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samedi 16 juillet 2011


Frequent Fliers, Obesity and Heart Disease
Gone are the days when flying around the world was a glamorous affair, when flying to distant locale itself had an exciting connotation. Nowadays most of the “jet setters” are middle-level managers of corporate world, lugging their luggages and computers, often deprived of the luxuries afforded to the senior managers who sit upfront in the aircraft and enjoy good wines and a nice dinner winging their way to their destinations.
A recent study published article on the increased prevalence of obesity and heart attacks among the frequent flying jetsetters has caught some attention. Any one spending time at airports in North America or Europe will confess to the stress experienced while transiting through them. Not all airports are modeled after Changi in Singapore or Kuala Lumpur International airport where there are some provisions made for wary travellers.
The airports I frequent in North America are Houston, Newark and Miami; these are major hubs for air transport. The quality of food available at three of these mega airports are slightly worse than the quality available in the streets of these respective cities, that itself is not saying very much.
All three are crowded with comfortable seating while waiting for your flight, especially before you go through security clearance, is hard to come by.
On this context, one can understand why frequent fliers become obese and often suffer from heart attacks from their flying-related cardiac diseases.
They are most often seen rushing from point to point, as mentioned they are at the mercy of the bad food at the airports. There is the stress of boarding and flight delays. The hotels near the airports are what convenience stores are to supermarkets, just a place to lay down for a few hours to wait for the next connection. All these do add up to the stress, in addition to the stress of being a corporate middle- manager, which itself is dangerous to your health.
Professor Sir Michael Marmot who had conducted the mammoth Whitehall study about British Civil Servants, says:
So I spent quite a lot of time looking at it in the first Whitehall study, and the remarkable finding, which ran counter both to my expectations at the time, and I think most other people's, was firstly, just looking at heart disease, it was not the case that people in high stress jobs had a higher risk of heart attack, rather it went exactly the other way: people at the bottom of the hierarchy had a higher risk of heart attacks. Secondly, it was a social gradient. The lower you were in the hierarchy, the higher the risk.
Initially they thought the British civil servants a peculiar breed, but it extended not only to the rest of Britain but also countries such as Australia, New Zealand and some European countries. In a follow up study, Whitehall II, the earlier studies were confirmed and also the so called intangibles were identified as the important ingredients. We always look for tangible causes of disease: smoking, obesity, sedentary occupation, cholesterol but this study shows the importance of the mind-body connection when it comes to the reality of modern life.
Sir Michael:
So then the question is, what is it about position in the hierarchy that determines different rates of disease? And given that, the hierarchy in disease does change. All societies may have hierarchies, but we know that the social gradient in disease is not fixed. It's bigger in some places than others, and it can change over time. That could be because the magnitude of the hierarchies change, but there's always hierarchies. But, more importantly, it suggests what is it about where you are in the hierarchy that's related to disease, and can we do something about that? So you ask, is it money? Is it prestige, self-esteem? And, in fact, what I think is, it is has much more to do with how much control you have over life circumstances, and the degree to which you're able to participate fully in society; what Amartya Sen calls capabilities.

Human values, but in the end -- I'm a British empiricist, so human values, I think, are absolutely crucial here. But I'm also interested in empirical demonstration of how they translate into pathology, because in the end people go and get sick, and a value sounds like something rather abstract -- that it's the mind, where, in fact, what happens in the mind has a crucial impact on what happens in the rest of the body. The mind is part of our biological makeup as well. So the empirical study is how the sets of values translate into people's perception of reality, and that, in turn, changes physiology and leads to risk of disease. So we're trying to deal in a crude way with a mind/body question of how the one translates into the other.

For those of us, who have been interested in this mind body interface in our clinical practice, these words of Sir Michael are reassuring indeed.
And find a way to understand the stressed Frequent Flier and how to offer a solution to their distress.
I am a frequent flier (in the first six months of this year, two trips to Asia, five trips to the USA, from France among others) and I have found that taking care of your mind is very important while offering the body a bit of refuge as well.
Be loyal to one airline and they would be loyal to you with upgrades and offers of Business Class seats at economy prices or for free. Also when there is a delay in the flight or cancellation, the elite frequent fliers are attended to first.
Always be a member of the Club belonging to your favourite airline so that you have a refuge at busy airports, with free Internet, beverages and some clubs, reasonable repasts. Outside USA, such as ANA lounge in Tokyo or Virgin Atlantic lounge in London, the lounges are bistros, offer massages and haircuts and an array of drinks and other conveniences.

Relaxation is the key.

Recently I flew, Kuala Lumpur to Miami with stops in Bangkok, Tokyo and Houston. I thought about my trip the day before and deliberately had a slow day. Also made sure that I had a good sleep before boarding the flight since I was to spend the next two nights on planes. Continental Airlines as a reward for my being a loyal customer organized the entire flight, in Business Class.

Another thing which is important to me is the presence of a friend at the airport when you arrive after a very long intercontinental flight. Miami to Kuala Lumpur with stops in Frankfurt and Bangkok can be tedious, if you want to think that way, but the smiling face of my best friend in Asia waiting for me at KLIA and even the very thought of it was soothing.
Bon Voyage!