Social inequality and the biological standard of living: an anthropometric analysis of Swiss conscription data, 1875-1950

Health of neonates born in the maternity hospital in Bern, Switzerland, 1880-1900 and 1914-1922

The identification of factors impeding normal fetal development and growth is crucial for improving neonatal health. Historical studies are relevant because they show which parameters have influenced neonatal health in the past in order to better understand the present. We studied temporal changes of neonatal health outcomes (birth weight, gestational age, stillbirth rate) and the influence of different cofactors in two time periods. Moreover, we investigated particularly neonatal health in the wake of the 1918/19 influenza pandemic. Data were transcribed from the Bern Maternity Hospital and consists of two time periods: A) The years 1880, 1885, 1890, 1895 and 1900 (N = 1530, births' coverage 20%); B) The years 1914-1922 (N = 6924, births' coverage 40-50%). Linear regression models were used to estimate the effect of birth year on birth weight, and logistic regression models to estimate the effect of birth year and of the exposure to the pandemic on premature birth, stillborn and low birth weight (LBW). Mean birth weight increased only minimally between the two datasets; whereas, in the years 1914-1922, the preterm birth and stillbirth rates were markedly reduced compared with the years 1880-1900. Sex, parity, gestational age and maternal age were significantly associated with birth weight in both time periods. The probability of LBW was significantly increased in 1918 (OR 1.49 (95% CI 1.00-2.23)) and in 1919 (OR 1.55 (95% CI 1.02-2.36)) compared to 1914. Mothers who were heavily exposed to the influenza pandemic during pregnancy had a higher risk of stillbirth (OR 2.27 (95% CI 1.32-3.9)). This study demonstrated that factors influencing neonatal health are multifactorial but similar in both time periods. Moreover, the exposure to the 1918/19 pandemic was less associated with LBW and more associated with an increased risk of stillbirth. If this trend is confirmed by further studies, it could indicate some consistency across pandemics, as similar patterns have recently been shown for COVID-19.

Intergenerational transmission of height in a historical population: From taller mothers to larger offspring at birth (and as adults)

Changes in growth and height reflect changes in nutritional status and health. The systematic surveillance of growth can suggest areas for interventions. Moreover, phenotypic variation has a strong intergenerational component. There is a lack of historical family data that can be used to track the transmission of height over subsequent generations. Maternal height is a proxy for conditions experienced by one generation that relates to the health/growth of future generations. Cross-sectional/cohort studies have shown that shorter maternal height is closely associated with lower birth weight of offspring. We analyzed the maternal height and offspring weight at birth in the maternity hospital in Basel, Switzerland, from 1896 to 1939 (N = ∼12,000) using generalized additive models (GAMs). We observed that average height of the mothers increased by ∼4 cm across 60 birth years and that average birth weight of their children shows a similarly shaped and upward trend 28 years later. Our final model (adjusted for year, parity, sex of the child, gestational age, and maternal birth year) revealed a significant and almost linear association between maternal height and birth weight. Maternal height was the second most important variable modeling birth weight, after gestational age. In addition, we found a significant association between maternal height and aggregated average height of males from the same birth years at time of conscription, 19 years later. Our results have implications for public health: When (female/maternal) height increases due to improved nutritional status, size at birth-and subsequently also the height in adulthood of the next generation-increases as well. However, the directions of development in this regard may currently differ depending on the world region.

Chest circumference and structural and short-term changes: a study of the Italian military call-up registers from 1881 to 1909

The aim of this study is to demonstrate the utility of chest circumference measurements as a proxy for the socioeconomic characteristics of past populations. Our analysis is based on over 80,000 military medical examinations relating to Friuli (north-eastern Italy), recorded from 1881 to 1909. Chest circumference can be used to describe changes in standard of living, but also seasonal variations in food intakes and physical activities. The findings show the way in which these measurements are highly sensitive not only to long-term economic changes but, above all, to short-term variations in some economic and social elements, like corn prices and occupations.

Short men in poor lands: The agrarian workers from southwestern Spain in anthropometric perspective

With a sample of heights of almost 60,000 men, born between 1855 and 1979 and recruited between 1876 and 2000, our work analyzes the nutritional gap between the agrarian and non-agrarian population in Extremadura, a Spanish region located among the poorest ones in Europe. The analysis reveals that this difference is not only statistically significant, but also tends to increase as the average stature of the active population grows. Among the causes of the agrarian height penalty, our article focuses mainly on the economic differences. However, the research also insists on the roots of these differences, especially those linked to the adverse physical conditions of the territory, the dynamics of the Christian conquest in the Middle Ages and the strong and persistent concentration of land ownership in the region. In short, this paper concludes that the anthropometric gap between agrarian and non-agrarian workers is due not only to economic causes, but also to geographical, historical and institutional reasons.

Life-history tradeoffs in a historical population (1896-1939) undergoing rapid fertility decline: Costs of reproduction?

Evolutionary demographers often invoke tradeoffs between reproduction and survival to explain reductions in fertility during demographic transitions. The evidence for such tradeoffs in humans has been mixed, partly because tradeoffs may be masked by individual differences in quality or access to resources. Unmasking tradeoffs despite such phenotypic correlations requires sophisticated statistical analyses that account for endogeneity among variables and individual differences in access to resources. Here we tested for costs of reproduction using N=13,663 birth records from the maternity hospital in Basel, Switzerland, 1896-1939, a period characterized by rapid fertility declines . We predicted that higher parity is associated with worse maternal and offspring condition at the time of birth, adjusting for age and a variety of covariates. We used Bayesian multivariate, multilevel models to simultaneously analyze multiple related outcomes while accounting for endogeneity, appropriately modeling non-linear effects, dealing with hierarchical data structures, and effectively imputing missing data. Despite all these efforts, we found virtually no evidence for costs of reproduction. Instead, women with better access to resources had fewer children. Barring limitations of the data, these results are consistent with demographic transitions reflecting women's investment in their own embodied capital and/or the adoption of maladaptive low-fertility norms by elites.

Biological Well-Being and Inequality in Canary Islands: Lanzarote (Cohorts 1886-1982)

Developments in anthropometric history in the Iberian Peninsula have been remarkable in recent decades. In contrast, we barely know about the behavior of insular population groups and infants' and adults' growth during the nutritional transition in the Canary Islands. This paper analyzes the height, weight and body mass index of military recruits (conscripts) in a rural municipality from the eastern Canaries during the economic modernization process throughout the 20th century. The case study (municipality of San Bartolomé (SB) in Lanzarote, the island closest to the African continent) uses anthropometric data of military recruits from 1907-2001 (cohorts from 1886 to 1982). The final sample is composed of 1921 recruits' records that were measured and weighed at the ages of 19-21 years old when adolescent growth had finished. The long-term anthropometric study is carried out using two approaches: a malnutrition and growth retardation approach and an inequality perspective. In the first one, we use the methodology recommended by the World Health Organization (WHO) that is based on z-scores. In the second one, we implement several inequality dimensions such as the coefficient of variation (CV), percentiles and an analysis for height and BMI evolution by five socioeconomic categories. The data suggest that improvements in biological well-being were due to advances in nutrition since the 1960s. They show that infant nutrition is sensitively associated with economic growth and demographic and epidemiological changes.

The association between male height and lifespan in rural Spain, birth cohorts 1835-1939

This article analyses the relationship between male height and age at death and its evolution over time among conscripts born in fourteen villages in north-east rural Spain. A total of 1,488 conscripts born between 1835 and 1939 (and who died between 1868 and 2019) have been included in the analysis (based on the study of 3 sub-periods: 1835-1869, 1870-1899, and 1900-1939). The height data have been obtained from military service conscription records and the demographic and socioeconomic information of the deceased was obtained from parish archives and censuses. The data have been linked according to nominative criteria using family reconstitution methods. For the statistical analysis, we have used ordinary least squares (OLS) linear regressions with heteroskedasticity-robust estimation. The results suggest a positive relationship between height and lifespan in the long-term. For the birth cohorts of 1835-1869, conscripts with a height of 170 cm or more lived on average 7.6 years longer than conscripts measuring less than 160 cm. This difference in life expectancy tended to disappear for the birth cohorts of 1900-1939, benefiting especially the short conscripts who had greater possibilities to increase their average lifespan. The reasons that might explain these changes could reside in the improvements experienced by this group in terms of their living conditions, health and nutrition during the twentieth century.

Height and health in late eighteenth-century England

Adult stature has become a widely used indicator of childhood nutritional status in historical populations and may provide insights into health inequalities that are not discernible in mortality rates. However, most pre-twentieth-century British data on heights suffer from selection biases. Here we present unique evidence on heights of adult males by occupation from an unbiased sample of adult males in Dorset in 1798-99. The mean height of fully grown (married) men was very similar to that of older military recruits, and our sample therefore confirms the taller stature of English males relative to males of other European countries in the same period. In contrast to previous evidence of negligible or U-shaped socio-economic gradients in mortality in this period, we found a fairly linear gradient in height by socio-economic status, that is similar in magnitude to class differences in adult height among English males born in the mid-twentieth century.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2020.1823011.

Rethinking the Fertility Transition in Rural Aragón (Spain) Using Height Data

Based on an analysis of the life trajectories of 2510 conscripts and their families from a Spanish rural area in the period 1835–1977, this paper studies the development of the fertility transition in relation to height using bivariate analyses. The use of heights is an innovative perspective of delving into the fertility transition and social transformation entailed. The results confirm that the men with a low level of biological well-being (related to low socio-economic groups) were those who started to control their fertility, perhaps due to the effect that increased average family size had on their budget. The children of individuals who controlled their fertility were taller than the children of other families. Therefore, the children of parents who controlled their fertility experienced the largest intergenerational increase in height (approximately 50% higher). This increase could be due to the consequence of a greater investment in children (Becker’s hypothesis) or a greater availability of resources for the whole family (resource dilution hypothesis).

Rural Height Penalty or Socioeconomic Penalization? The Nutritional Inequality in Backward Spain

This article studies the evolution of nutritional inequality, measured through the male adult height, in one of the poorest regions of Spain, in southwestern Europe: Extremadura. With a wide sample of statures of recruits born between 1855 and 1979, conscripted between 1876 and 2000, the research delves into the urban-rural height gap using coefficients of variation, tests of equality of means and proxy variables of a socioeconomic nature. The results of the analysis reveal that the strong anthropometric growth that Extremadura experienced since the last decades of the 19th century was accompanied by a less internal inequality. The lower heterogeneity did not eliminate, however, the urban-rural height gap during the period under study. In this sense, despite the absence of environmental differences between urban and rural areas in Extremadura, there was a clear rural height penalty in the region from the mid-19th century to the late 20th century. Rural punishment was fundamentally related to the greater presence of agrarian workers and the lower presence of wealthy families in villages and small towns. On the contrary, educational differences or differences in terms of nutritional health were not as decisive in the rural height penalization, at least when such differences are measured with the sources of military recruitment.

Height of Male Prisoners in Santiago de Chile during the Nitrate Era: The Penalty of being Unskilled, Illiterate, Illegitimate and Mapuche

This article contributes to the study of inequality in the biological welfare of Chile’s adult population during the nitrate era, ca. 1880s–1930s, and in particular focuses on the impact of socioeconomic variables on height, making use of a sample of over 20,000 male inmates of the capital’s main jail. It shows that inmates with a university degree were taller than the rest; that those born legitimate were taller in adulthood; that those (Chilean born) whose surnames were Northern European were also taller than the rest, and in particular than those with Mapuche background; and that those able to read and write were also taller than illiterate inmates. Conditional regression analysis, examining both correlates at the mean and correlates across the height distribution, supports these findings. We show that there was more height inequality in the population according to socioeconomic status and human capital than previously thought, while also confirming the importance of socioeconomic influences during childhood on physical growth.

Filling the weight gap: Estimating body weight and BMI using height, chest and upper arm circumference of Swiss conscripts in the first half of the 20th century

We estimate weight and BMI values based on height, chest circumference, and mid upper arm circumference measures of Swiss conscripts in the city of Zurich for each year between 1904 and 1932. Height, chest circumference, and mid upper arm circumference were measured each year from 1904 to 1951. Body weight is available from 1933 to 1951. We used prediction equations from the literature, and also developed our own equations, which we tested and validated on the dataset from 1933 to 1951. We used a representative sample of usually 19-year-old Swiss males (N = 88,792, coverage > 88 %). There was an increase in average height and chest circumference between 1904 and 1951. During both world wars, chest circumference, mid upper arm circumference, weight, and BMI decreased, while height stagnated. Overall mean weight and BMI increased from 1904 to 1951, but decreased during the Great Depression. After World War II, weight quickly returned to the pre-war and pre-Great Depression level, while BMI had not reached the 1933 level by 1951. Average weights of the lower and middle socioeconomic groups were catching up with average weight of the upper socioeconomic group from 1904 to 1951. The convergence in height is less pronounced. Finally, we show that it is possible to accurately predict mean weight and BMI from other anthropometric measurements. We suggest that our estimation approach could be replicated for other historical populations to obtain more information on how nutritional status changed over time.

Social class-specific secular trends in height among 19-year old Polish men: 6th national surveys from 1965 till 2010

The results presented in this study concern the assessment of the secular trend of body height in 10 % a random national sample (N = 134,224) representing all regions of Poland in 8 homogeneous social groups over 45 years in Poland (1965-2010). Very significant political, social and economic changes in Poland occurred in the period studied. The political revolution that began in Poland at the turn of the 1980s and 1990s dramatically changed the picture of social inequalities in the country. It rapidly transformed (in different directions and to a different degree) the economic situation, working conditions, lifestyles and the prestige of particular social classes and professional groups. A positive secular trend was observed in 19-year-old participants in the period analysed in all homogeneous socio-professional groups, however, with different intensity in each group. The highest body height increases in 1965-2010 were observed in the sons of farmers with post-primary father's education (7.77 cm). The lowest were observed among the sons of professionals, only 5.45 cm. Although social distances between extreme socio-economic groups significantly decreased (from 4.89 cm in 1965 to 2.76 cm in 2010), social gradients of body height, despite the improvement in the standards of living of the entire society remained exceptionally stable and unchanged for nearly half a century.

Ladies first: Female and male adult height in Switzerland, 1770-1930

When investigating the well-being of a society, the living conditions of females are of special importance, not only due to the immediate impact for those directly involved, but also because of the potential intergenerational effects. Studying the dimorphism in the mean height helps to depict variation in the basic biological sex difference due to gender-related factors that potentially determine net nutrition. To expand knowledge of diachronic development in Swiss well-being conditions we investigate changes in the height of adult females born 1770-1930, and compare the series with data on contemporary males from the same sources: We employ a sample of N = 21'028 women and N = 21'329 men from passport-, convict-, maternity hospital-, and voluntary World War II army auxiliary records. The secular height trend is found both in males, from the 1870s/1880s, and in females starting with the 1840s/1850s birth cohorts. During the decades under study, mean height increased from 157 cm to 164 cm in female and 167 cm to 172 cm in male passport applicants, 154 cm to 159 cm in female and 167 cm to 169 cm in male convicts, 159 cm to 163 cm in female auxiliaries, and 155 cm to 159 cm in females giving birth in the maternity hospital of Basel. Because females seem to have started the secular trend in height earlier than their male contemporaries, the height dimorphism decreased during the second half of the 19th century. Differences between socio-economic status (SES) and data sources are found in both females and males: Women with low SES were significantly shorter than those of the other SES groups in all sources (on average 1.40 cm, p-values between 0.00 and 0.03). In men we found individuals of upper SES to be significantly taller (on average 1.96 cm, p-value = 0.00-0.10). Concerning differences between the sources, overall, passport applicants were the tallest for men as well as women; in females the individuals measured at the maternity hospital and in prison were the shortest. The variances across the datasets highlight the importance of considering different sources to depict average living conditions. Noteworthy is the finding that the diverse sources under study all show the same trajectory of increasing mean height over the course of the 19th century. In the long run, the improving net nutritional status of Swiss females may have been one of the contributors behind the general rise in well-being of the country's population from the later 19th century onwards.

Pubertal height gain is inversely related to peak BMI in childhood

BACKGROUND

Childhood BMI may influence subsequent growth in height as well as the timing of puberty. The aim of the present study was to investigate associations between BMI in childhood and subsequent height gain/pubertal growth.

METHODS

Longitudinal growth data were used (GrowUp₁₉₉₀Gothenburg cohort, n = 1,901). The QEPS growth-model was used to characterize height gain in relation to the highest BMI_SDS value between 3.5 and 8 y of age. Children were defined as overweight/obese (OwOb) or normal weight/underweight (NwUw), using the 2012 International Obesity Task Force criteria.

RESULTS

A negative association between childhood BMI_SDS and pubertal height gain was observed. Already at birth, OwOb children were heavier than NwUw children, and had a greater height velocity during childhood. Onset of puberty was 3.5/3.0 mo earlier in OwOb girls/boys, and they had 2.3/3.1 cm less pubertal height gain from the QEPS-models specific P-function than NwUw children. Adult height was not related to childhood BMI.

CONCLUSION

We found that pubertal height gain was inversely related to peak BMI in childhood. Higher childhood BMI_SDS was associated with more growth before onset of puberty, earlier puberty, and less pubertal height gain, resulting in similar adult heights for OwOb and NwUw children.

What does the mean menarcheal age mean?-An analysis of temporal pattern in variability in a historical swiss population from the 19th and 20th centuries

OBJECTIVES

Age at menarche is one of the most important factors when observing growth and development. The aim of this study was to assess the temporal pattern in variability of menarcheal age for a historic Swiss population from the 19th and 20th centuries.

METHODS

Medical health records from the Bernese women's hospital (Switzerland) were analyzed. From 10,081 women of a historical Swiss population (born from 1815 to 1954), menarcheal age was calculated. A possible decline in average menarcheal age and variance and skewness were analyzed with the use of descriptive statistics, generalized additive models, and correlation.

RESULTS

Mean menarcheal age declined from 17.34 years (n = 358) around 1830 to 13.80 years (n = 141) around 1950. Within-cohort variance decreased from 7.5 to 2.1 year(2) . Skewness was negatively correlated with birth year (r = -0.58).

CONCLUSION

This study provided evidence for a secular trend in various statistical parameters for age at menarche since the 19th century. Furthermore, the results of the analysis of temporal pattern in variability revealed that the secular trend in menarcheal age happened in two phases. Am. J. Hum. Biol. 28:705-713, 2016. © 2016 Wiley Periodicals, Inc.

Body mass index values of conscripts in the Polish lands under Prussian rule in the late 19th and early 20th centuries

The Body Mass Index (BMI) of conscripts from the Polish lands under Prussian rule and its causative factors and changes over time was to characterize. A total of 9965 conscripts aged 20 were examined. Differences in the mean BMI were tested using one-way analysis of variance ANOVA and Tukey's-test (post-hoc test). Factor analysis and multiple regression were employed. The highest BMI values characterized sons of peasants, workers and craftsmen, and the lowest, sons of intelligentsia: the difference for peasants/intelligentsia -0.59kg/m(2) (p=0.0004), and that for workers/intelligentsia and craftsmen/intelligentsia, 0.48 and 0.5kg/m(2) (p=0.0004 and p=0.0057, respectively). The difference in BMI of conscripts from the first and last birth cohorts was 0.61kg/m(2) (p=0.0001). The highest BMI values were noted in conscripts from villages (21.50kg/m(2)), and the lowest, in those from towns (21.15kg/m(2)) and cities (21.19kg/m(2)). The differences for village/town and village/city were statistically significant (p=0.0026 and p=0.0026, respectively). The BMI difference between Poles and Germans was 0.35kg/m(2) (higher value among Poles).

Determinants of height and biological inequality in Mediterranean Spain, 1859-1967

This article analyses not only the determinants of the height of Spain's male populations between 1859 and 1960 but also the influence that social inequality had upon biological well-being. The height data of 82,039 conscripts constitute the principal source for this analysis. The study area comprises the current Valencian region, located in central Mediterranean Spain. During the period under study, the average height of conscripts increased by 7.5cm, while the coefficient of variation decreased by 0.6 between the 1870s and 1930 indicating that height inequality declined, although it increased by 0.2 among the cohorts born during the period of Francoist regime. Our results show that, in the long run, the height and biological well-being of the populations conscripted in Mediterranean Spain were determined by socioeconomic status and environmental contexts: that there was a close correlation among education, occupation, income, and stature. Literate conscripts were always taller than illiterate ones (by nearly 1cm), and agricultural workers, with fewer economic resources, were significantly shorter (by 3.6cm) than highly qualified non-manual workers.

Socioeconomic differences in child mortality in central Poland at the end of the nineteenth century

Analyses of historical or modern populations indicate a strong relationship between mortality level and standard of living, measured, among other factors, by degree of urbanization. The aim of this study was to assess mortality rates in children of up to 5 years of age in two populations living under different conditions in central modern Poland at the end of the 19th century: the rural parish of Kowal, under Russian partition, and Toruń, an industrial and urbanized centre under Prussian partition. Data on births and deaths were taken from birth certificate registries and from the Prussian statistics yearbooks for 1876-1894. Death rates of children aged 0-5 years were calculated, and also for annual age ranges. The urban population had lower birth rates (37.19‰), natural increase rates (8.0‰), population dynamics rates (1.26‰), which provide information about the relation between two components of a natural increase, i.e. births and deaths, and an over-mortality of boys in relation to girls. In the rural population these values were all higher: 53.67‰, 18.11‰ and 1.59‰ respectively. No impact was found of social stratification on child mortality in the wide age group of 0-5 years. However, for subsequent one-year age groups significant relationships between mortality level and size and industrialization level of the population centres were noted. The living conditions of infants in Toruń, although being in a better position as an area annexed by Prussia, were markedly worse than those of rural Kowal Parish. In the urban centre infant mortality was slightly over 269 for 1000 live born, and in Kowal Parish it was 163 for 1000 live born. The high infant mortality was balanced in Toruń by the higher mortality levels of children aged 2-5 years compared with Kowal Parish. Natural selection in the city had the greatest impact on infants, who did not have the protective influence of breast-feeding because women had to return to work shortly after giving birth. The lower infant mortality of mothers in the countryside due to longer breast-feeding led to larger family sizes. In 1871-1890 in the villages the number of children per women was about 7.42, whereas in Toruń it ranged from 4.4 to 5.2. The probability of death among children who survived the first year of life was higher in the countryside than the town. In the rural parish, perhaps because of cultural factors such as breast-feeding or working practices making full-time baby-sitting possible, children who did not reach the age of 1 year were not subjected to such intensive natural selection. Overall, differences in child mortality in the two centres in 19th central Poland resulted from ecological and cultural conditions, rather than from social and economical reasons (living under different partitions).

Lessons from history of socioeconomic improvements: a new approach to treating multi-drug-resistant tuberculosis

This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.

"From growth in height to growth in breadth": the changing body shape of Swiss conscripts since the late 19th century and possible endocrine explanations

Because Swiss conscription has been mandatory and standardized since 1875 and measurement procedures for height and weight have not changed, recruitment data (representative for 80-100% of the living young men) provide a solid foundation for a detailed study of changes of young men in Switzerland over the past 140 years. The average Swiss body height increased markedly by 15 cm between the 1870s and the 1970s (birth years). Improvements in living conditions are likely to have been among the main environmental determinants of this increase, but there are other likely candidates, all of which worked via the endocrine system. First, widespread iodine deficiency at the end of the 19th century helps to account for an overrepresentation of very short conscripts, for the low level of average height in Switzerland in general as well as for the tremendous regional variation in average height. Second, the doubling of annual per capita milk consumption between 1875 and 1900 was probably a key factor in the height increase, operating directly on IGF-1 concentration. Third, public-health measures, such as the iodine-deficiency prophylaxis via weekly iodine tablets for schoolchildren and via iodized table salt, introduced in the 1920s, may have been largely responsible for the dramatic increase in height during the interwar period. Since the 1970s (birth years), the positive height trend slowed down, body shape in Switzerland has evolved from growth in height to growth in breadth. Precisely how today's complex of genetic, epigenetic, environmental, and endocrine factors limiting height growth and promoting body breadth and excess weight operates has yet to be completely understood.