Preventive Medicine Column
Dr. David L. Katz
A CDC report issued today reveals that drowning causes more deaths among children age 1 to 4 in the US than any other cause except congenital anomalies. This is a terrible, tragic, and obviously extremely important subject in its own right. But since my work doesn’t relate directly to drowning- other than having been a lifeguard and swim instructor earlier in life, and having taught all my kids- and many others- to swim- I want to talk about my usual topic- epidemic obesity- because I think the two are more related than most people realize.
The Institute of Medicine recently released its report on what it will take to fix the problem of epidemic obesity. Timed to coincide with the Weight of the Nation scientific conference, and mini-series on HBO, the intent- well served, I think- was to draw the nation’s attention to the urgency of this issue more forcefully than ever.
The novel elements that figured in the programming this time around included for one, a new perspective on the price tag- the opportunity to save, or spend, over a half trillion dollars on obesity between now and 2030. And for another, a dedicated focus on the solution.
There are, of course, plenty of particulars in “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation,” but the authors distilled the gist down to these 5 bullet points: Integrate physical activity every day in every way; Market what matters for a healthy life; Make healthy foods and beverages available everywhere; Activate employers and health care professionals; Strengthen schools as the heart of health.
That’s pretty succinct, but could be made more so. The solution to epidemic obesity and its unsustainable toll in both human and dollar costs is: fix everything.
I don’t disagree. We have epidemic obesity for many good reasons. Fundamentally, we have converted a world in which calories were relatively scarce and hard to get and physical activity unavoidable into a world where physical activity is scarce and hard to get and calories are unavoidable.
We’ve solved the age-old problem of food scarcity by devising, for our part of the world at least, food excess. We’ve solved the problem of over-taxed muscles by devising technology to do just about everything muscles used to do. We’ve solved the problem of food spoilage by devising highly processed foods that might literally have a longer shelf life than the person eating them.
The IOM and I agree- we need to fix everything. We need physical activity to populate our daily routines once again. We need healthful foods in reasonable quantities to constitute our diets once again. We need time for food preparation. We need to sleep better, and manage stress- so we have the energy and equanimity to eat well and exercise.
But there are problems with a ‘fix everything’ platform, no matter how defensible it may be. First, no one is in charge of everything. Calls to fix everything have the potential to lead nowhere- because every one assumes someone else should get it all done. And second, even if we can figure out where the buck should stop, fixing everything can be quite overwhelming.
I have settled on a particular view of what fixing everything looks like I hope might help. Fixing everything is like building a levee.
I like the levee metaphor- and have relied on it to guide my own health efforts, personal and professional, for years- for three reasons.
First, the challenges we confront may be likened to an obesigenic flood of energy-dense foods, labor-saving technology, and market forces. Second, a levee helps relieve the burden of a daunting task. Holding back a river is a daunting task. But no one person has to do all that! All anyone needs to do is stack a bag of sand. And, finally, the levee illustrates a precautionary tale. Imagine the folly of putting one bag of sand along the bank of a flooding river and then asking: are we dry yet? No one sand bag, no matter how good, can possibly contain a cresting river. No one sand bag can do what the whole levee can do. And similarly, no one program, or policy, or practice will fix obesity and related chronic disease for society.
In the case of drowning, it’s obvious we should not focus on lotions, potions, or pills. It’s obvious we should not focus primarily on better ways to treat drowning when we have the option to prevent it. It’s obvious the ‘fault’ lies with an environment that makes drowning possible or likely, and not with the children.
With regard to obesity, we have overlooked all these same considerations. So it’s time to start looking over the obesity flood plain we have been overlooking, and build the levee- one sandbag at a time.
And in the interim, we need to recognize we are drowning in a flood of calories and labor-saving technology, and will-power does not keep people afloat. Skill power does. Everybody can learn how to swim- and while waiting on the world to change, everybody needs to do just that.
Dr. David L. Katz; www.davidkatzmd.com