Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Obesity, Smoking, and Life Expectancy in the U.S.

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When we think of people who enjoy the outdoors, the images in our minds are often of healthy and vibrant individuals - stereotypes are young athletes engaged in vigorous activities like climbing, biking, skiing, etc. Of course, going outdoors is for everyone, and persons may be young or old, active or sedentary, and healthy or infirm. We carry our personal health status with us wherever we go, and the health habits we pursue in our daily lives form the framework for our participation in adventures, recreation and other outdoor activities. Therefore, public health issues are important, be they adherence to precautions to avoid infectious diseases or life style modifications to maintain optimal physical and mental health.

Someone once mentioned to me that if there were three things one could do to maintain proper health, it would be to control my blood pressure, never use tobacco products, and follow proper nutritional habits. With regard to the latter, that can be further refined by avoiding excess processed sugar and hydrogenated fats. So, it was with great interest that I read the article entitled "Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy," by Susan Stewart, Ph.D. and colleagues in the New England Journal of Medicine (2009;361:2252-60).

In this very interesting article, the authors forecasted life expectancy and quality-adjusted life expectancy for a "representative 18-year-old," assuming a continuation of past trends in smoking (e.g., a reduction in the amount of smoking) and past trends in body-mass index (BMI), for which an increasing number (it is indeed trending up) indicates a propensity for obesity. In this evaluation, the negative effects of increasing BMI in the U.S. overwhelmed the positive effects of declines in smoking. In other words, even though there are positive effects gained from declining smoking rates, these are more than neutralized by the negative effects on the health of the U.S. population due to increases in obesity.

These are trends and therefore, as the authors point out, do not necessarily apply to any given individual based on his or her particular smoking habits and BMI combination. However, if this analysis is correct, the implications are fairly clear - we must do everything we can to control our epidemic of obesity, which contributes heavily to morbidity and mortality. It is not a good thing from a health perspective to be obese under any circumstance, and certainly - notwithstanding the possible luxury of an insulating layer of fat on a cold day - not beneficial in the outdoors. When one puts stress on the cardiovascular system (which leads to strokes, heart attacks and other serious medical problems), this can be magnified in a situation of high physical stress, such as commonly occurs outdoors. I have had to good fortune to be trekking on mountains, scuba diving, river rafting and so forth over the past few years, and have noticed that people are seemingly larger, and not in a good way. This paper is a graphic example of how serious has become our nation's battle with obesity.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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