title: The hidden cost of moving up: type 2 diabetes and the escape from persistent poverty in the American South.
abstract: OBJECTIVE
  The paper tests the thrifty phenotype hypothesis, according to which nonharmonious growth trajectories are costly for adult health.
  
  
  METHODS
  The American surge in the prevalence of type 2 diabetes is concentrated in the South, a region characterized by a long history of poverty followed by rapid economic growth beginning in the 1960s. Civil rights legislation further accelerated income growth for African-Americans in the region. The paper investigates the hypothesis by using per capita income at the state level as a proxy for net nutritional conditions.
  
  
  RESULTS
  Regressions at the state level explain 56% of the variation in the prevalence rate of type 2 diabetes in 2009 using two explanatory variables: the ratio of per capita income in 1980 to that in 1950 and the share of the population that was African-American. The paper discusses ways that rapid economic growth may have translated into weight gain and type 2 diabetes.
  
  
  CONCLUSIONS
  If the thrifty phenotype hypothesis is correct, future rates in the prevalence of type 2 diabetes are predictable based on income history. The forecast for rapidly developing countries such as India and China are ominous.
authors.affiliation: Economics, Anthropology and History Departments, Ohio State University, 1945 N. High St., Columbus, OH 43210, USA. Steckel.1@osu.edu
authors.forename: Richard H
authors.initials: RH
authors.lastname: Steckel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000208:ethnology; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology