Preventive Medicine Column
Dr. David L. Katz
Among the more contentious issues regarding health and weight control is the role of personal responsibility. Unfortunately, this readily devolves into discord, because the cultural tendency of our time is to denigrate those with whom we disagree, and hunker down in our distal, opposing corners. Just take a look at Congress to see how well this is working out for us! In that context, I would like to suggest that obesity may be likened to drowning, and consider the implications for personal responsibility.
If we are going into the water, it makes sense that we first know how to swim. It makes sense that a parent on the beach would watch their own child with great vigilance. It makes sense that families would keep watch over their backyard pools. And it makes sense that we would put on life preservers while white-water rafting. So far, this sounds like a pretty hefty dose of personal responsibility.
But then again, it also makes sense that we have lifeguards at the beach. It makes sense that we put fences around pools. It makes sense that if someone falls into the water and can’t swim, someone who can rushes in to help.
It also makes sense that we don’t run advertisements at the beach encouraging swimmers to try their luck with the most dangerous riptides. It makes sense that the body politic and culture don’t conspire to make people drown.
All of this would make exactly comparable sense in the management of weight, and health. There, too, a blend of personal responsibility and public empowerment could help us all add years to life and life to years, while wearing clothes in the size we prefer along the way. But we don’t do this. We act as if we should be debating between parental vigilance and lifeguards; swimming lessons, or fences around pools. Why preclude the choice of choosing both?
Obesity is much like drowning. We have been told by Michael Moss, and others before him, that our food supply is willfully manipulated by smart and highly trained people to maximize the eating we all do, the calories it takes to feel full, and-of course- the money we spend along the way. Similarly, the demands of survival are mostly met with technology now, not muscle power- so we are drowning in labor-saving technology, too.
Responsibility for all of this resides squarely in the middle, between those opposing corners. Nobody is going to eat well on our behalf; nobody is going to exercise for us. But how much sense does it make to acknowledge far and wide the calamitous effects of childhood obesity, yet continue to peddle multi-colored marshmallows to 6-year-olds as “part of a complete breakfast”? That’s analogous to holding people accountable for their own swimming, yet actively encouraging them to try out those riptides. It is, in a word- hypocritical. With regard to weight and health, America runs on constant hypocrisy.
And, of course, thinking of obesity as a variant on the theme of drowning solves the problem of according it medical legitimacy without the need to label it a disease. If obesity is a disease- a proclamation made during the past year by the American Medical Association– then all of our obese children are, suddenly, “diseased.” As a parent, grandparent, or reasonable adult looking on- are you really ok with that? I’m not.
I’m not because sometimes adults and kids can be heavy and healthy. I’m not because sometimes adults and kids can have the metabolic profile of obesity despite a normal weight or body-mass index. And I’m not because a disease implies something is wrong with the affected bodies.
But nothing is wrong with a body that drowns other than staying under water too long; normal, healthy human beings drown if they stay under water too long. Normal, healthy human beings get fat if they stay in our obesigenic culture too long, too. As we export our diet and lifestyle around the world, we see just how universal this vulnerability is.
The treatment of diseases emphasizes the medical system, drugs, and procedures. Is that really where we want the focus to be when the problem is one of bodies behaving normally in an abnormally obesigenic environment? If so, we might also seek to develop drugs to treat drowning- while removing the fences from around pools, the lifeguards from the beaches, and never bothering to teach anyone to swim.
Folks, let’s acknowledge that bodies fare best when self-care and the actions of the body politic are aligned rather than in battle. Individuals can learn to “swim” through our obesigenic culture. But those swimming lessons need to be accessible, affordable, applicable, and actionable. Meanwhile, responsibility for and scrutiny of the water’s edge should be a job not just for each one of us- but for all of us.
Dr. David L. Katz