Is taller better?
CONVENTIONAL wisdom has it that taller men make more money, get more dates and are more likely to win a presidential election. Shorter women aren’t taken seriously, and boys and girls both suffer psychologically well into adulthood if they’ve grown up the shortest in their class. Right?
Well, maybe ... or maybe not. What people thought they knew about the height advantage doesn’t always hold up to the cold eye of psychological and sociological research. Experts are digging deeper into data on the consequences of shortness, and though recent studies validate some of society’s long-held assumptions about height, others are getting chipped away -- even dismissed.
“There is little or no evidence that making short people taller changes their lives in any meaningful way,” says Dr. Norman Fost, professor of pediatrics and bioethics at the University of Wisconsin Medical School.
The reality of the relative advantages of being tall is increasingly important because in 2003 the Food and Drug Administration approved the use of synthetic growth hormone for kids with idiopathic short stature, or shortness for no apparent medical reason.
The treatment, an injection every day for many years, is expensive and not consistently covered by insurers. The average benefits -- an increase of about 2 inches in height -- are modest. Although no one expects ill health consequences down the road, no one really knows for sure what might happen. And critics say all this risk and expense is aimed at altering healthy children who are objects of social prejudice, rather than attacking the prejudice itself.
There’s little doubt that short kids get teased, even occasionally ridiculed. But most grow up to do just as well as their taller taunters. Take the common perception that employers discriminate against short men in hiring and income. That isn’t exactly what happens. It turns out the much-touted income advantage of height is more closely linked to high school experiences than to hiring practices in the adult workplace. And when brothers are studied, one tall and one short, the two have exactly the same employment opportunities and income, regardless of height.
“There’s still a widespread perception that male success is measured in stature,” says Dalton C. Conley, chairman of the sociology department at New York University. “But in terms of total income, earnings and occupational outcomes, the male height issue is really a red herring.”
Other widely held notions about short people do hold up. Based on history, there can be no doubt that Americans like their presidents tall. And on the dating scene, women go for taller men. When it comes to romance, height is often a deal-breaker.
Children who can be treated for idiopathic short stature are the shortest 1.2%, measuring 2.25 or more standard deviations below the mean, according to FDA guidelines. That translates, for 10-year-old boys and girls, to 4 feet, 1 inch and to a projected adult height of less than 4 feet, 11 inches for females and less than 5 feet, 3 inches for males.
Some of these children are short simply because both parents are short. But, the FDA panel reasoned, maybe the parents, grandparents and on down the family line were short for some as-yet-unidentified medical reason. If children of short stature with a known medical diagnosis, such as growth hormone deficiency, can be treated to help them grow taller, children whose very short stature has no presently known cause should be allowed treatment too, it said.
Treatment with growth hormone helps some, but not all, children grow taller. Medical tests cannot predict in advance which children will respond. In general, growth hormone works best when started younger, given in higher doses and administered for longer periods of time. On average, treatment helps children grow a little taller -- but not much. An analysis of studies published in 2002 in the Archives of Pediatric & Adolescent Medicine found that children with idiopathic short stature who were given growth hormone for an average of 5.3 years had an average gain of 1.6 to 2.4 inches in height over what had been predicted when they began the drug.
The added height comes at a cost of $52,634 per gained inch, according to a study in the March 2006 issue of the same journal. About 410,000 U.S. children qualify under the FDA guidelines. If they were all treated with growth hormone, the total healthcare cost would be more than $8 billion a year, wrote Dr. Leona Cuttler, pediatric endocrinologist at Rainbow Babies and Childrens Hospital in Cleveland, in a February 2004 editorial in the journal.
Beating the odds
Jesse’s growth pattern fell at the lowest end of the bell-shaped curve of average height. When he was 13, after not growing at all between the ages of 2 and 4, and barely coming up to his classmates’ armpits by sixth grade, his physician, Dr. Francine Kaufman, a pediatric endocrinologist at USC’s Keck School of Medicine, estimated that his final height was likely to be 5 feet 2 inches. He and his family, who don’t want their last name used, weighed available medical evidence as well as their own gut feelings about prospects for his future as they decided to start treatment. “We live in a world where there are prejudices, not just against short people,” his mother says. “If there was a way to help him get past those prejudices, we thought it would give him a better shot.” Jesse, now a 17-year-old high school senior in Santa Barbara, has just completed nearly four years of daily injections with synthetic growth hormone. He stands 5 feet, 6 inches tall, just an inch shorter than his father, 3 inches taller than his mother and 4 inches taller than he might have been without the treatment.
He and his family were warned that the treatment might not work, and that if it did work, it might add no more than an inch or two to his final height. They understood there were rare side effects and that no one knew if growth hormone might cause unforeseen health problems decades down the road. With so few promises and so many unknowns, was treatment worth it?
“No regrets,” says Jesse. Then, with an enviable dose of self-confidence, he adds: “I’ve always been smart. I’ve always had friends. I don’t think being shorter would have limited me in the work world. But it could limit me as far as sports and girls.” His mother says, “I’ve always known Jesse was a great kid with a lot of potential. But I definitely worried about how he was going to do socially.”
Social science research backs her concern. The cultural imperative for men to be taller than their female mates is so strong it was dubbed “the cardinal principal of dating and mating,” by Ellen Berscheid and Elaine Hatfield in their groundbreaking 1969 book, “Interpersonal Attraction.” “When the ‘cardinal principal’ is violated [think Henry and Nancy Kissinger], you can be sure the man is more powerful in certain other ways,” says Berscheid, a psychologist at the University of Minnesota.
Body height in a mate is important to both sexes but even more important to women, according to a meta-analysis of eight studies by Charles Pierce, published in 1996 in the journal Social Behavior and Personality. He can only speculate about why women so strongly prefer their mates to be taller.
“It may be that the height of a male is positively associated with traits such as dominance, superiority, fearlessness, protectiveness, athleticism, physical strength, leadership and social power,” says Pierce, a business professor at the University of Memphis. “On average, women tend to find these traits appealing.”
The female preference for a taller mate probably goes back to prerecorded times. Taller cavemen might have been faster than predators and stronger when it came to hurling rocks. Modern humans, seated in front of computer screens and television sets, arguably don’t need those skills as much. But social science shows that the trend for women to marry taller has persisted through the last 20 years.
In 1986, NYU’s Conley found that in 3.8% of couples, the wife was taller. In newly analyzed and unpublished data from 2003, he found that figure has gone up, but just barely, to 3.9%. But maybe couples are getting a bit more willing to see eye to eye. In 1986, 7.8% of women were just as tall or taller than their husbands. In 2003, 8.3% of wives were equal to or taller than their men. Shorter men, of course, aren’t completely out of the running romantically. But they, along with taller than average women, are fishing in a smaller pond.
As discouraging as that news might be to short people, it apparently doesn’t hurt them psychologically. David Sandberg, pediatric psychologist and director of child behavioral health at the University of Michigan, has spent decades studying the effect of short stature on psychological development. He has found none.
“The data from multiple studies show that you can’t distinguish between short kids and average and tall kids in their educational and psychological development,” Sandberg says. His concern over the FDA approval of growth hormone for healthy, short children is that medical treatment sends the wrong message. “You communicate that something is wrong,” he says. “And so wrong that it justifies daily injections for years.”
Sure, short kids get teased, he says. And throughout elementary school, they are often treated as younger than their years. But they get over it.
Even through the hurtful school years, short kids have friends -- often tall friends. “We found short kids had as many reciprocated friendships as kids with tall stature,” Sandberg says. “The friends weren’t matched by height in any manner.”
But the real nitty-gritty of the so-called height advantage is money. Tall men make more money.
That has been borne out by multiple studies, including one reported in the October 2004 Journal of Political Economy. Researchers reported that for white men in the United States, every additional inch of height is associated with a 1.8% increase in wages. The tallest quarter of the population earns 13% more than the shortest quarter.
But those same researchers, from the University of Pennsylvania, analyzed the data further. They found that increased income isn’t associated with final adult height. Rather, boys who are taller in their teen years, even if their final height was average or short, earned more than boys who were short during adolescence, even if their final adult height was tall.
So short men who went through a tall spell in high school, around the age of 16, but then stopped growing had similar earning power to tall men who were short at 16, then had a growth spurt. It’s likely, the researchers say, that the workplace isn’t discriminating against short men. Rather, those men who were shorter than their peers in high school may have missed out on opportunities in dating, sports and other activities that teach kids skills that the work force will some day value. “Those who were relatively short when young were less likely to participate in social activities associated with the accumulation of productive skills,” the paper reported.
Conley of NYU studied the income research from yet another angle. In a May 2005 National Bureau of Economic Research online publication, Conley looked at brothers raised in the same home with one brother ending up short, the other tall. Conley found no income differences. “When you compare brothers with the same diet, the same cultural background and educational opportunities, it turns out that male height has no effect,” he says. “The notion is still very strong that there’s a social bias against short men. But they do just fine despite that perception.”
Problem for boys and girls
More than half the kids being treated with growth hormone for unexplained short stature are boys. When girls are referred, according to a February 2005 study in the Journal of Pediatrics, they show up at the doctor’s office later -- 35 months after falling off their expected growth curve, compared with 24 months for boys.
Despite society keeping a closer eye on boys’ height, short girls can suffer too, though, like Kyra Stark, 14, of Sherman Oaks, they might have a bit of extra fun in the early years.
She was always the shortest kid in class. “I could hide anywhere. I could fit inside Barbie’s Dream House until I was about 9,” she says. “It was cool.” Teachers used to say she was like a doll, and classmates couldn’t stop carrying her around. “The teachers would have to keep telling the other kids to put her down,” says Shelley Eisinger Stark, Kyra’s mother. Eisinger Stark worried that her daughter would never be taken seriously, would never be able to activate an automobile air bag and would need a specially equipped kitchen with a never-ending supply of step stools to reach counters. There was never an explanation for Kyra’s slow growth, but her doctor’s best guess was that she’d probably top off at 4 feet, 6 inches without growth hormone. Kyra’s mother is 5 feet, 1.5 inches and her father is just taller than 6 feet. Eisinger Stark never minded her own short stature but worried that her daughter’s even more extreme shortness might cause her problems. “Picture a 40-year-old woman,” she says. “I don’t know how seriously you’d be taken at 4 feet 6.” So Kyra started the injections in September 2005, when she was about 4 foot 3. At her last check-up in December, she measured 4 feet, 10 inches.
“I’m hoping to get her to four-eleven,” says Eisinger Stark. “Then I’m willing to stop and thank my lucky stars.”
That would be 2 1/2 inches taller than Ellen Frankel’s final height. She’s a social worker in Marblehead, Mass., and author of “Beyond Measure: A Memoir about Short Stature and Inner Growth.” At 45, Frankel is still patted on the head by strangers, called a “little girl” and once was even lifted off her feet at a business meeting.
Despite those outward signs of disrespect, she worries about treating a cultural bias against short people with a pharmaceutical solution. “We’re just medicalizing a social prejudice,” she says.
Fost has the same concern. But, he says, at the extreme margin of normal height identified by the FDA guidelines, in which social stigma is joined by very real problems, such as driving a standard car, reaching shelves or finding a life partner, “Let’s bring them into the normal range.”