So let’s say you’re seeing your doctor, whether for a checkup or an acute problem. She looks you over carefully. Just on the basis of your appearance, she decides you’re at risk for significant health problems.
Sure, most readers of this blog are aware that appearance counts for a lot (too much!) when it comes to work and dating. But in the doctor’s office? Did you know that one common measure of health is whether you look your age? For all the time I’ve spent studying medicine, this practice was new to me.
Researchers at St. Michael’s Hospital in Toronto report, via Eurekalert:
“Few people are aware that when physicians describe their patients to other physicians, they often include an assessment of whether the patient looks older than his or her actual age,” says Dr. Stephen Hwang, a research scientist at St. Michael’s Hospital and an associate professor at the University of Toronto. “This long standing medical practice assumes that people who look older than their actual age are likely to be in poor health, but our study shows this isn’t always true.”
For patients, it means looking a few years older than their age does not always indicate poor health status. The study found that when a physician rated an individual as looking up to five years older than their actual age, it had little value in predicting whether or not the person was in poor health. However, when a physician thought that a person looked 10 or more years older than their actual age, 99 per cent of these individuals had very poor physical or mental health.
Where I live – in an Appalachian county in Southeast Ohio – I suspect you actually do see lots of people who look a decade older than their chronological age. I’m basing this on anecdata gathered partly while in the waiting room at the ob/gyn’s office, where grandmothers-to-be often accompany their young pregnant daughters. I live in a pocket of endemic poverty. Poverty does beat people down. It ensures that they’ll grab cheap, satiating calories over a bunch of colorful veggies – just because it’s not pleasant to go to sleep at night with a gnawing sensation in one’s belly. We know that diabetes, for instance, is rampant in this region. So is extreme obesity.
But the pitfalls of using appearance as a proxy for health ought to be obvious, too. Take, for example, your faithful blogger Sungold, whose miraculously youthful complexion is due to … being born near the 49th latitude with her head in a book. I think I probably do look a few years younger than my age (especially compared to the local population) just because I didn’t get much sun as a youngster. But does that mean I’m healthy? Long-time readers know that I’ve got something undiagnosed, which is sort of like fibromyalgia and a bit like thyroid issues and a mimic of multiple sclerosis – but is apparently none of the above.
People who have a medical problem but look healthy are not well served by this rough-grained appearance test. Doctors will tend to dismiss their complaints because hey, they don’t look sick.
People who look much older than their actual age may also be poorly served. For example, too many doctors address problems like obesity on a radically individualized level, often with a dollop of shaming for letting oneself get too fat. The people in my region look old because they face multiple oppressions. Whatever wise or foolish decisions they’ve made in the past, they need a doctor to propose constructive solutions, not prejudge them based on appearance.
I hope doctors will take this study to heart and move toward evidence-based medicine when it comes to appearance. By all means, if someone looks extraordinarily aged, use that as a reason to inquire further. But do inquire. Please do ask. Appearance can only project a 2-D image. Patients’ words and embodied experiences can supply the essential third dimension.
Patron cat of Kittywampus (1985-2001)
I agree with you that appearances can be deceiving with respect to health, however there’s one big thing that I don’t think you address directly in this post: stress. Stress is one of the biggest factors in making people look older before their time. Whether it’s the stress of a high powered job (look at how much our presidents age in their 4 to 8 years in office) or grinding poverty, stress will make people look older and it’s decidedly not good for their health.
I suspect that the five years older range is the 49th parallel with a lifetime of sunblock effect, but the 10 years or more seems like it’s more likely indicative of chronic stress.
Yes! This is one hazard of blogging on the fly, late in the evening – it’s easy not to connect the dots. When I spoke of people enduring multiple oppressions, stress is absolutely the main connection between their social situation and the state of their health. While it’s true that high-powered jobs are stressful and can take a real toll, the literature has pretty consistently found that low-income people suffer an even greater toll from stress, precisely because they are so often powerless.
It’s great to hear from you. I hope all is well with you and Baby Fizz (who must be approaching Toddler Fizz by now?).
While it’s true that high-powered jobs are stressful and can take a real toll, the literature has pretty consistently found that low-income people suffer an even greater toll from stress, precisely because they are so often powerless.
Very much so. I tend to think of two things when I read that sentiment: Terry Pratchett and The Warmth of Other Suns.
For the life of me I can’t remember which novel it is, but Pratchett talks at one point about how one of the things that’s so grinding about being poor is the inability to make small capital investments that make life much easier and save money in the long run. The example in the story is boots: it costs more to keep buying cheap ones that fall apart every year and aren’t nice to your feet than it does to buy the expensive ones that are very comfortable and last a long time. And the need to keep oneself shod prevents saving money which would enable you to move up. There’s no upward mobility if you can’t take the incremental steps that would help you advance. It’s the small things that make you aware that you’re stuck and not going anywhere and that has to be grinding.
There’s a bit in The Warmth of Other Suns (which is an AMAZING book) where Isabel Wilkerson tries to explain the lessons that black families are teaching their children about survival in the Jim Crow south and how fear (plus subservience) is going to be the only thing that keeps them alive. She kind of uses it to rationalize what I’d probably call child abuse (i.e., whipping kids for any perceived insolence), but she’s also trying to explain that these families are working to survive in the only way they know how and making sure their kids know it too. You don’t have to be powerless in the way that black Americans were in the Jim Crow south to feel that sense of powerlessness.
Of course, I also suspect that the way in which social welfare and public assistance programs are run in the US doesn’t give anyone who receives benefits any warm cozy feelings about their lives. The US is big into judging the poor and making them demonstrate their worthiness for aid. Nothing like reminding people of their lot in life to make it less stressful…
Baby Fizz is doing really well, and is most assuredly into toddlerhood. She just passed the 16 month mark and is charging around with the sort of vigor you’d expect at that age.
Oh my – 16 months is a really wild ride, or at least that’s how I remember it – to the extent I remember anything at all!
I haven’t read anything by Pratchett, but the boots example could be multiplied thousands of times. Investing in birth control is another one – the cost can be prohibitive for poor people, and yet a child is so much more expensive.
One of the things I’ve heard from African-American students I’ve taught is a pretty high acceptance of corporal punishment. I was one of the few kids of my generation to *never* get a spanking. A majority of my students now come from families where physical punishment was rare or nonexistent. But nearly all of my African-American students experienced it.