Tag Archives: health

Sleep: Everyone Needs It, but Who Gets It?

Black man in bed awake, hands clasped on foreheadDebbie says:

Katherine Ellison’s article, “The Great Sleep Divide,” in Knowable Magazine/Ars Technica, applies a race and class analysis to the human need for sleep. While her findings are not surprising, they are troubling … and valuable.

it turns out that the poor, as well as socially disadvantaged racial minorities, sleep much less well on average than the rich, which can take a major toll on their physical and mental health.

As Ellison explains, lack of sleep is a major problem in the United States: huge percentages of adults and teens don’t get the recommended number of hours of sleep, and a quarter of  us suffer from actual insomnia (this got worse during the pandemic, as you might expect). And lack of sleep has long been known to have long-term, sometimes catastrophic, health effects, including increases in frequency of cardiovascular disease and dementia.

Researchers have only comparatively recently started to delve into the socioeconomic factors that impact sleep:

Over the years, researchers repeatedly have found evidence that people in poverty get less sleep than those with more money. In 2013, for instance, a large CDC survey found that 35.2 percent of people earning below the poverty level reported sleeping less than six hours in an average 24-hour period, compared with 27.7 percent of those earning more than four times the poverty level.

The disparities are even sharper among racial groups. A rigorous 2015 study involving both lab tests and self-reports from more than 2,000 US participants found that, compared with whites matched for age and sex, Blacks were five times as likely to sleep for shorter periods. [About twice as many Hispanics and Chinese Americans get insufficient sleep than whites.] …

As we all know from our own experience, sleep isn’t only quantitative, it’s qualitative:

As [Girardin] Jean-Louis [a sleep researcher at New York University] and other researchers have found, Blacks tend to spend less time than whites in slow-wave sleep, the deep slumber that supports physical and mental health. In a longitudinal study involving home and lab studies of 210 elderly people, including 150 African Americans, Jean-Louis is exploring the degree to which this deficit may contribute to higher rates of heart disease and dementia.

The best thing about Ellison’s article is that it actually addresses solutions and clarifies that sleep issues are systemic and social, not purely individual.

Sleep has traditionally been seen as a purely individual responsibility: don’t drink coffee at night; keep the room dark; don’t look at your phone in bed, etc., etc. [Wendy] Troxel [of the RAND Corporation], Jean-Louis and other scientists argue that we need to widen our perspective to reimagine sleep as a public health opportunity.”

One clearly helpful intervention, not too difficult to implement, is changing school hours (which of course impact parents and teachers as well as students):

Major national debate has focused on one relatively straightforward change, which scientists contend could help tens of millions of Black, white, rich, and poor children and their families sleep better: namely, delaying school start times by as much as an hour. The science is solid. For their physical and mental health, teens need a lot more sleep than they’re getting.

Many school districts that have moved back their starting clocks have seen benefits including more alert students, better academic outcomes, and fewer car accidents. So far, however, fewer than 20 percent of US middle and high schools have made the change, Troxel notes. (When schools closed for the pandemic, many set their remote schedules later, and some surveys of students suggest that this has allowed students more sleep.)

Class and race inequality pervade all aspects of our lives: this is one where we can make improvements both systemically and in our own networks.

Now go get some sleep!

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Everything We Know About Obesity Is Still True

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copyright (c) Laurie Toby Edison

Debbie says:

When you’ve been doing the same activist work for thirty years and more, it’s hard not to be all “Oh, well, here we are again” when someone new comes out with a hard-hitting article that says all the things you’ve been saying for years.

At the same time, each of these new articles is fresh to the writer, and fresh to many of its readers, and makes a dent in the walls around your ideas. So after one deep sigh, I really welcome Michael Hobbes’ “Everything You Know About Obesity Is Wrong,” published in the Huffington Post.

Hobbes starts with what he calls “scientific myopia,” a quick review of how hard it is to get scientists to step away from their dominant paradigm, and then goes on to make his key point: “Years from now, we will look back in horror at the counterproductive ways we addressed the obesity epidemic and the barbaric ways we treated fat people—long after we knew there was a better path.”

After that, the piece follows what fat activists will recognize as a familiar path: how much social prejudice against fat hurts people, how diets don’t work — I wish he had credited Gina Kolata’s 11-year-old landmark book, Rethinking Thin, which I reviewed as “old news” when it was published — and then gets to his first core point, which is that fat and health are not inextricably entwined. I see that every time I go to the doctor, and the medical tech is slightly surprised at my perfectly reasonable blood pressure, which goes hand in hand with my perfectly reasonable cholesterol numbers. However, Hobbes is good and clear on these points:

individuals are not averages: Studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy. They show no signs of elevated blood pressure, insulin resistance or high cholesterol. Meanwhile, about a quarter of non-overweight people are what epidemiologists call “the lean unhealthy.” A 2016 study that followed participants for an average of 19 years found that unfit skinny people were twice as likely to get diabetes as fit fat people. Habits, no matter your size, are what really matter. Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.

He doesn’t mention the famous “nurses’ study,” which demonstrated that “moderately obese” people live longer than people whose weight is “normal” or “appropriate.”

Next on the roadmap of this kind of article is the issue of medical misuse and abuse, beginning with a profile of a fat victim. Again, Hobbes is clear-eyed and thoughtful:

Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Hobbes gives lots of examples of how doctors misuse fat patients, and how they are taught to do so. None of it is new, but all of it is useful fuel for the fire. Then he goes on to the mental, emotional, and social toll all of this takes on fat people, again with real-life stories and useful statistics, and the obligatory quotations from therapists who work with fat patients.

The only place he goes off the rails is in his — often true — argument that

perhaps the most unique aspect of weight stigma is how it isolates its victims from one another. For most minority groups, discrimination contributes to a sense of belongingness, a community in opposition to a majority. Gay people like other gay people; Mormons root for other Mormons. Surveys of higher-weight people, however, reveal that they hold many of the same biases as the people discriminating against them. In a 2005 study, the words obese participants used to classify other obese people included gluttonous, unclean and sluggish.

Of course, this happens. But I personally know so many groups in which fat women gather to discuss our experiences, and to fight the system together, so many blogs, so many websites, so many meetups. I’m sad that Hobbes didn’t find any counterexamples to his theory, and I don’t think he looked very hard. I’d be curious about whether that 2005 study (which, by the way, looked at only 46 people!) would be different in 2018.

Then, he goes to some of the real scientific roots of both increased obesity and increased health issues which don’t relate to weight: issues of the food system. The only thing in the article which surprised me was his claim that people who eat nuts four times a week have statistically significantly lower diabetes incidence and lower mortality. More nuts for me!

And finally,

Our shitty attitudes toward fat people. According to Patrick Corrigan, the editor of the journal Stigma and Health, even the most well-intentioned efforts to reduce stigma break down in the face of reality. In one study, researchers told 10- to 12-year-olds all the genetic and medical factors that contribute to obesity. Afterward, the kids could recite back the message they received—fat kids didn’t get that way by choice—but they still had the same negative attitudes about the bigger kids sitting next to them. A similar approach with fifth- and sixth-graders actually increased their intention of bullying their fat classmates.

And here he does get to fat activism, although he still doesn’t seem to see that fat activism requires that fat activists like each other and work together. His fat activism quotations are mostly from a journal editor; I’d love to know how many fat activists he spoke to. I’m right here, and I’m hardly alone!

I salute Michael Hobbes for researching and writing this article. I hope thousands of people see it and lots of people share it and discuss it. And I long for the day when the next one of these isn’t in the pipeline somewhere, because the point has been made.

Follow me on Twitter @spicejardebbie . Thanks to @ribbonknight for tweeting this link out.