A century of healthy bestsellers the skinny on childbirth trends east versus west in the Bay State emulating Popeye stress and depression in Boston and New Bedford

Big sales for light reads

In any given week, as many as half of the nonfiction bestsellers in the US are health-related–with diet books the most common subgenre. That wasn’t always the case, and a look at Publishers Weekly annual bestseller lists over the past century shows that the reading habits of the health-conscious have changed quite a bit over the years.

Actually, there was one hugely popular diet book during the 1920s. Lulu Hunt Peters’s Diet and Health with a Key to the Calories recommended chewing your food very slowly–possibly to make eating such a chore that it loses its appeal. But during the next two decades, many bestsellers focused on public health and on the heroic efforts of doctors to battle pestilence. There was Hans Zinsser’s Rats, Lice, and History, a greatest-hits book about microbial diseases; Victor Heiser’s memoir An American Doctor’s Odyssey, about conquering leprosy in the Philippines; and Gordon Seagrave’s autobiographical Burma Surgeon, about bringing modern medicine to a remote region of Asia.

After World War II, “self-help” books came into their own. In 1951, Gayelord Hauser’s Look Younger, Live Longer denounced “empty” foods full of white flour and refined sugar. In 1956, the top nonfiction book of the year was Dan Dale Alexander’s Arthritis and Common Sense, signaling a big audience for books about problems that come with longer life expectancies. Four years later, the top seller was D.C. Jarvis’s Folk Medicine, which instructed people on how to treat minor ailments without seeing a doctor. By 1968, diet books overshadowed all other kinds of medical topics. For the first time, there were three diet books among that year’s top 10: The Doctor’s Quick Weight Loss Diet, The Weight Watcher’s Cook Book, and Better Homes and Gardens Eat and Stay Slim. They have been ubiquitous since then, with Dr. Atkins’ Diet Revolution in 1972 and The Complete Scarsdale Medical Diet in 1979 standing out as especially big sellers.

But a more recent phenomenon is what might be called the extreme self-help book. In 1980, Norman Cousins’s Anatomy of an Illness as Perceived by the Patient pretty much ended the presumption that you could learn more from doctors than from the people they treated. And in 1991, Derek Humphry challenged the idea that one’s doctor should have the last word, writing one of the more surprising bestsellers of all time: Final Exit: The Practicalities of Self Deliverance and Assisted Suicide for the Dying.

In with the new

Earlier this year the Department of Public Health released “Massachusetts Births 2002,” its annual report on all things maternal in the Bay State. According to the DPH, a record 28.2 percent of all births in Massachusetts were delivered by cesarean section in 2002. Since 1997, c-sections have increased by an average of 7 percent per year. Also on the upswing are multiple births (twins, triplets, etc.), which accounted for 4.9 percent of all births in 2002–almost double the 1990s rate of 2.6 percent.

Massachusetts is ahead of the curve in the increasingly common practice of putting off childbirth until later in life. The average age of first-time mothers here in 2002 was 28.0 years, considerably above the national average of 25.1 years.

Walking tall

The American Podiatric Medical Association recently designated Boston as the third best “walking city” in America, behind New York and San Francisco. Boston scored especially high in the number of people who walk to work (13 percent of the population) and the number of health clubs per capita. Where was it lame? The number of podiatrists per capita.

Directional signals

In April, the state Department of Public Health released its annual “Profile of Health Among Massachusetts Adults” (five months earlier and 10 pages longer than the previous edition), and reminded us that statewide figures often mask regional differences. Based on a telephone survey of nearly 7,500 Massachusetts residents conducted in 2002, the report noted that an unlucky 13.3 percent described their health as “fair or poor,” up from 12.1 percent the year before. That figure was highest (14.7 percent) in the southeastern part of the state and lowest in Metrowest (10.6 percent). Boston proper was the only region not to see an increase from year to year (it dropped from 15.4 percent to 14.1 percent), but the city is helped by its relatively youthful population. When the DPH adjusted for regional differences in age distribution, Boston actually ranked highest, with 17.1 percent of its inhabitants reporting fair or poor health.

In several respects, Boston’s population skews toward the healthier side. The number of respondents with “six or more teeth missing” ranged from 11 percent in Boston to 23 percent in western Massachusetts. Overweight respondents ranged from 46 percent in Boston to 59 percent in the central part of the state. But on the delivery of certain health services, Boston comes up short. In Metrowest, 70 percent of children received dental sealant (a procedure to prevent tooth decay), but only 43 percent of Boston children got the same benefit.

One of the most striking regional differences was limited to women who had been pregnant in the previous five years. Only 10 percent of respondents in Metrowest reported an “unplanned” pregnancy, whereas 37 percent of those in the southeastern part of the state said that their pregnancies had been unplanned.

Mind your peas and kumquats

One of the few questions on the Department of Public Health’s telephone survey that produced a large gender gap had to do with diet. Thirty-five percent of the female correspondents claimed to eat at least five servings of fruits and vegetables per day, but only 24 percent of men said the same thing. Overall, 29.7 percent of the state’s respondents said they eat like Popeye.

The DPH data was integrated into the Centers for Disease Control’s annual health survey, which put Massachusetts in a tie for second place with Maryland, and just behind Connecticut, in the percentage of residents saying that their “average frequency of fruit and vegetable consumption” is more than five times a day. At the other end of the scale, only 14.4 percent of people in Oklahoma made the same claim.

Either Bay Staters have unusually responsible diets or they know how to give pollsters unusually responsible-sounding answers.

Sleepless in New Bedford?

The Hub may be calm, but other parts of the state are feeling a bit tense, according to a new study of “Stressful Cities” in America. Sperling’s BestPlaces, which publishes a variety of “where to live” guides, measured such factors as divorce rates, commuting times, alcohol consumption, and cloudy days to conclude that Boston is only the 77th most stressful of 100 metropolitan areas in the US. Springfield was a bit more jittery, but at 63rd place it was still more easygoing than most large cities. Tacoma, Wash., was the most stressful (all that rain or all that coffee?), and Albany, NY, was at the blissful bottom.

Meet the Author

But the picture wasn’t as mellow for a couple of smaller Massachusetts cities. Lawrence was the 41st most stressful out of 114 mid-sized metro areas, and New Bedford ranked 34th out of 117 smaller metro areas.

The Sperling study didn’t rank entire states, but a federal Centers for Disease Control survey in 2001 placed Massachusetts almost squarely in the middle (tied for 21st) in the percentage of residents reporting “poor mental health” within the previous month. Thirty-four percent of Bay State respondents said they had had the blues, compared with 43 percent in first-place Utah and 16 percent in last-place Hawaii (or did people in the “island paradise” feel too guilty to admit they were depressed?).