 years old
in 500 bc, the
ancient Indian surgeon Sushruta described
“obesity, voracity, gloss of the body, increased
soporific tendency and inclination for lounging
in bed or on cushion”
Avicenna, the great Persian physician, prescribed
an appetite suppressant for his obese patients
Hippocrates said, “Men who
are constitutionally very fat are more likely to
die quickly than those who are thin.” Galen of
Pergamon, physician to several Roman Emperors,
described the polysarkos phenotype, who “cannot
walk without sweating, cannot reach when sitting
at the table because of the mass of his stomach,
cannot breathe easily, cannot give birth, cannot
clean himself”
44
Early modern ideas of Obesity as an issue of willpower
Jean Anthelme Brillat-Savarin (1755–1826), The Physiology of Taste or, Meditations on Transcendental Gastronomy (1825)
“(Obesity) is not actually a disease, it is at least a most unpleasant state of ill health, and one into which we almost always fall because of our own fault.”
45
Railway spine: diseases of modern technology
Caplan, E. 'Trains, Brains, and Sprains: Railway Spine and the Origins of Psychoneuroses'
- Railway spine: paralysis, headaches, other ailments, following traumatic high-speed rail crash
- First materialistic (spine)
- Psychological (hysteria/neurasthenia)
Erichsen (1866): 'concussion of the spine': must be organic disturbance, as 'couldn't fathom' that men could fall victim to hysteria, too.
Jean-Martin Charcot and Herbert Page, insisted that some symptoms could be caused by hysteria (now known as conversion disorder).
46
1980, the American Psychiatric Association, post-traumatic stress disorder
(PTSD) in the third edition of its Diagnostic and
Statistical Manual, the DSM III (APA, 1980).
Bracken, P. J., 'Post-Modernity and Post-Traumatic Stress Disorder', Social Science & Medicine 53 (2001), 733-43
The
condition is defined in terms of intrusive symptoms
(such as nightmares, flashbacks and persistent memories),
avoidance symptoms (such as emotional numbing,
withdrawal from the world and avoidance of
reminders) and symptoms of overarousal (such as
insomnia and irritability). There have been a number
of changes to the syndrome in subsequent versions of the
DSM but its basic structure remains the same
-- parallels with Royal College of Psychiatrists' definition in the UK
47
Does PTSD have a universal validity?
Bracken, P. J., 'Post-Modernity and Post-Traumatic Stress Disorder', Social Science & Medicine 53 (2001), 733-43
assumed to across cultures and time by Diagnosis and Statistics Manual (DSM, US), WHO
48
PTSD - invented or discovered?
What, according to OBrein, do lots of ppl think?
PTSD is merely the renaming or the synthesis of an
| age-old condition (O’Brien, 1998, p. 5).
49
Is PTSD a particularly modern, new, disease?
Bracken, P. J., 'Post-Modernity and Post-Traumatic Stress Disorder', Social Science & Medicine 53 (2001), 733-43
While historically there is considerable evidence of
physical and psychological reactions to terrifying events
in the medical and non-medical literature, most of these reports point to symptom complexes which are not
co-terminus with the defined symptoms of PTSD
US Civil War: 'soldiers heart' (withdrawn)
WW1: 'shell shock' (nerve damage, organic)
--> the
symptoms of these military syndromes were simply not
the same as those of PTSD
50
The Counstruction of PTSD
Young, 1995,
The disorder is not timeless, nor does it possess an
intrinsic unity. Rather, it is glued together by the
practices, technologies, and narratives with which it
is diagnosed, studied, treated, and represented and by
the various interests, institutions, and moral arguments
that mobilized these efforts and resources
51
PTSD as a Post Modern Disease?
Bracken, P. J., 'Post-Modernity and Post-Traumatic Stress Disorder', Social Science & Medicine 53 (2001), 733-43
```
Modernity and Self-Identity: Self and Society in the Late
Modern Age (Giddens, 1991)
```
- In the move from modernity to the condition of postmodernity,
disorder becomes an integral part of life. In
the post-modern cultural arena ‘meaning’ itself is
systematically undermined and reality is experienced as
fleeting and unstable.
---> . If the post-modern condition does involve an undermining
of meaning, order and coherence, perhaps this goes
some way towards explaining the current level of interest
in PTSD, a syndrome said to be the result of a
breakdown in the meaningfullness of the victim’s world.
52
Supposed evidence of PTSD being a timeless condition
Jones et al., Flashbacks and post-traumatic stress disorder:
the genesis of a 20th-century diagnosis
Shay (1991) suggested that elements
of the disorder could be identified in
Homer’s Iliad.
Samuel Pepys, who lived
through the plague and Great Fire of London,
is said to have recorded the features
of PTSD in his diary (Daly, 1983),
53
Testing hypothesis: the
symptom clustering associated with PTSD
existed before psychiatrists recognised it
as a formal disorder.
Jones et al., Flashbacks and post-traumatic stress disorder:
the genesis of a 20th-century diagnosis
- Tested cases of disordered action of the heart/shellshock/psychoneurosis from Boer to Persian Gulf
- Had to accommodate for changing language (eg 'flashback' wasn't a word in WW2, so included 'visual hallucinations instead)
-->
- Although we did find cases from the First and Second World Wars which would meet today’s criteria for PTSD, their incidence was significantly lower than for the Gulf conflict. Previous historical investigations have relied on single
case studies to make the point that PTSD is a timeless disorder. However, such studies
lack a denominator and are instead
based on an active search through historical literature for descriptions that resemble modern formulations of PTSD, while presumably
discarding presentations that
appear different.
------> Our
findings imply that the psychopathology
of trauma is not static and that culture has an impact on the expression of distressing
memories. There is no single way for human beings to respond to the terrifying events of war, and the concept of a ‘universal
trauma reaction’ appears flawed. We suggest that PTSD is one more phase in the continually evolving picture of human reaction to adversity (Young, 1995)
54
Look After Yourself! Campaign
'Do you hold your breath when a man looks at you?
'You'll be in better shape all round if you lose a few pounds. And you'll feel better, too.'
Is your body coming between you and the opposite sex?
55
Early concern for Modern Life
George Cheyne, The English Malady (1733).
Immoderate and luxurious modern lifestyle was bad for health.
Advocate of vegetarianism.
Diseases of Modern Life, B. W. Richardson, 1876
'Diseases from Worry and Mental Strain...Influence of the Passions...Impurity of Air'
Discusses dangers of smoking for changes to the blood, but denies smoking causes cancer as 'Cancer was present for ages before tobacco was introduced as a luxury'
56
Quote from B. W. Richardson that perfectly captures the debate over 'modern diseases'
Smoking does not cause cancer: 'Cancer was present for ages before tobacco was introduced as a luxury'
-- Disease is not 'modern', but new causes are modern: entertains the idea that cancer may 'excite, locally...the disease cancer?'
57
Berridge, 'Introduction', 'Marketing Health'
SMOKING: systematic gradualism and coercive permissiveness
Systematic gradualism was a strategy particularly important in the 1950s and 1960s when smoking as an activity was deeply embedded in society, in cultural and social practices
Coercive permissiveness, on the other hand, was the strategy which emerged in the 1960s and 1970s and grew in importance for public health both nationally and internationally as the cultural significance of smoking began to wane. It argued for individual self‐determination—but within a framework of behaviour increasingly defined by the state.
58
Berridge, 'Introduction', 'Marketing Health'
SMOKING:
Early attitudes to smoking
Nineteenth‐century public health paid little attention to smoking as a health hazard, and its health dangers were little discussed
Its health benefits were more central and were recognized to include alleviation of stress. Manufacturers submitted cigarettes to the Lancet for medical approval
the smoker might be weak willed but he was not diseased.
59
Berridge, 'Introduction', 'Marketing Health'
SMOKING: Increased opposition and the situation in Britain?
The main period of concern came in the early 1900s when a number of anti‐smoking organizations were founded to oppose smoking in children.
British Lads Anti‐Smoking Union
Work linking Smoking to Cancer in US/Germany
BUT
In Britain in these interwar years, there was little connection between formal public health and opposition to smoking...MoHs worked to contain infectious disease, ....Changing individual habits like smoking were not part of this mindset at all.
Later banned advertising on TV in 1965
Public smoking ban in 2005
60
Diseases of modern life: Killer Chairs?
This grim conclusion may surprise you, but 18 studies reported during the past 16 years, covering 800,000 people overall, back it up. In 2010, for example, the journal Circulation published an investigation following 8,800 adults for seven years. Those who sat for more than four hours a day while watching television had a 46 percent increase in deaths from any cause when compared with people who sat in front of the tube for less than two hours.
https://www.scientificamerican.com/article/killer-chairs-how-desk-jobs-ruin-your-health/
61
Berridge, 'Introduction', 'Marketing Health'
Smoking: Establishing the link between smoking and lung cancer
Concern was roused by the gradual increase in the incidence of cancer
This was the origin of the work carried out in the Statistical Research Unit at the London School of Hygiene and Tropical Medicine (LSHTM) by Professor Bradford Hill and Dr Richard Doll. The results, published in the British Medical Journal (BMJ) in 1950, concluded that there was a ‘real association’ between carcinoma of the lung and smoking and that smoking was a factor, and an important one, in the production of carcinoma of the lung.
In the UK context, the work of Doll and Hill was the watershed.
The Parliamentary Secretary to the MH on 27 June 1957 expressed for the first time unambiguous support for the conclusions reached by Doll and Hill in 1950.
--> MH circular encouraging local authorities to develop health education campaigns on smoking
62
Berridge, 'Introduction', 'Marketing Health'
SMOKING: Economic issues with anti-smoking in UK: Evidence
Macmillan commented about the statement to be made in 1956 by the minister of Health, ‘Cabinet approved a statement to be made by the minister of Health about Tobacco and cancer of the lung. It was a much better draft than the original one. I only hope it won't stop people smoking!’62
63
Berridge, 'Introduction', 'Marketing Health'
SMOKING: not perceived as a disease?
Smoking, it argued, was not a ‘disease’ in the way cancer, or indeed infectious disease was. It might lead to disease, but not for many years. The notion of long‐term ‘risk’, as we have seen, was not yet central to public health in the 1950s.
64
The Fourth Stage of the Epidemiologic Transition: The Age of Delayed Degenerative
Diseases
Ault
`Thesis?
- Since 1960s, death rates for cancer, heart disease falling, population aging rapidly
- Mortality patterns remain the same as in Omran's third stage (age of manmade and degenerative conditions), but occurs later in life
65
Fifth Phase of the Epidemiologic Transition
The Age of Obesity and Inactivity
J. Michael Gaziano,
Thesis?
The steady gains made in both quality of life and longevity by addressing risk factors such as smoking, hypertension, and dyslipidemia are threatened by the obesity epidemic.
4th stage (Ault) of delayed degenerative diseases to be superceded by 5th stage of obesity and inactivity
deleterious health effects strongly linked to excess weight. These include increased risk of coronary heart disease, ischemic stroke, hypertension, dyslipidemia,
type 2 diabetes, joint disease, cancer, sleep apnea,
asthma, and a host of other chronic conditions
66
Richardson, diseases of modern life (1876)
Disease from worry and mental strain, in people engaged in 'arts, science and literature, political life' due to failure of nervous system
Dementia caused by 'excessive mental strain'
