Quality of life by age, sex and body mass index

Just a quick post on some data reported in Section 6 of NICE Clinical Guideline 43 (originally from a 2004 publication by Macran) which reports quality of life (QoL) by sex, and BMI and age brackets:1Macran S. The Relationship between Body Mass Index and Health-Related Quality of Life. 190. 2004. York, The Publications Office, Centre for Health Economics. Centre for Health Economics Discussion Paper.

NICE CG43 QoL Figure

The only unexpected aspect of the data is the high QoL in males with BMI greater than 40 aged 25-34 and females aged 18-24, but that’s likely driven by low sample size. Otherwise, there’s a general downward trend with age and an inverted J-shaped curve with respect to BMI, which approximately mirrors the J-shaped curves observed when plotting BMI against mortality 2Berrington de Gonzalez A, Hartge P, Cerhan JR et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9.,3Tobias DK, Pan A, Jackson CL et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014;370(3):233–44.,4Dudina A, Cooney MT, Bacquer DD et al. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators. Eur J Cardiovasc Prev Rehabil. 2011;18(5):731-42. and certain diabetes complications.5Sohn MW, Budiman-Mak E, Lee TA, Oh E, Stuck RM. Significant J-shaped association between body mass index (BMI) and diabetic foot ulcers. Diabetes Metab Res Rev. 2011;27(4):402–9.

References   [ + ]

1. Macran S. The Relationship between Body Mass Index and Health-Related Quality of Life. 190. 2004. York, The Publications Office, Centre for Health Economics. Centre for Health Economics Discussion Paper.
2. Berrington de Gonzalez A, Hartge P, Cerhan JR et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9.
3. Tobias DK, Pan A, Jackson CL et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014;370(3):233–44.
4. Dudina A, Cooney MT, Bacquer DD et al. Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators. Eur J Cardiovasc Prev Rehabil. 2011;18(5):731-42.
5. Sohn MW, Budiman-Mak E, Lee TA, Oh E, Stuck RM. Significant J-shaped association between body mass index (BMI) and diabetic foot ulcers. Diabetes Metab Res Rev. 2011;27(4):402–9.

50ms

As had been widely anticipated, Apple announced the Apple Watch (styled WATCH in the logo mark) on Tuesday 9th. There is much to consider and much that’s still unknown about the device, but it certainly looks like it will initially make an interesting accessory to the iPhone and, in time, a useful free-standing addition to the gadget armamentarium. I’ll reserve overall judgement until it’s released, but the positioning of the Apple Watch is certainly worth considering now.

While the Apple Watch clearly does function as a timepiece, I found the name odd at first. As MG Siegler noted regarding the choice of name:

“It’s a hell of a lot more than a watch. I find the name at best lazy, at worst boring.”

But name aside, the Apple Watch wasn’t introduced as being only a watch. Horace Dediu wrote a typically insightful piece on the three “tentpoles” (key features) of the Apple Watch as listed by Tim Cook in the keynote:

  • A precise timepiece
  • A new, intimate way to communicate
  • A comprehensive health and fitness device

And to be fair, Apple did cover the non-timepiece tentpoles thoroughly in the keynote (in addition to the payment aspect, the ability to use it as a hotel door key, a remote control and the world’s smallest photo album, etc.). But I still found the emphasis on the time-telling abilities of the watch curious at first. There was repeated mention of the watch’s 50 millisecond accuracy in the Keynote. At 59:55 into the keynote, almost the first thing Tim Cook said about the watch was the following:

“We set out to make the best watch in the world. One that is precise. It’s synchronized with a universal time standard and it’s accurate within plus or minus 50 milliseconds.”

Then at 70:22, Jony Ive says:

“Apple Watch is incredibly accurate. It uses multiple technologies keeping time to plus or minus 50 milliseconds. We have worked closely with horological experts from around the world to help us understand the cultural and historical significance of timekeeping.”

Certainly in the technology world, ±50 millisecond accuracy is unimpressive to the point of actually being relatively inaccurate. NTP, which has been around since 1985, is comfortably able to synchronise a device to within a few milliseconds of UTC over a decent internet connection. And since the Apple Watch relies on the iPhone, presumably it’s actually just synchronising to the iPhone’s internal clock, which in turn is set using NTP and/or the cellular carrier and/or the GPS signal. So although Tim Cook put forth “precision timepiece” as one of the tentpoles of the Apple Watch, I was still left wondering about the emphasis on the watch’s accuracy. For a company that is usually both plainspoken and concise in their communication, it struck me as odd that they would draw attention to this unremarkable technological feat twice in ten minutes.

But thinking about it a bit more, I think the emphasis relates to where the watch (lowercase “w”) exists at the intersection of technology, fashion and timekeeping. It’s clear from the event invitees, some of Apple’s recent hires, and the extremely high quality of the devices, that the Apple Watch is competing not with existing smartwatches, but with watches full stop. While the S1 “computer on a chip” clearly does represent haute technologie, Apple is aiming first and foremost for haute horologie. Looking at the 50ms from a programmer’s perspective is completely misguided. By framing the Apple Watch in the same technical class as mechanical watches from Patek Philippe, Jaeger-LeCoultre, et al., Apple is likely trying to make it clear that, along with its exquisite aesthetics, the Apple Watch also holds its own against the precision, accuracy and meticulous engineering found in timepieces from the established Swiss watchmakers.

Now, it’s worth noting that no one in the market for a high-end watch would actually be swayed by the 50 millisecond accuracy argument. After all, a $10 Casio watch keeps time better than a Rolex and, at the high end of the watch market, people aren’t actually all that concerned with sub-second timekeeping accuracy (Patek Philippe watches might drift by, say, one second a day). But I can see Apple’s reasoning here. They’re a new entrant to the watch market and they need to demonstrate that they’re getting the basics right. By conveying that image of precision out of the gate, they’re trying to put themselves on an even footing with extremely prestigious brands in a completely new market for them.

Obviously the traditional watchmakers themselves have not reacted well to this, dismissing the Apple Watch as a fad (as opposed to the “eternity in a box” provided by traditional Swiss watchmakers). Their haughtiness is perhaps in part an early attempt to thwart Apple’s early marketing efforts and put some distance between the Apple Watch and their own products in customers’ minds. But then it’s probably also fuelled by the fact that Apple has recently made a good few strategic hires from amongst their ranks and perhaps even a sense of panic the likes of which haven’t been felt by incumbents since the launch of the original iPhone.