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THE FIFTH AGE OF HUMAN LONGEVITY
BY CONOR MAGEE MD FRCS, CONSULTANT SURGEON
Modern medicine and surgery is a true marvel - we can replace
exhausted joints and failing organs, we can expect to live in to
our eighties and have a quality of life undreamt of by those born
two or three generations before us. So, all would appear to be
good and we should be able to reap the benefits of future medical
progress as we get older?
But look closer and a more sobering, worrying situation is at hand.
The scientist Thomas Gaziano believes we are entering the “Fifth Age
of Longevity”. Gaziano describes humanity as passing through four
phases of health. The first age (which encompasses most of human
history) is one of pestilence and famine resulting in infectious disease
and malnutrition leaving an average age expectancy of around
30 years. The second age is heralded by the industrial revolution-
urbanisation and increasing wealth is accompanied by better food
availability, water and sewer systems lead to receding pandemics
and life expectancy increases. In the mid-20th Century there is a
step back with the development of degenerative and human made
disease, think smoking, cancer and cardiovascular disease. However,
the fourth age from the mid 1960s onwards see great strides in the
treatment of degenerative and cardiovascular disease with better
prevention and technological progress. But this is a shortlived
golden age, we are now entering the Fifth phase where all those gains
are threatened by an age of obesity and inactivity.
It is almost assured that obesity will overtake smoking as the number
one public health threat. The latest childhood obesity figures show
there are 22,000 severely obese (not including the simply overweight
or mildly obese) in the last year of primary school. These are
staggering figures especially when we know that obesity not only
leads to devastating diseases such as type 2 diabetes and cancer but
also shortens life and can destroy quality of life. We probably accept
that obese children are susceptible to bullying but it is heartbreaking
to realise that an obese child's quality of life is similar to that of
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one diagnosed with cancer or that 90% of 9-11 year old overweight
children believe that teasing and harassment from their peers would
end if they could lose weight and 69% felt that if they were thinner
they would have more friends.
There is a pernicious myth that the answer to obesity is “Eat less
and Move more” - this is simply untrue. Science tells us that weight
gain is easy - shifting it is hard. The human body is hardwired to
store energy as fat. There is a metabolic “set point”, similar to the
thermostat in your house, that will not shift by crash diets and their
like. The body’s thermostat will resist simple dietary measures which
is why there are thousands of “yo-yo” dieters who cannot keep the
weight off. Add into this the fact that food today is incredibly energy
dense and designed to be exceptionally palatable - to give that instant
hit to the pleasure centres in the brain - and stir in the realisation
that our entire environment is geared towards minimal effort
(remote controls, the explosion of cars for commuting, fast food
home delivery, escalators, lifts…) and the appearance of the obesity
epidemic is a no-brainer. We live in an obesogenic environment, and
the obesity epidemic is already here.
There are no simple answers - surgery is the most durable effective
treatment for obesity but we can’t operate on everyone. Prevention is
better than cure - it is also much cheaper than cure - but it requires
support across so many areas.
The Chinese have the longest journey starts with one step - food
education, sugar levys and increased school physical activities are
essential first steps. I believe there is a Sixth Age of Longevity but to
achieve it we have to make changes now.
Mr Magee operates at Spire Murrayfield Hospital and can be contacted
there. He can be followed on Twitter @mageefrcs.