Tag Archives: Body fat

Retirement: good or bad for your heart?

Across the globe, more people are spending more time in retirement than ever before. So staying healthy in later life is critical. Yet political debates on ageing tend to ignore a growing body of research on how retirement can affect our health. Baowen Xue and colleagues from the Department of Epidemiology and Public Health at UCL looked at links between retirement and cardio-vascular disease – and found unexplained differences between Europe and the US.

Is retirement good for your heart, or bad for it? The question is an important one because cardio-vascular disease (CVD) is the biggest cause of death globally and costs health services a huge amount of money.

Some studies have shown retired people have a higher risk of being diagnosed with CVD than those who are still working. But until now the evidence has been unclear.

We set out to review evidence from across the world, so that we could help to build a more accurate picture of whether, and how, retirement might affect our cardio-vascular health. As CVD is linked to our lifestyle, diet and other behaviour, there are lots of ways in which changes that take place in retirement might have an effect – both negative or positive.

Longitudinal studies

We looked for longitudinal studies that could help answer our questions, and found 82 which measured risk factors for CVD and 14 which looked at actual incidence of CVD. The second set of 14 papers provided the answer to our first question – does retirement affect our cardio-vascular health?

The answer revealed a major difference between the USA and Europe. Studies conducted in the US showed no significant effect, good or bad, on retirees’ cardio-vascular health. In Europe, meanwhile – with the exception of France – studies consistently showed a link between retirement and an increase in CVD.

Data from the British Regional Heart Study, for instance, showed that healthy men who retired before the age of 60 were more likely than others to die from circulatory disease within five and a half years. Fatal and non-fatal CVD was also more common among retirees in Denmark, Greece, Italy and the Netherlands.

Why might this be? Could there be cultural or lifestyle differences between Europe and the US which might cause this difference? We took a systematic look at the risk factors.

Weight gain

First, we looked at weight gain. If Americans were less likely to put on weight after retirement compared to Europeans, that might help to explain the difference. But when we looked at this, we found that body mass index (BMI) actually increased after retirement in the USA – and also Japan -but did not change in England, Denmark, France, Germany, Switzerland or Korea. While those who do physically demanding jobs are likely to put on weight after they retire, most people aren’t.

Could it be that retired people generally do less exercise – another risk factor – in Europe? The studies suggest that’s not the reason. While many retirees did more physical activities, they also spent more time sitting still – so the effect was a balanced one. For instance, a retiree might play more golf, but also watch more television.

Do retired people perhaps smoke more, we asked? Again, there were contradictory results but 12 out of 14 studies either showed no effect or showed retirement led to people smoking less.

Perhaps retired people in Europe drink more, then? Again, this couldn’t be identified as the reason. Studies in Australia, the UK, Japan and the USA suggested there was no association between retirement and alcohol consumption.

Diet is another possible cause of CVD, but again, there was no clear pattern of between retirement and diet emerged from reviewed studies.

No benefits

So the picture isn’t straightforward, and we don’t have answers as to why retirement might put Europeans at risk but not Americans. What we can say, though, is that none of the studies we looked at found any beneficial effects of retirement on CVD.

Apart from a decrease in smoking, there wasn’t evidence of any general ‘relief’ effect of retirement on people’s cardio-vascular health – so the supposition that working could be bad for our health and therefore retirement better for it doesn’t necessarily hold true.

However, studies that showed retirement brought negative health effects should be interpreted with caution. Many assessed the health effects of retirement by comparing retired people with employed people – and we know people who stay in the labour market are generally healthier than retirees. We do know people who have CVD, diabetes or hypertension are more likely to retire.

What our review has done is to reveal the complex nature of the underlying mechanism through which retirement might impact on the risk factors for CVD. Different people react differently to retirement, depending on their life experiences and the cultural and policy environments in which they live. So there isn’t one global solution to any of this – each country needs to plan its citizens’ retirement according to their individual needs.

The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studies, by Baowen Xue, Jenny Head and Anne McMunn, is published by The Gerontologist.

Woman warehouse worker

Out of work and overweight: Think again.

There’s a widely held preconception that people who are out of work are overweight, perpetuated by the media and, indeed, reinforced by some academic studies. But recent robust evidence throws a whole new light on things and indicates that unemployed people are in fact much more likely to be underweight, and less likely to be overweight, than their peers who have not recently been unemployed. Amanda Hughes from the Institute for Social and Economic Research explains how she came to question narratives about benefit claimants being lazy and overweight and go on to undertake research she believes provides a more accurate picture.

While I was doing my PhD, I volunteered at a foodbank, and noticed that there were more people coming in who were painfully thin than too heavy. Some had not eaten that day or the day before. Others had walked for two hours to get there, because paying for a return bus journey was out of the question.

Of course, not all people who are out of work turn to food banks, and not all people who turn to foodbanks are unemployed. But that experience got me thinking: have researchers and public health officials been so concerned with obesity that they have missed a crucial part of the story? If weight loss or weight gain can occur during unemployment depending on personal circumstances, might there be an overlooked ‘U-shaped’ association of unemployment and body weight, with excess obesity and excess underweight among jobseekers?

We know that risk of dying is higher for jobseekers than for employed peers, and it is often assumed that increased overweight and obesity among jobseekers plays a role. But studies on the relationship of unemployment and body weight have been inconclusive; some document weight gain with unemployment, but others suggest weight loss. However, previous studies have compared only average effects – average change in body weight following job loss, or average differences between unemployed people and controls, and may have missed a more complicated ‘U-shaped’ association.

Working age BMI

Using Understanding Society, a longitudinal, nationally representative survey of more than 40,000 UK households, my colleague Meena Kumari and I were able to look at the BMI (body mass index) of 10,737 working-age adults between 2010 and 2012.

What was different about our study, was that we did not assume unemployment would impact BMI in the same direction for everyone. Rather, we allowed for a simultaneously raised risk among jobseekers of both underweight and obesity, by comparing the probabilities of being underweight, overweight, and obese between current jobseekers, recent jobseekers, and people who had not been unemployed since the start of the survey (the control group). To isolate the impact of unemployment itself, we took into account other factors such as demographics, chronic health conditions and mental health, smoking and physical activity.

A small proportion (0.7 per cent) of the people in our study who were employed were classed as underweight (i.e. had a BMI below 18.5). But for those in our sample who were unemployed, the proportion shot up to almost 4 per cent. This pattern remained when we took into account factors such as their education, gender, smoking, overall health, physical activity and alcohol consumption.

Certain groups were especially at risk: there were more extreme effects for longer-term unemployed people, for men, and people from lower-income households, suggesting household reserves or the support of family members may act as a sort of buffer against weight-loss effects. At the same time, currently unemployed people were much less likely to be overweight than peers who had not recently been unemployed (29 per cent v 40 per cent).

We did find that unemployed people were more likely to be obese, perhaps suggesting changes in dietary quality following unemployment towards energy-dense but nutrient-poor foods. However, this was only the case for non-smokers, which might reflect competing priorities between tobacco, food and other essentials for smokers on severely restricted budgets.

Quantitative evidence

Together, these results point to a complex picture in which jobseekers, depending on the complexities of individual lives, are at increased risk of both underweight and obesity, each with their own associated health risks.

The elevated underweight and reduced overweight among current jobseekers are quantitative evidence that many unemployed people are not eating enough in simple caloric terms. Despite the political importance of this question, evidence of this effect has so far been fairly anecdotal.

Our results make an important contribution to research trying to explain the increased risk of chronic illness and mortality for unemployed people – suggesting that, at least in contemporary Britain, being underweight may contribute to that much more than previously realised.

At the very least, I hope our evidence will be used to challenge preconceptions and debunk myths about unemployment. It has implications for the way politicians, journalists and the wider public perceive unemployment, and for anyone concerned with the health effects of being out of work.

Unemployment, underweight and obesity: Findings from Understanding Society is research by Amanda Hughes and Meena Kumari at the Institute for Social and Economic Research at the University of Essex, and published in the journal Preventive Health.

You can also read an article about this research in The Guardian.

Photo credit: At Work in the Capital Area Foodbank Warehouse, Geoff Livingston

Want to be fit at forty? Don’t have a baby early!

Having a family early may not be good for your health later on. That was the conclusion of a team of researchers at the ESRC International centre for Lifecourse Studies when they looked at the interplay between the work and family lives of men and women, whose lives have been tracked over time in the 1958 Birth Cohort Study. But was it the same story for people born earlier and has it been the same for people who were born later? Dr Rebecca Lacey, who led the research, has been looking at the lives of thousands of adults in three Birth Cohort Studies to see whether the way their work and family lives intertwine impacts on the likelihood of them becoming overweight or obese later on.

In a recent blog for WorkLife, my colleague Anne McMunn outlined some of our research showing that, for both men and women, having children early, especially as a teenager, was closely linked with poorer health once they got into their forties.

Not only did the people we looked at for that piece of research have bigger waists, but they also had a great deal more fat circulating in their blood and less ‘good’ cholesterol, both of which are linked with a heightened risk of heart disease and diabetes.

Those findings stayed strong, even for young parents who had a job and were married, a clear indication that having children early on, with all the associated stresses and strains, seems to take a heavy toll on health over the life course.

For that piece of research, we looked only at people who had taken part in the National Child Development Study, also known as the 1958 Birth Cohort. For this research we looked, in addition at thousands more people, born in 1946 (National Survey of Health and Development) and another group born in 1970 (the British Cohort Study) whose lives had been tracked since birth.

Across cohorts

The reason for looking across cohorts was to see whether changes across generations in how we combine work and family (having children later, more cohabitation and less marriage, more women working etc.) have contributed in some way towards poorer health for some.

As with the earlier research, we made use of 12 specially created lifecourse types covering information on employment, partnerships and parenthood, such as ‘Work, Later family’ ‘Later family, Work break’, ‘Teen parent’.

Each individual in each birth cohort was ascribed a lifecourse type and this was then linked to their Body Mass Index (BMI) and how that changed over time. We went on to see how those figures differed between lifecourse types within and across the three cohorts. We used the World Health Organisation’s (WHO) definition of overweight (BMI greater than or equal to 25) and obesity (BMI greater than or equal to 30).

In addition, we took a host of other factors including our participants’ socio-economic background, prior health and educational attainment into consideration.

We anticipated that, as our earlier research had shown, that people who worked less and had children earlier would show steeper increases in BMI and that across the three cohorts, those increases would become more pronounced.

Changing attitudes and behaviours

The distribution of lifecourse types across the three cohorts reflected, as we thought it would, changing attitudes and behaviours across generations, with increasingly more women in employment and early parenthood becoming less and less common.

In the 1946 cohort, the average BMI of a very small group of men who were ‘Teen parents’ increased from 20.3 to 26.76 between age 16-42, significantly more than any other work-family combination. The same was true for male teen parents in the 1958 cohort and also for those who worked and had a family early. In the 1970 cohort, men who had no children or had children later had BMI that increased significantly less than those who became parents earlier. The only exception to this was a group of men with no family and unstable work.

Another notable finding across all three cohorts was that average BMIs for men at age 42 in all of the work-family groups were higher than the WHO threshold for overweight. The only exception was men who had children later or no children at all.

For women in the 1946 study, there was no real difference between the groups when we looked at how their BMI increased between the ages of 16 and 42. The average BMI of the 1958 cohort women who had children early increased significantly more than that of women who had them later. Women in the 1970 cohort who did not work and had children early had the biggest BMI rise (6.69) with teen parents (6.31) close behind. The average BMI of the 42 year-old women in these two groups was on the WHO obesity threshold (30), with the average BMI for the remaining work-family groups all falling under the WHO definition of overweight (25 and above).

Other interesting things to emerge included:

  • BMI increased more for male teen parents than female in the 1970 cohort
  • Marriage seems to have particular health benefits for men
  • Divorce has greater negative health effects for men than women

Negative impact

This research reinforces what we found earlier, which is that for both men and women having children early (especially in your teens) no matter what your background, is likely to have a negative impact on your health in mid life, especially if you don’t have a job or if your work is irregular or unstable. Looking across three cohorts, we can also see that those differences have become more pronounced.

How to explain and better understand how all this plays out in the day to day lives of younger parents is a challenge. Having children early may disrupt someone’s education or career. Younger parents may also be more likely to smoke and drink and exercise less than their older counterparts, unhealthy behaviours which can become established early and set in across adulthood.

Whatever the context and the reasons, there are some important messages here for young people, prospective parents, health and education professionals as well as for Government; not least that decisions about how to combine work and family life, especially when to become a parent, may have long lasting ramifications for your health.

This research adds to a growing body of evidence which makes it clear that, as far as obesity is concerned, early intervention is key and that we need to consider the complex way in which our biological and social lives intertwine over time.

Further information

Work-family life courses and BMI trajectories in three British birth cohorts is research by Rebecca Lacey, Amanda Sacker, Steven Bell, Meena Kumari, Diana Worts, Peggy McDonough, Diana Kuh, and Anne McMunn. It is published in the International Journal of Obesity.

Photo credit: Baby Fingers, Thomas

How travelling to work can work for you

There can’t be too many commuters who aren’t now aware that ditching the car and walking to work is much better for them. Considerable evidence has shown that walkers and cyclists are likely to weigh less and be slimmer than their car commuting counterparts. What they may be less aware of is that ditching the car in favour of the bus, train or the tube could have nearly the same benefits. A programme of research by a team at the London School of Hygiene and Tropical Medicine and the ESRC International Centre for Lifecourse Studies, UCL has been taking a closer look at the benefits of being an ‘active commuter’. As researcher Ellen Flint explains, the findings point to some clear ways forward, not just for individuals, but for policy makers too.

Physical inactivity and being sedentary for large parts of the day are a leading cause of obesity and premature death. In England alone something like two thirds of adults do not meet the recommended levels of daily exercise. At the same time there are growing numbers of people commuting to work. In England and Wales that figure is around 24 million people, 67% of whom take the car.

The time of life when most adults become obese is in middle age, with 50-65 year-olds less than half as likely as young adults aged 16-29 to use public transport, nearly half as likely to walk to and from work and two thirds less likely to get on their bikes. So it’s this age group that we have focused on in our programme of research looking at the relationship between active commuting and obesity in mid life.

To help us do this, we have used information from a long term household survey called Understanding Society and a large study called UK Biobank.

Public transport benefits

Our first piece of research used Understanding Society and showed us that not just walking or cycling to work but even catching the bus or the tube are all linked to lower body weight and body fat composition compared with those who get to work by car.

7,534 BMI and 7,424 percentage body fat measurements from men and women who took part in the survey were used in conjunction with information about journeys to work.

Men who commuted via public or active modes had BMI scores around 1 point lower than those who used private transport, equating to a difference in weight of 3kg (almost half a stone) for the average man.

Women who commuted via public or active transport had BMI scores around 0.7 points lower than their private transport using counterparts, equating to a difference in weight of 2.5kg (5.5lb) for the average woman.

When it came to body fat, men who actively travelled to work (walking, cycling or public transport) had body fat that was roughly one per cent point lower than those who commuted by car, confirming the picture seen when looking at BMI.

What’s important to note here is that these differences are larger than those seen in the majority of individually focused diet and physical activity interventions to prevent overweight and obesity.

Second study reinforces

In work just published in The Lancet Diabetes and Endocrinology, we were able to use information from more than 70,000 men and 80,000 women aged 40-69.

More than 60% of these people commuted by car, with only 4 percent and 7 percent respectively reporting walking as their only method of commute and 4 percent and 2 percent cycling. Around one in five was an active commuter some or all of the time.

Except for those who mixed car and public transport, all other groups had significantly lower BMI and percentage body fat than those men and women who ONLY commuted by car.

The biggest differences were for cyclists and the results stayed strong even when we accounted for a wide range of other factors such as social and economic background, their general health and even whether or not they did exercise outside of their daily commute.

The men who cycled were around 5 kg lighter whilst women cyclists were on average nearly 4.5kg lighter than their car commuting counterparts.

Unsurprisingly, walking to work had the next biggest association with reduced obesity. Compared with their car commuting counterparts, men who walked to work were on average 3.0kg lighter; and women typically weighed 2.1kg less.

However, what was perhaps more interesting, and what also reinforced our interesting earlier findings from Understanding Society, was that even those who used a mixture of public transport and active methods of commuting still had significantly lower BMI and body fat percentage than those who commuted exclusively by car.

In fact, it was similar to those who only walked to work. Compared with car commuters, men and women who mixed public transport with some walking or cycling typically weighed 3.1kg and 2.0kg less, respectively.

Active commuting at heart of policy

Separately these two studies make interesting reading, but together they combine to make a powerful and growing body of evidence around the benefits of active commuting and do more than hint at potential interventions for policy makers.

There is now a clear case for the health benefits of active commuting to be taken into consideration by transport planners, town planners and urban designers.

Cities can be active by design and the more evidence that we have to confirm that people who commute actively really are lighter and have a healthier body composition, the more impetus there is for these health related outcomes to be at the heart of policy.

It is time to realise the untapped population health improvements potential of these big shifts we can make in how people travel to and from work.

Photo credit: Chris Rubberdragon