Preventive Medicine Column

Dr. David L. Katz

We tend to find the patterns we are seeking.  The image of Jesus in a grilled cheese sandwich comes to mind.  He has, apparently, turned up in shower mold as well.  Those might be miracles, but I am guessing they are more like the constellations: a bit of vague resemblance to something, a dose of wishful thinking, and a hearty application of predisposed imagination.  Seriously, other than the dippers, big and little- can you actually see any of that stuff up there in the night sky?  I blame it all on Greek wine and insomnia.

But I digress.  We find the patterns we are seeking, and when I writeas I mostly do– about losing weight and/or finding health, people find in my writing the patterns they love to love, or love to hate. The divisive topic du jour is personal responsibility.

Divisive it is.  The role of personal responsibility in the management of health and weight has long attracted both professionals and everyone else to choose a place in opposing corners.  In one corner is the group that invokes personal responsibility as the answer to all ills.  We need no regulation, we need no environmental reforms, we need no food control, or gun control, or any kind of nannying.  We just need to make good choices.

In the other corner are environmental determinists who, at the extreme, might wait around for someone to spoon feed the quinoa and escort them to the gym.

I trust you’ve seen the Spiderman movies, and know the axiom they memorably deliver: with great power, comes great responsibility.  Anyone pausing to think about this even a little recognizes that if there is such a correlation between power and responsibility, it has to run both ways.  With vanishingly negligible power comes vanishingly negligible responsibility.  In fact, we all know and believe this already, because we apply just such thinking to newborns.  They have no power, and aren’t responsible for anything.  We raise children to take on more responsibility as their capacity to do so evolves.

And so it is that public health can, and should, embrace the Spiderman principle, but place equal emphasis on the implied corollary: before we can ask or expect anyone to take responsibility, they must be empowered.

We have known for years, and been reminded recently, that Big Food hires PhDs and uses advanced technologies to engineer foods that are, for all intents and purposes, addictive.  We could call on every soccer Mom and grade school kid to just deal with it- but come on!  This is a contest that makes David and Goliath look like they were in the same weight class.  And lest you think that Big Food’s mischief is a thing of the past, we learned only recently that the very soda companies that got a photo op with the First Lady for agreeing to promote water intake had devised strategies to discourage water and encourage soda.

There is a point at which invoking personal responsibility to deal with a contrived array of obstacles is both benighted and callous.  Yes, everyone should try to eat well- but they should not have to overcome the ingenious manipulations of highly paid mercenaries conspiring against them to make it so.

We have no scientific evidence whatsoever to suggest that the current crop of Homo sapiens is less endowed with personal responsibility than every prior crop.  We certainly have no suggestion in either science or sense that today’s 7 and 8-year-olds are less personally responsible than every prior cohort of 7 and 8-year-olds.  So if obesity and chronic diseases related to lifestyle are now rampant among adults and children alike despite a constancy of personal responsibility, it suggests the problem is more all around us than within us.  The body politic has responsibility, too.

As far as I’m concerned, we have failed to take a personally, and publicly, responsible approach to the matter of personal responsibility.  Who decided in the first place that we are obligated to choose between this corner, and that corner?  We are not.  The common ground is in the middle.

What I do with my feet and my fork is, ultimately, up to me.  No one else is going to exercise for me, or eat broccoli on my behalf.  So too for you- and everyone else. But the choices any of us makes are subordinate to the choices we have.  In the real world, we need to have good choices to make good choices, and even when we have good choices, we still have to make them our own.

Enough nonsense about personal responsibility. For public health to advance, we must choose to renounce our opposing corners; to come out and shake hands.  We must choose a culture in which we collectively ensure we have good choices, and then- and only then- take personal responsibility for making the most of them.




Dr. David L. Katz