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21) Time in partnership with CNN

Wednesday, Mar. 03, 2010

Titanic vs. Lusitania: How People Behave in a Disaster

By Jeffrey Kluger

It's hard to remember your manners when you think you're about to die. The human species may have developed an elaborate social and behavioral code, but we drop it fast when we're scared enough — as any stampeding mob reveals.

That primal push-pull is at work during wars, natural disasters and any other time our hides are on the line. It was perhaps never more poignantly played out than during the two greatest maritime disasters in history: the sinking of the Titanic and the Lusitania. A team of behavioral economists from Switzerland and Australia have published a new paper in the Proceedings of the National Academy of Sciences (PNAS) that takes an imaginative new look at who survived and who perished aboard the two ships, and what the demographics of death say about how well social norms hold up in a crisis. (See the top 10 scientific discoveries of 2009.)

The Lusitania and the Titanic are often thought of as sister vessels; they in fact belonged to two separate owners, but the error is understandable. Both ships were huge: the Titanic was carrying 2,207 passengers and crew on the night it went down; the Lusitania had 1,949. The mortality figures were even closer, with a 68.7% death rate aboard the Titanic and 67.3% for the Lusitania. What's more, the ships sank just three years apart — the Titanic was claimed by an iceberg on April 14, 1912, and the Lusitania by a German U-Boat on May 7, 1915. But on the decks and in the passageways and all the other places where people fought for their lives, the vessels' respective ends played out very differently.

To study those differences, the authors of the PNAS paper — Bruno Frey of the University of Zurich and David Savage and Benno Torgler of Queensland University — combed through Titanic and Lusitania data to gather the age, gender and ticket class for every passenger aboard, as well as the number of family members traveling with them. They also noted who survived and who didn't. (See a survival guide to catastrophe.)

With this information in hand, they separated out one key group: all third-class passengers age 35 or older who were traveling with no children. The researchers figured that these were the people who faced the greatest likelihood of death because they were old enough, unfit enough and deep enough below the decks to have a hard time making it to a lifeboat. What's more, traveling without children may have made them slightly less motivated to struggle for survival and made other people less likely to let them pass. This demographic slice then became the so-called reference group, and the survival rates of all the other passenger groups were compared to theirs.

The results told a revealing tale. Aboard the Titanic, children under 16 years old were nearly 31% likelier than the reference group to have survived, but those on the Lusitania were 0.7% less likely. Males ages 16 to 35 on the Titanic had a 6.5% poorer survival rate than the reference group but did 7.9% better on the Lusitania. For females in the 16-to-35 group, the gap was more dramatic: those on the Titanic enjoyed a whopping 48.3% edge; on the Lusitania it was a smaller but still significant 10.4%. The most striking survival disparity — no surprise, given the era — was determined by class. The Titanic's first-class passengers had a 43.9% greater chance of making it off the ship and into a lifeboat than the reference group; the Lusitania's, remarkably, were 11.5% less likely. (See pictures of the Queen Elizabeth 2's final voyage.)

There were a lot of factors behind these two distinct survival profiles — the most significant being time. Most shipwrecks are comparatively slow-motion disasters, but there are varying degrees of slow. The Lusitania slipped below the waves a scant 18 min. after the German torpedo hit it. The Titanic stayed afloat for 2 hr. 40 min. — and human behavior differed accordingly. On the Lusitania, the authors of the new paper wrote, "the short-run flight impulse dominated behavior. On the slowly sinking Titanic, there was time for socially determined behavioral patterns to reemerge."

That theory fits perfectly with the survival data, as all of the Lusitania's passengers were more likely to engage in what's known as selfish rationality — a behavior that's every bit as me-centered as it sounds and that provides an edge to strong, younger males in particular. On the Titanic, the rules concerning gender, class and the gentle treatment of children — in other words, good manners — had a chance to assert themselves.

Precisely how long it takes before decorum reappears is impossible to say, but simple biology would put it somewhere between the 18-min. and 2-hr. 40-min. windows that the two ships were accorded. "Biologically, fight-or-flight behavior has two distinct stages," the researchers wrote. "The short-term response [is] a surge in adrenaline production. This response is limited to a few minutes, because adrenaline degrades rapidly. Only after returning to homeostasis do the higher-order brain functions of the neocortex begin to override instinctual responses."

Once that happened aboard the Titanic, there were officers present to restore a relative sense of order and to disseminate information about what had just happened and what needed to be done next. Contemporary evacuation experts know that rapid communication of accurate information is critical in such emergencies.

Other variables beyond the question of time played important roles too. The Lusitania's passengers may have been more prone to stampede than those aboard the Titanic because they were traveling in wartime and were aware that they could come under attack at any moment. The very nature of the attack that sank the Lusitania — the sudden concussion of a torpedo, compared to the slow grinding of an iceberg — would also be likelier to spark panic. Finally, there was the simple fact that everyone aboard the Lusitania was aware of what had happened to the Titanic just three years earlier and thus disabused of the idea that there was any such thing as a ship that was too grand to sink — their own included.

The fact that the two vessels did sink is an unalterable fact of history, and while ship design and safety protocols have changed, the powder-keg nature of human behavior is the same as it ever was. The more scientists learn about how it played out in disasters of the past, the more they can help us minimize loss in the future.

____________________________________22) America’s War on the Overweight



Anti-fat rhetoric is getting nastier than ever. Why our overweight nation hates overweight people.

By Kate Dailey and Abby Ellin | Newsweek Web Exclusive 

Aug 26, 2009 | Updated: 8:08 a.m. ET Aug 26, 2009

Correction (published Sept. 28, 2009): This article originally misrepresented activist MeMe Roth's comments on Jordin Sparks, and since been corrected. It also stated that Roth "derided" Jennifer Love Hewitt for having cellulite, when in fact Roth noted that Hewitt was of a healthy weight and body size, and caught in an unflattering light.

Practically the minute President Obama announced Regina M. Benjamin, a zaftig doctor who also has an M.B.A. and is the recipient of a MacArthur "genius grant," as a nominee for the post of Surgeon General, the criticism started.

The attacks were vicious—Michael Karolchyk, owner of a Denver "anti-gym," told Fox News' Neil Cavuto, "Obesity is the No. 1 issue facing our country in terms of the health and wellness, and she has shown not that she was born this way, not that she woke up one day and was obese. She has shown through being lazy, and making poor food choices, that she's obese."

"This is totally disgusting to have some one so big to be advocating health," wrote one YouTube commenter.

The anger about Benjamin wasn't the only example of vitriol hurled at the overweight. Cintra Wilson, style columnist for The New York Times, recently wrote a column so disdainful of JCPenney's plus-size mannequins that the Times' ombsbudman later wrote that he could read "a virtual sneer" coming through her prose. A NEWSWEEK post about Glamour’s recent plus-size model (in fact, a normal-sized woman with a bit of a belly roll) had several commenters lashing out at the positive reaction the model was receiving. "This model issue is being used as a smoke screen to justify self-destructive lifestyle that cost me more money in health care costs," one wrote. Heath guru MeMe Roth has made a career crusading against obesity, and made waves when she suggested that American Idol contestant Jordin Sparks needed to lose weight. (That MeMe Roth is considered something of an extremist doesn't stop the media attention) Virtually any news article about weight that is posted online garners a slew of comments from readers expressing disgust that people let their weight get so out of control. The specific target may change, but the words stay the same: Self-destructive. Disgusting. Disgraceful. Shameful. While the debate rages on about obesity and the best ways to deal with it, the attitudes Americans have toward those with extra pounds are only getting nastier. Just why do Americans hate fat people so much?

Fat bias is nothing new. "Public outrage at other people's obesity has a lot to do with America from the turn of the 20th century to about World War I," says Deborah Levine, assistant professor of health policy and management at Providence College. The rise of fat hatred is often seen as connected to the changing American workplace; in the early 20th century, companies began to offer snacks to employees, white-collar jobs became more prominent, and fewer people exercised. As thinness became rarer, says Peter N. Stearns, author of Fat History: Bodies and Beauty in the Modern West and professor of history at George Mason University, it was more prized, and conversely, fatness was more maligned.

At the same time, people also paid a lot of attention to President Taft's girth; while Taft was large, he wasn't all that much heavier than earlier presidents. Newspapers questioned how his weight would affect diplomacy and solicited the funniest "fat Taft" joke. "This [period] is also when you get ready-to-wear clothing," says Levine. "For the first time, [people were] buying clothes in a certain size, and that encourages a comparison amongst other people." Actuarial tables began to connect weight and shorter lifespan, and cookbooks published around World War I targeted the overweight. "There was that idea that people who were overweight were hoarding resources needed for the war effort," Levine says. She adds that early concerns were that overweight American men would not be able to compete globally, participate in international business, or win wars.

Fatness has always been seen as a slight on the American character. Ours is a nation that values hard work and discipline, and it's hard for us to accept that weight could be not just a struggle of will, even when the bulk of the research—and often our own personal experience—shows that the factors leading to weight gain are much more than just simple gluttony. "There's this general perception that weight can be controlled if you have enough willpower, that it's just about calories in and calories out," says Dr. Glen Gaesser, professor of exercise and wellness at Arizona State University and author of BigFat Lies: The Truth About Your Weight and Your Health, and that perception leads the nonfat to believe that the overweight are not just unhealthy, but weak and lazy. Even though research suggests that there is a genetic propensity for obesity, and even though some obese people are technically healthier than their skinnier counterparts, the perception remains "[that] it's a failure to control ourselves. It violates everything we have learned about self control from a very young age," says Gaesser.

In a country that still prides itself on its Puritanical ideals, the fat self is the "bad self," the epitome of greed, gluttony, and sloth. "There's a widespread belief that fat is controllable," says Linda Bacon, author of Health at Every Size: The Surprising Truth About Your Weight. "So then it's unlike a disability where you can have compassion; now you can blame the individual and attribute all kinds of mean qualities to them. Then consider the thinner people that are always watching what they eat carefully—fat people are symbols of what they can become if they weren't so virtuous."

But considering that the U.S. has already become a size XL nation—66 percent of adults over 20 are considered overweight or obese, according to the Centers for Disease Control—why does the stigma, and the anger, remain?

Call it a case of self-loathing. "A lot of people struggle themselves with their weight, and the same people that tend to get very angry at themselves for not being able to manage their weight are more likely to be biased against the obese," says Marlene Schwartz, director of the Rudd Center for Food Policy and Obesity at Yale University. "I think that some of this is that anger is confusion between the anger that we have at ourselves and projecting that out onto other people." Her research indicates that younger women, who are under the most pressure to be thin and who are also the most likely to be self-critical, are the most likely to feel negatively toward fat people.

As many women's magazines' cover lines note, losing the last five pounds can be a challenge. So why don't we have more compassion for people struggling to lose the first 50, 60, or 100? Some of it has to do with the psychological phenomenon known as the fundamental attribution error, a basic belief that whatever problems befall us personally are the result of difficult circumstances, while the same problems in other people are the result of their bad choices. Miss a goal at work? It's because the vendor was unreliable, and because your manager isn't giving you enough support, and because the power outage last week cut into premium sales time. That jerk next to you? He blew his quota because he's a bad planner, and because he spent too much time taking personal calls.

The same can be true of weight: "From working with so many people struggling with their weight, I've seen it many times," says Andrew Geier, a postdoctoral fellow in the psychology department at Yale University. "They believe they're overweight due to a myriad of circumstances: as soon as my son goes to college, I'll have time to cook healthier meals; when my husband's shifts change at work, I can get to the gym sooner.…" But other people? They're overweight because they don't have the discipline to do the hard work and take off the weight, and that lack of discipline is an affront to our own hard work. (Never mind that weight loss is incredibly difficult to attain: Geier notes that even the most rigorous behavioral programs result in at most about a 12.5 percent decrease in weight, which would take a 350-pound man to a slimmer, but not svelte, 306 pounds).

But why do the rest of us care so much? What is it about fat people that makes us so mad? As it turns out, we kind of like it. "People actually enjoy feeling angry," says Ryan Martin, associate professor of psychology at the University of Wisconsin, Green Bay, who cites studies done on people's emotions. "It makes them feel powerful, it makes them feel greater control, and they appreciate it for that reason." And with fat people designated as acceptable targets of rage—and with the prevalence of fat people in our lives, both in the malls and on the news—it's easy to find a target for some soul-clearing, ego-boosting ranting.

And it may be, that like those World War I-era cookbook writers, we feel that obese people are robbing us of resources, whether it's space in a row of airline seats or our hard-earned tax dollars. Think of health care: when president Obama made reforming health care a priority, it led to an increased focus on obesity as a contributor to health-care costs. A recent article in Health Affairs, a public-policy journal, reported that obesity costs $147 billion a year, mainly in insurance premiums and taxes. At the same time, obesity-related diseases such as type 2 diabetes have spiked, and, while diabetes can be treated, treatment is expensive. So the overweight, some people argue, are costing all of us money while refusing to alter the behavior that has put them in their predicament in the first place (i.e., overeating and not exercising).

The reality is much more complicated. It's a fallacy to conflate the unhealthy action—overeating and not exercising—with the unhealthy appearance, says Schwartz: some overweight people run marathons; eat only organic, vegetarian fare; and have clean bills of health. Even so, yelling at the overweight to put down the doughnut is far from productive. "People are less likely to seek out healthy behaviors when they're criticized by friends, family, doctors, and others," says Schwartz. "If people tell you that you're disgusting or a slob enough times, you soon start to believe it." In fact, fat outrage might actually make health-care costs higher. In a study published in the 2005 issue of the Journal of Health Politics, Policy and Law, Abigail Saguy and Brian Riley found that many overweight people decide not to get help for medical conditions that are more treatable and more risky than obesity because they don't want to deal with their doctor's harassment about their weight. (For instance, a study from the University of North Carolina found that obese women are less likely to receive cervical exams than their thinner counterparts, in part because they worry about being embarrassed or belittled by the doctor because of their weight.)

The bubbling rage against fat people in America has put researchers like Levine in a difficult position. On the one hand, she says, she wants to ensure that obesity is taken seriously as a medical problem, and pointing out the costs associated with obesity-related illnesses helps illustrate the severity of the situation. On the other hand, she says, doing so could increase the animosity people have toward the overweight, many of whom may already live healthy lives or may be working hard to make heathier choices.

"The idea is to fight obesity and not obese people," she says, and then pauses. "But it's very hard for many people to disentangle the two."



Correction: Due to an editing error, this article originally attributed Andrew Geier as saying that rigorous behavior-based weight loss programs result in a 25 percent decrease in weight, not 12.5 percent. The statistic, and corresponding example, have been corrected.

____________________________________23) Time in partnership with CNN



Friday, Feb. 12, 2010

Orthorexia: Can Healthy Eating Be a Disorder?

By Bonnie Rochman

Kristie Rutzel was in high school when she began adhering precisely to the government food pyramids. As the Virginia native learned more about healthy eating, she stopped ingesting anything processed, then restricted herself to whole foods and eventually to 100% organic. By college, the 5-ft. 4-in. communications major was on a strict raw-foods diet, eating little else besides uncooked broccoli and cauliflower and tipping the scales at just 68 lb. Rutzel, now 27, has a name for her eating disorder: orthorexia, a controversial diagnosis characterized by an obsession with avoiding foods perceived to be unhealthy.

As the list of foods to steer clear of (bye-bye, trans fats and high-fructose corn syrup) continues to grow, eating-disorder experts are increasingly confronted with patients like Rutzel who speak of nervously shunning foods with artificial flavors, colors or preservatives and rigidly following a particular diet, such as vegan or raw foods. Women may be more prone to this kind of restrictive consumption than men, keeping running tabs of verboten foods and micromanaging food prep. Many opt to go hungry rather than eat anything less than wholesome.

Yet when Rutzel first sought help for anemia and osteopenia, a precursor of osteoporosis triggered by her avoidance of calcium, her doctor in upstate New York, where she attended college, had never heard of orthorexia. "You should be trying to eat healthy," she remembers him telling her. He couldn't quite grasp that he was talking to a health nut who believed there were few truly healthy foods she felt were safe to eat. Her condition was eventually identified as anorexia, a diagnosis that organizations like the Washington-based Eating Disorders Coalition think is a mistake. The group, which represents more than 35 eating-disorder organizations in the U.S., wants orthorexia to have a separate entry in the bible of psychiatric illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

For the past decade, psychiatrists have been working on the fifth edition of the DSM — referred to as DSM-V — to refine the classifications used by mental-health professionals to diagnose and research disorders. Without a listing in the DSM, it's tough to get treatment covered by insurance. And for researchers angling for grant money, a disorder's absence from the DSM makes it hard to get research funded.

On Wednesday, the first draft of DSM-V was published online, kicking off a three-year process of public comment and further revisions that will culminate in a new and improved version come 2013. Orthorexia is not listed in this new draft and, despite the ongoing efforts of various eating-disorder groups, is unlikely to make its way into the final edition.

"We're not in a position to say it doesn't exist or it's not important," says Tim Walsh, a professor of psychiatry at Columbia University who led the American Psychiatric Association's work group that reviewed eating disorders for inclusion in DSM-V. "The real issue is significant data." Getting listed as a separate entry in the DSM requires extensive scientific knowledge of a syndrome and broad clinical acceptance, neither of which orthorexia has.

Most doctors think a separate diagnosis is unwarranted. Orthorexia might be connected to an anxiety disorder or it might be a precursor to a more commonly diagnosed condition, says Cynthia Bulik, director of the eating-disorders program at the University of North Carolina at Chapel Hill. "We don't want people to be mislabeled and not get the care they need because they're actually on the slippery slope to anorexia," she says.

Kathleen MacDonald, who oversees legislative policy at the Eating Disorders Coalition, agrees with Bulik that people should get the care they need. Which is precisely why she thinks orthorexia should have its own classification. Although Bulik and others often use cognitive behavioral therapy, in which patients like Rutzel are coached to replace obsessive thoughts with healthy ones, MacDonald worries there is not enough known about which treatments work best for orthorexia. "It's hit-or-miss," she says.

After seeking help at three different facilities, Rutzel finally embraced a program of meal plans that challenged her to gradually incorporate foods she had blacklisted. Still slim in a size 2, she is engaged to a man whose oldest daughter is 9. And Rutzel says she is looking forward to sharing her experiences with food with her soon-to-be stepdaughter. "It's O.K. to eat potato chips and Pop-Tarts," says Rutzel, "but only every now and then."



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