Reprinted online July 2008
is – perhaps more than most others – a disease of modernization.
From increasing inactivity to worsened dietary and environmental
quality, many factors contribute to this condition in modern societies.
Anthropologists look at this disease in its total context from cultural
to biological factors. In this review, I will focus on body mass
and obesity as significant risk factors for heart disease and their
evolution in developing societies. I describe in detail findings
from a recent article in Human Biology
(Reddy 1998) on this topic. I also discuss some additional risk
factors including poor air quality and migration. In addition, I
look at various anthropological solutions to this and related disorders
including pharmaceuticals derived from natural sources used for
stroke and meditation.
Body Mass and Socioeconomic
Reddy looked at more than 1,000 people – both male and female,
age 18 to 75 years – in a socio-economically diverse region
called Andhra Pradesh, India. She noted that body mass index (BMI),
an indicator of body mass, increased with age to age 50 and then
declined, and also increased with socioeconomic status and decreased
physical activity level. In more urban people and those with higher
income and reduced physical activity levels, obesity levels increased.
The prevalence of obesity (BMI over 25) is 6.6% in males and 10%
in females. Previously Reddy (1998) discovered that high BMI increased
risk of cardiovascular disease in this same population.
Occupational specialization in complex societies contributes to
heart disease risk by limiting physical activity levels and optimal
nutrition among certain parts of society. In India, the traditional
caste system also increases this division of labor. Reddy drew her
sample from seven castes of varying social status and a traditional
semi-nomadic tribe (the Yerukala). The castes and the tribe were
categorized into four groups, including the traditional semi-nomadic
tribe (the Yerukala) (Group One), hard-working agricultural and
other laborers of the Mala caste and Muslims (Group Two), the land-owning
agriculturists castes, Reddy and Balija (Group Three), and urban,
sedentary Brahmin, Vyshya, and Marwadi (Group Four). Group Four
(Brahmin, Vyshyas, and Marwadis) is urban and works in government
service or in business, while Groups one and two are rural, and
Group Three is semi-rural. The Group One Yerukala tribe is semi-nomadic
and treks around between villages with herds of pigs, living in
tents. They primarily beg for food since all of their traditional
foraging resources have been eliminated by agriculture. Group Two
people are from the lower castes and depend on hard physical labor
Anthropometric variables were assessed and physical activity was
classified according to three categories: heavy, medium, and light.
The former was used for farm laborers, rickshaw pullers, and washermen,
while shopkeepers, landowners, servants, and housewives made up
the medium level, and professionals made up the light level. Groups
Three and Four (more affluent) consumed more fatty foods and oils,
dairy products, and protein (mostly vegetarian protein sources,
such as lentils, since all groups were largely vegetarian). Groups
Three and Four also consumed more leafy vegetables. Statistical
analysis was performed using SPSS software. Although only about
two percent of the adult males in the hard working rural groups,
one and two were found to be obese, eight percent of males of the
land-owning agriculturist Group Three and 14% of males of the most
affluent Group Four were found to be obese. For females, these proportions
were similar for the first three groups, but 24%, compared with
14% in males, were found to be obese in the affluent Group Four.
This frequency is as high as that found for the US population (Van
Itallie 1985). Ironically, in India, the vegetarians, who make up
most of Group Four, are more obese than the non-vegetarians (Groups
One to Three). However, this is due to their more sedentary lifestyle
and a diet richer in fats and oils than a vegetarian diet. A high
fat intake may be conducive to weight gain through its effect on
metabolic rate (Flatt 1978; Achenson et al. 1984; Swaminathan et
al. 1985). In addition, the non-vegetarian groups are really semi-vegetarian
since they consume meat and fish very infrequently.
Obesity and heart disease risk is a double-edged sword in anthropology
since, in developing societies, the rich get fatter while the poor
get thinner. Many subjects in Groups One and Two suffered from chronic
energy deficiency (CED) and inadequate household food supply: 53%
of adult males and 40% of adult females suffered from some form
of CED in Groups One and Two, while only 18% and 36% suffer from
it in Group Three, and 25% and 19% in Group Four, respectively.
Persistence of CED in about 20% of the adult population of even
the most affluent Group Four is typically characteristic of developing
nations. Naidu and Rao (1994) noted that in Indian rural populations,
CED is of primary significance rather than obesity or overweight,
as is the case in Western populations. Men are particularly at risk
for CED since they do most of the hard physical labor in India.
Another interesting finding of this study has been echoed in many
previous ones as well: women are more susceptible to obesity than
men. Age is more strongly associated with BMI in females than in
males. The enhanced association between age and BMI in females is
thought to be an artifact of cumulative impact of pregnancies (Noppa
and Bengtsson 1980), because some of the weight gained during pregnancy
may be retained. That the significant association between BMI and
age is characteristic only of the two affluent Groups Three and
Four and not of the rural groups confirms de Vasconcellos' (1994)
observation among Brazilians that BMI decreases with age in rural
areas and increases with age in urban areas.
In contrast to the positive association between socioeconomic status
and BMI in developing countries, modern Western populations show
a negative association between these variables (Van Itallie 1985;
Forman et al. 1986; Garn 1986; Shah et al. 1989; Khan et al. 1991;
Croft et al. 1992; Gortmaker et al. 1993; Randrianjohany et al.
1993; Stunkard and Sorensen 1993). Anthropologists suggest that
this is due to the fact that the industrialized Western populations
experienced the effects of a protein and fat-rich diet and a subsequent
rise in cardiovascular deaths. As a result of this experience, the
more literate upper strata of the population began to eat a more
balanced diet, consciously avoiding food items that may contribute
to obesity and high cholesterol levels. They also began to exercise
during their leisure time.
Other researchers have discovered patterns similar to Reddy's.
Shah et al. (1989) found that occupation and income are the most
important determinants of BMI in males, whereas in females, alcohol
intake, caffeine intake, and race are the key variables. De Vasconcellos
(1994) studied BMI in Brazil and found that low BMI is also related
to low income in this country. Delpeuch et al. (1994) note that
in the Congo, a central African country, high BMI is an urban phenomenon
while low BMI occurs in rural areas. In India, Naidu and Rao (1994)
note that landless agricultural laborers and other low-income groups
have a lower BMI than cultivators, artisans, and high-income groups.
In southern West Bengal, Bharati (1989) noted that BMI is related
to socioeconomic status and Sanjeev et al. (1991) also note that
no lower socioeconomic status individuals are in the overweight
category, whereas 12.1% of upper socioeconomic status subjects were
overweight or severely overweight.
What does this mean for people in industrial societies? Put simply,
given the long-term relationship between high BMI and high social
status in traditional societies, we can understand the difficulty
we experience in losing body mass in order to reduce risk of heart
disease. "Bigger" people appear to be wealthier and
of higher status to us since that is often the situation in developing
societies. As a result, we try to "be big" with disastrous
effects on our health.
With increased urbanization, air quality is worsened, which may
result in higher risk of heart disease. For example New York City
(NYC) residents' unusually high rate of ischemic heart disease (IHD)
results from chronic exposure to that city air among other factors.
One recent study used all US death certificates for 1985-1994 to
examine (correcting for age, race, and sex) IHD deaths in three
groups: NYC residents who died in the city, non-NYC residents visiting
the city, and NYC residents traveling out of the city. The researchers
found that IHD deaths among NYC residents dying in the city were
155% of the expected proportion. Among visitors to the city, such
deaths were 134% of the expected proportion. The proportion of IHD
deaths among NYC residents dying out of the city was only 80% of
the expected value. These effects are not due to nearby commuters,
recent immigrants, local classification practices, or socioeconomic
status, and they do not appear in other US cities. With both chronic
and acute effects of exposure to NYC air, these data are consistent
with the hypothesis that the stress of NYC is linked to the high
rate of IHD.
Increased migration is an important aspect of developing and developed
societies. With additional transportation technologies, it becomes
easier for people to move from one location to another. However,
it appears that this migration can increase risk of heart disease.
Studies by Cassel (1970: 196-198) and associates show that people
who move farthest away from their childhood class level and place
of residence have the highest rate of heart disease. Epidemiological
correlations have been found between geographic mobility and coronary
heart disease in North Dakota (Syme: 1964) and North Carolina (Tyroler
and Cassel: 1964), especially where cultural discontinuity occurs,
such as changes from rural to urban environments. (Mausner and Bahn:
Other anthropological studies are looking at how certain ethnopharmaceuticals
can help prevent or treat cardiovascular disease or stroke. For
example, a blood-thinning drug derived from the venom of the Malayan
pit viper can reverse symptoms in stroke victims, researchers reported
recently in the Journal of the American
Medical Association. The experimental treatment follows the
discovery that blood failed to clot in people bitten by the snake.
Scientists figured the venom could be used as an anticoagulant to
help stroke victims who have a clot that is blocking blood flow
to the brain. In a study of 500 stroke patients, 42% who were given
the drug Ancrod within three hours after the onset of symptoms regained
significant functioning vs. 34% of those who got a placebo. The
study was led by Dr. David Sherman, a neurologist at the University
of Texas Health Science Center in San Antonio, and was conducted
in the United States and Canada. The promising results led Ancrod's
manufacturer, BASF Pharma, to launch a separate European study to
see if it would also work within six hours of symptoms. Ancrod is
similar to the clot-buster TPA, the only federally approved drug
for strokes. TPA dissolves clots, while Ancrod lowers blood levels
of fibrinogen, a substance that can help form clots. That allows
blood to flow more freely. Both drugs are given intravenously. TPA,
like Ancrod, has a three-hour treatment window. About 700,000 Americans
have strokes each year. Many end up with paralysis, impaired speech,
and other debilitating effects. Until the recent use of TPA, there
was little doctors could do to treat strokes once symptoms such
as numbness and difficulty speaking appeared. BASF Pharma keeps
a colony of snakes in Germany and milks them regularly to extract
the venom, which is necessary since no synthetic version has been
Numerous traditional practices, such as meditation, are being tapped
to help people fight heart disease. A growing body of research shows
that meditation reduces heart rate and blood pressure, improves
immune function, and decreases stress-hormone levels. Meditation
focuses on making a shift from thinking and planning to just being.
Techniques emphasize learning to avoid worrying or replaying negative
thoughts, also called mind chatter or mental turbulence, which raises
stress hormone levels and limits the ability to enjoy life. In one
study, people who performed transcendental meditation every day
for three months had a drop in systolic pressure that was ten points
greater than the drop in people who were counseled on lifestyle
changes such as losing weight, reducing dietary salt, exercising,
and reducing alcohol intake. The meditators' diastolic pressure
dropped by approximately six points more than subjects in the advice-only
groups did. Meditation may work by reducing stress, and so it can
help people curb unhealthy behaviors such as overeating or drinking
too much alcohol. In studies, people who were counseled to make
lifestyle changes made few alterations in their day-to-day habits,
but the meditation groups went from roughly 11 drinks a week to
five, indicating that meditation may make it easier for people to
implement other healthy changes. What's more, while blood
pressure drugs including diuretics, calcium channel blockers, and
ACE inhibitors can lead to a rise in blood cholesterol, impotence,
fatigue, dry mouth, nasal congestion, diarrhea, nausea, headache,
and dizziness, meditation has no side effects.
While warm baths are thought to be potentially dangerous for heart
patients in Western cultures, Japanese doctors routinely prescribe
them as heart disease therapy. Now, findings from a small study
suggest that warm baths improve exercise endurance in the elderly,
regardless of whether they are heart patients or healthy people.
Ten minutes of soaking boosted performance on the treadmill and
improved fatigue and leg pain among 16 elderly men and women, some
who had heart disease and some who did not, according to researchers
from Kagoshima University in Japan. Dr. Megumi Shimodozono and his
colleagues presented their findings at a recent annual meeting of
the American Academy of Physical Medicine and Rehabilitation. Study
co-author Dr. Nobuyuki Tanaka explained that it is widely believed
heart disease patients should avoid warm baths because they may
speed the heart rate. However, according to Tanaka, warm baths are
safe for the heart and dilate blood vessels and thus allow more
blood to get to the muscle. A short dip of ten minutes in a 41-degree
Celsius (106°F) bath was used in the study. Other anthropological
studies show that people in traditional societies have larger hearts
and better cardiovascular performance than industrial people. Similarly
wild rabbits have larger hearts and better cardiovascular performance
To wrap up, anthropological research is showing that heart disease
and the closely related risk factor of obesity are deeply intertwined
with our cultural and evolutionary environment. Through various
means, we are conditioned, in developed and developing countries,
to consume infinitely, which encourages obesity and cardiovascular
disease. At the same time, traditional societies offer important
clues for ways to prevent and fight heart disease, from new drugs
developed through studies of traditional medicine to meditation,
relaxation, exercise, and even hydrotherapy.
About the Author
Tim Batchelder, BA, is a communications consultant who specializes
in the anthropology of science and technology.
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