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The Mystery of the Dying British Bus Drivers

More than 50 years ago, epidemiologists in the UK realized that the death rate among British bus drivers was twice that of bus conductors. This was from all causes of death—heart attacks, cancer, strokes, everything. During their investigations, they concluded the villain was inactivity.  Back then, and until recently, there were two operators on every bus (most of them the familiar double-deckers). First, a driver who simply sat in his seat all day and drove, and second, a conductor who scrambled around like a monkey, up and down the stairs, making his way among passengers, collecting fares in the ka-ching-y machine strapped to his waist.

This was really one of the first times doctors began to appreciate the link between early death and an inactive, sedentary life or, conversely, the protective effects of physical activity. Being overweight or obese wasn’t taken much into account back then as many of the drivers were of normal weight. Now, a half century later, the link between a sedentary life and early death has been reconfirmed in dozens of studies worldwide.

But also during the past 50 years, more than 50% of us became either overweight or obese. And just as you’d expect, being both inactive and overweight places you at even greater health risks than the inactive-but-normal-weight bus drivers.

To keep things simple, you need to know the answers to several questions (you likely know a lot of this already):

  1. “If I’m sedentary but not overweight, am I risking my health?” Answer: YES. You’re just like the bus driver.
  1. “Is this risk reversible by increasing my activity level?” Answer: YES (definitely).
  1. “If I’m overweight or obese, do I have increased health risks?” Answer: Have you been living on Mars?
  1. “If I lose weight, will it lower my risks?” Answer: See #3
  1. “If I’m overweight and inactive, is this the worst place to be?” Answer: See #3
  1. “I’m inactive and I can’t lose weight! Or I lose it and just gain it back again? Is there nothing I can do that will reduce my risks?!” Answer: YOU ARE IN LUCK!

Obviously, both losing weight and getting religious about physical activity would be ideal, but if you did one with gusto and were less successful with the other, you’d still come out ahead.

Are weight and inactivity separate risks?
Which now brings us to a massive study (more than 300,000 patients) from the UK published this week in the American Journal of Clinical Nutrition.

The study’s conclusion answered one troubling question: Can weight and inactivity be considered separate risks? And the answer here is yes. It’s even worthwhile to treat them separately.

What this means is that if you’re both overweight and inactive, if you’re among the majority who can’t get the weight off and keep it off, simply exercising will dramatically reduce a lot of your risks. This is in the realm of really important information because many people who are overweight mistakenly think they’ll lose weight with exercise, becoming discouraged and depressed when they don’t lose it and then give up on exercising.

I’m here to tell you this is all wrong. Regular exercise will reduce many of the health risks associated with both being overweight and inactive. Even if you don’t lose the weight you want, you’ll come out ahead. By doing something physical every day, you’ll make a significant improvement in your longevity. And FYI, according to the investigators the minimum is a brisk 20-minute walk every day of your (now longer) life.

The reason this study is so important is readily apparent to anyone who has struggled to lose weight, which is about half of us, including me. We all know that it’s much (much!) easier to exercise than it is to lose weight. In fact, you can do something physical right this minute but it might take you months to get your weight to a level you’re happy with.

But a second study adds a warning…
A recent and well publicized article showed protracted sitting of any kind, whether you’re driving a bus or tucked into a cubicle staring at a computer screen, increases your disease and death risks, reconfirming the bus driver issue. But what was especially disappointing was that eight hours of sitting and then exercising was not as helpful as breaking up the workday with physical activity.

Ideally, the bus driver and the conductor would switch jobs every hour. For you, if you have a sedentary job, break it up with some physical activities during the day (climb a few flights of stairs, for example). Then at the end of the day (or before work, if you’re an early riser), head to your health club two or three times a week for something really strenuous.

In fact, it might be a good idea to download one of the many apps that monitor how much you’re actually walking during the day (fitbit does this handily, too, and so does a plain old pedometer). One of my patients, a waitress in a busy restaurant, told me she averages five miles at work alone, and a mile walking to and from her L stop. And from a flight attendant: Parking lot, through O’Hare, the flight, and home again, four miles.

Don’t expect a lot of help from your doctor (unless you’re at WHC)
As a side note, a recent article in the British Medical Journal took primary care physicians to task for their failure to provide patients with nutritional counseling, weight control guidance, and exercise recommendations. This revelation became apparent with the increasingly widespread use of electronic medical records, whose charts can be audited and recommendations made. The chart evaluations found that among obese and overweight patients virtually no medical recommendations had been made for healthy eating, calorie restriction, referrals to nutritionists, or exercise programs.

Of course, none of this applies if you happen to be a WholeHealth Chicago patient. We have three nutritionists ready and waiting, rulers poised ready to rap your knuckles (kidding), and with increased encouragement from health insurers to cover nutritional counseling, you can’t say we didn’t offer!

Be well,
David Edelberg, MD

PS:  Because of the popularity and beneficial effects of the HCG (human chorionic gonadotropin) weight-loss program, WholeHealth Chicago is presenting a short workshop to discuss the HCG protocol.  I will be there with Seanna Tully, one of our nutritionists. Though it’s free and open to all, due to limited seating please call and reserve a space for Monday, February 9th at 6:30 pm.  773-296-6700


Leave a Comment

  1. Jude Mathews says:

    I imagine the bus driver study did not account for the potential of stress to affect health. As an urban car owner, I shudder to think of the cumulative effect of years of driving some 2,000 hours per year. The conductors may have had their particular stressors, but those associated with driving would not have been among them. They also may have had a chance to “shake off” their irritations with a little vigorous bus-stair climbing.
    I am neither a doctor nor an epidemiologist, but I believe that stress will be soon come to be seen as a “top five” killer and will easily beat adipose tissue to the finish line.

  2. Dr E says:

    Hi Jude
    During the 1950’s and 1960’s, stress was only beginning to be considered as a health risk. Nowadays, so many people are stressed to the gills, that “stress” is indeed being regarded as a major health risk. I fully agree with you–it’s safer to be overweight and go through life relaxed than be of normal weight and living in a constant fight-or-flight mode
    Dr E

  3. Dr E says:

    Hi Jude
    You’re totally correct. Back during the bus driver study, stress was not appreciated as a health risk. Over the years, researchers appreciated the deleterious effects of the bus drivers facing tight schedules, traffic jams, angry passengers, filthy air and other factors that contributed to their mortality. I fully agree that a life fraught with unrelenting stress is far more dangerous than a few extra pounds.

  4. Catherine says:

    I agree with Jude and stress in this country and throughout a large part of the world is dangerously high. Also, isolation and lack of supportive relationships is a health risk. Our society requires change for quality of life. Thank you for an interesting article and study.

  5. Even better, the bus driver’s salivary cortisol and DHEA-S levels taken in comparison to the bus conductors would have given us a clue as to how much stress was indeed involved with causing a much higher mortality rate here. It is not stress itself that is the issue, but how the person handles the stress. Some patients I see live high stress lifestyles and are perfectly well, whereas others live low stress lifestyles and are on all kinds of drugs both prescribed and recreational.

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Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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