The Oldest Old and their Foundational Years

There is a wealth of evidence to support Lifestyle Medicine in healthy ageing. What interests me as a geriatrician though, is considering the early lifestyles that set the foundations for our oldest old.

It is well known that having a strong foundation in childhood is key to becoming a healthy adult and sound and appropriate nutrition is one of three fundamentals; the other two being stable and responsive relationships and a safe and supportive physical environment (1).

The 1920’s was a period where Britain was recovering from the “Great War.” The government still controlled certain food prices and there was the ever present shadow of food shortages. The mainstay of the diet was carbohydrate laden food such as potatoes and bread with the addition of refined sugars. Those who could, were able to afford meat or dairy (2). But for those families out of work or without a “breadwinner” this was a time of hunger. Consequently, mortality rates were high for those living in poverty (3).

However, the 1920’s was also a decade of greater understanding of nutrition and the need for good quality diets as opposed to just copious quantities of any food. Even in this era there was much scientific debate about what constituted a healthy diet. With many physicians publicly denouncing fad diets, with such statements as ‘My advice to the people is to have a sufficient and varied supply of wholesome food and not to bother about vitamines’(sic)(4). Nutritional charts with recommended daily intake of food groups and vitamins were also published. School meals were provided and nutritional support was offered to women in maternity clinics.

It was also during this period that US producers started to market convenience foods such as breakfast cereals and soon enough sugary confectionary started to become more readily available.

During the 1930s, diets continued to improve and ever more food was imported. At the start of the second world war, 76% of cheese, 88% of flour, 82% of sugar, 55% of meat and 40% of eggs came from abroad (5). As the war started the fear of food shortages became a real possibility and this prompted the resurrection of the Land Army (originally formed in 1917) and rationing was introduced in 1940. Because of the decades of work on nutrition, it is now considered to be one of the healthiest periods in British history. People had more to eat, there was a greater focus on fresh fruit and vegetables and refined grains were not as easily available. The infant mortality rate fell, children were taller and heavier and life expectancy increased. Importantly, the nutrition gap between poorer and wealthier individuals declined significantly (6). Rationing continued until 1954, with meat being the last item to remain rationed.

Of course, during this period very few people had cars, there were was no television or computer games. People relied on public transport, walking or cycling and children spent more time out doors (7). Clearly the war was a period of immense loss and suffering which cannot be underplayed but it was also a period where community mostly came together and briefly, the nutritional societal playing field was levelled.

As I watch society around me and notice younger patients attending hospital with complications of lifestyle related diseases. I do genuinely wonder, if we are seeing the last generation of the oldest old. Recently, I was stuck by two pieces of information. Firstly, prior to the pandemic it was noted that in England life expectancy had stalled (8). Secondly, it is predicted by 2050 that half of all children will be living with obese (9). I do not suggest we return to rationing which came about through circumstances we would never wish to repeat but I do suggest that there is a greater focus on early years nutrition by the government (as there was during the second world war) to embed lifelong habits that can lead into healthy adulthood.

References:

1. https://developingchild.harvard.edu/science/deep-dives/lifelong-health/
2. Phil Lyon & Ethel Kautto (2022) A healthy diet: British newspaper narratives in the 1920s, History of Retailing and Consumption, DOI: 10.1080/2373518X.2022.2129190
3. Gazeley, Ian; Newell, Andrew T.; Reynolds, Kevin; Rufrancos, Hector Gutierrez (2018) : Nutrition in Interwar Britain: A Possible Resolution of the Healthy or Hungry 1930s Debate?, IZA Discussion Papers, No. 11588, Institute of Labor Economics (IZA), Bonn
4. Phil Lyon & Ethel Kautto (2022) A healthy diet: British newspaper narratives in the 1920s, History of Retailing and Consumption, DOI: 10.1080/2373518X.2022.2129190
5. https://www.findmypast.co.uk/1939register/britain-food-1930s
6. https://www.medicalnewstoday.com/releases/9728#1
7. https://www.iwm.org.uk/history/how-childrens-lives-changed-during-the-second-world-war
8. https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england
9. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/287943/07-1469x-tackling-obesities-future-choices-summary.pdf