I first heard about the Blue Zones project when I learned that some “moms” (their term) in Wilton were suggesting that we become a Blue Zones town, and I started to read up on it.

The term “blue zone” was coined by Belgian demographer Michel Poulain when studying the characteristics of centenarians in Sardinia, where he and his coworkers realized there was an unusual cluster of very old people in this region, and they drew a circle around the cluster using a blue marker. Imagine the controversy if he had used a red marker!

Soon journalist Dan Buettner had jumped into this study, travelling to this and several other regions to report on the clusters of centenarians in and discuss common characteristics among them. This led to an article he wrote for National Geographic and to a 2008 book, revised in 2012: Blue Zones, 9 lessons fir living longer from people who lived the longest. Note that while Buettner is a very polished writer, he is not a scientist and has no scientific training nor an advanced research degree.  He could just as well have interviewed centenarians near where he lives, and this might had been equally interesting, and would have eliminated some of the cultural differences among the groups he wrote about.

He boiled down his findings to nine basic points (trademarked as The Power of Nine), some obvious and some rather unusual, but never tested his findings using any sort of control groups. Boiled down, these are

• Move naturally (avoid mechanical aids)
• Find a sense of purpose
• Find time to relax and downshift
• Eat until “80% full,” exclaiming Hara bachi bu, (or maybe Hakuna matata, or perhaps Ai ai Cthulu!)
• Eat more vegetables
• Drink wine at 5
• Belong to a religious group
• Put your family first
• Choose a support social circle.

Being a scientist myself, I was surprised to discover that Buettner never published any of his findings in actual peer-reviewed scientific journals, but only in his popular book and magazine articles, so his conclusions have never been subjected to scientific scrutiny or peer review. Instead, Buettner formed a Blue Zones organization to try out his recommendations in a few communities. He then licensed the Blue Zones brand to Healthways of Tennessee who is involved in promoting these findings as a commercial enterprise.

Further, Buettner seems to have committed correlation without causation. Or as one of my colleagues called it, the Texas Sharpshooter Fallacy, where the target shooter shoots bullets at the side of a barn, and then draws a target around the bullet holes! To put it more clearly, he has not proven that any of these common findings cause longevity. He has not set up any kind of control group or test to prove their efficacy.

Academics respond

I contacted a couple of researchers who have written scientific articles about centenarians, and both responded to me.

Professor Jeremy Yorgason at Brigham Young University said, in part,

“…My understanding is that the “Blue Zones” work is aimed at replicating diet and other trends found in such areas. I agree with the principles put forth by those that encourage blue zone trends among seniors, however I’m not a fan of the commercialism they have introduced. Nutritious diet, exercise, and genetics will all influence our longevity. Environment likely also plays a role. People have some control over some of these factors, and I encourage us to do what we can to live healthy into our later years.  I hope this helps.”

Professor Stuart Jay Olshansky at the University of Illinois, Chicago, said:

“I reviewed their proposal for National Geographic when it was first thought of, and I rejected the Blue Zone idea because Dan was not going to verify the ages of the alleged centenarians — he didn’t know this was important. So, he connected with someone who can do this reliably. That part of the science is now sound. He exaggerates the importance of diet as genetics is critical in these folks, and I was not happy early on that they were selling items from the various locations as longevity boosters, which supposedly they stopped doing.  However, there are also some strong elements to what they do.  I think there’s little doubt that pockets of exceptional longevity exist. Does that help?”

 

Professor Eric D. Carter

Perhaps the most wide-ranging criticism of the project came from Professor Eric Carter of Macalester College, published in the journal Social Science and Medicine, titled Making Blue Zones: Neoliberalism and nudges in public health promotion.

Carter notes that the Blue Zones Project (BZP) is a “place-based, community centered and commercial health promotion enterprise, and that it advocates a kind of “deep neoliberalism—neoliberal govermentality.” In social science jargon, “neoliberalism” refers to programs where the individual has to take responsibility for his own health, rather than being provided by a government entity. He calls this “libertarian paternalism” whose purpose is to “nudge” people towards healthy behaviors.

In fact, the BZP is “thoroughly desocialized” and more or less ignores health problems associated with poverty, unemployment, race, ethnicity, education or other social determinants. He cautions about the role of “lifestyle” or “wellness” industry professionals in framing the discussion about healthy places.

Carter notes that some of Buettner’s points, such as “sense of purpose” and “belong to a faith-based community” are unlikely to be cited by health professionals, and while Buettner claims that these can add up to 7 years to your life expectancy, this individualizes findings that are aggregate and probabilistic in nature.

Further, I suggest that the idea that communing with an imaginary Sky-Daddy having an effect on health is probably much too narrow. You might achieve the same group comfort from singing in a community chorus or playing Bingo weekly.

The original demonstration community, Albert Lea, MN adopted Buettner’s recommendations for a 10 month trial run, building more sidewalks (but only in the downtown area) and residents agreed to “deconvenience” their lives, walking more and putting aside snowblowers for snow shovels, a recommendation that cardiologists might dispute. At the end of this period using an on-line “Vitality Calculator,” they claimed residents had added 3.1 years to their life expectancy. However, their simple diet and exercise questions have not actually been validated.

And, the BZP has almost nothing to say about the health care sector: doctors, clinics, and hospitals. It concentrates on health-promotion and lifestyle management. Not having medical buy-in to this project seems short-sighted.

It also has nothing to say about diseases, other than making the preposterous claim that one Greek man living in the U.S., Stamatis Moriatis, had developed “terminal lung cancer,” but on return to his home in Ikaria, the disease eventually vanished, as if the healthy village lifestyle somehow cured his cancer. Spontaneous remission in cancers do happen, but outlandish claims like this one border on magical thinking. Buettner has spread articles about Moriatis all over the Internet, but that does not make them true. And he presents no medical evidence.

The Iowa Project

Carter notes that the BZP cooperated with Iowa Governor Terry Branstad to set up four demonstration sites, and after a competition among Iowa cities, four northern locations were chosen: Cedar Falls, Waterloo, Mason City (home of The Music Man’s con game) and Spencer. Financing for these 4 projects was provided by Iowa’s Wellmark Blue Cross, who paid Healthways $25 million for the five year demonstration. This also means that all Iowans did not have equal access to the potential benefits: another trait of such neoliberal projects.

In Iowa’s case, Branstad wanted to use the BZP to avoid expanding Medicaid for the Affordable Care Act, giving the BZP a political tinge as well.

Iowa outcomes

Recently, we learned that Cedar Rapids and Marion, IA were dropping the Blue Zones project. At the end of the demonstration period, towns had to pay to continue, and

“Cost was a factor as we would have to pay to continue to use the brand and tap into their Blue Zones network,” said Geoff Fruin, Iowa City manager.”

Cedar Rapids was selected as a Blue Zones demonstration site in 2013 and certified in 2016.

Cedar Rapids contributed up to $25,000 a year matched by $30,000 over three years from Linn County, and about $50,000 total in private contributions to pay for four full time staff members and office space, said Assistant City Manager Sandi Fowler.

She said the fee to renew with Blue Zones is considered proprietary information, and therefore was confidential.

Discussion

The BZP, according to Carter, is classic neoliberal governmentality: a commercial venture with a public-private partnership that asks people to take responsibility for and govern themselves. Such a system can only work in a homogeneous community and has no remedy for “persistent structural causes of health inequality.”

The BZP requires community buy-in to such things as “walkability and bike-ability,” that may require substantial investment to achieve. Wilton is a rural New England community, and outside of the diminutive downtown area of a couple of dozen stores, there are basically no sidewalks or bike paths. The town is built on rocky hills, and such construction could run into millions of dollars. It is instructive to note that most of the demonstration communities are in the Midwest, where there are few hills, while towns like Wilton are nearly all hills, making walkability and bike-ability that much harder to achieve.

Much of what BZP proposes amounts to changes in eating habits, which they then proudly trumpet in aggregate weight loss statistics. This is essentially a diet, and research has continually shown that diets do not work. People tend to regress to the mean about the time the demonstration period ends.

Further, the BZP has frequently suggested things like small bowls as glasses in restaurants to keep people from overeating. Unfortunately this is all based on Brian Wansink’s work at Cornell, nearly all of which has been retracted and Wansink dismissed from Cornell for essentially faking his data!

Improving physical activity and eating more vegetables are laudable goals and based on solid science, but Buettner’s insistence on including religion and “sense of purpose” are not. While there is no question that the Wilton organizers have their hearts in the right place,  the BZP is not a science project, but a profit-making entity who plays its cards rather close to the vest. If they were a non-profit, I might consider their proposal, but a profit-making business who won’t disclose their fees does not impress me.

It probably is one we should not get involved in.

Fort Worth

We just learned that in Fort Worth , the project has had little success. After 2 years, reported BMIs are still rising, and given Texan’s steak and pick-up truck habits, this will probably take a very long time. Meanwhile the original Blue Zones are fading away, and demographer Michel Poulain has noted that the eating habits of Okinawa are much like anywhere else, and the obesity much the same. Similar findings are reported for Ikaria.

Oh, and to top it all off, it’s recommend by Doctor Oz!