Preventive Medicine Column
Dr. David L. Katz
I spoke last week at a symposium on nutrition and public health at the Tuck School of Business at Dartmouth College. Among others on the panel with me was Richard Starmann, the former head of Corporate Communications for McDonald’s, who asserted more than once that rampant obesity and related chronic disease was enormously, intractably complicated and would require diverse efforts, a great deal of private sector innovation, minimal government intercession, lots of time, lots of money, and many conferences, committees and panels such as the one we were on to fix. I had trouble deciding where to start disagreeing with this one. If you have ever served on a committee, you likely know as well as I that the surest way to never fix something is to convene a whole lot of committees and panels to explore every possible way of disagreeing. Just look at our Congress.
But more importantly: obesity is not complicated. Hard, yes; complicated, no!
As a culture, we are drowning in calories of mostly very dubious quality, and drowning in an excess of labor-saving technology. I have compared obesity to drowning before, but want to dive more deeply today into the implications for fixing what ails us.
Let’s imagine, first, if we treated drowning the way we treat obesity. Imagine if we had company executives on panels telling us why we can’t really do anything about it today, because it is so enormously complicated. Imagine if we felt we needed panels and committees to do anything about epidemic drowning. Such arguments could be made, of course.
For, you see, drowning is complicated. There is individual variability- some people can hold their breath longer than others. Not all water is the same- there are variations in density, salinity, and temperature. There are factors other than the water- such as why you fell in in the first place, use or neglect of personal flotation devices, and social context. There are factors in the water other than water, from rocks, to nets, to sharks.
The argument could be made that anything like a lifeguard is an abuse of authority and an imposition on personal autonomy, because the prevention of drowning should derive from personal and parental responsibility. The argument could be made that fences around pools hint at the heavy hand of tyranny, barring our free ambulation and trampling our civil liberties.
We would, if drowning were treated like obesity, call for more personal responsibility, but make no societal effort to impart the power required to take responsibility. In other words, we wouldn’t actually teach anyone how to swim (just as we make almost no systematic effort to teach people to ‘swim’ in a sea of calories and technology).
Were we to treat drowning more like obesity, we would have whole industries devoted to talking people into the choices most likely to harm them- and profiting from those choices. One imagines a sign, courtesy of some highly-paid Madison Avenue consultants: “Awesome rip current: swim here, and we’ll throw in a free beach towel! (If you ever make it out of the water…)”
If we treated swimming and eating more alike, we would very willfully goad even the youngest children into acts of peril. An announcer near that unfenced pool would call out: “Jump right in, there’s a toy at the bottom of the deep end! And don’t worry, the pool water is fortified with chlorine – part of a healthy lifestyle!”
We have the time perception of our ancestors, contending with the immediate threats of predation and violence on the Savannahs of our origins. We are poorly equipped to perceive calamitous cause-and-effect when it plays out in slow motion. One imagines viewing ourselves through the medium of time-lapse photography, and suddenly seeing the obvious: we topple into the briny, obesigenic depths of modern culture, and emerge obese. Cause and effect on vivid display, no committees required.
Consider how differently we would feel about junk food if it caused obesity or diabetes immediately, rather than slowly. Imagine if you drank a soda, and your waist circumference instantly increased by two inches. It likely will- it’s just a matter of time.
We could fix obesity. It’s hard, because profit and cultural inertia oppose change. But it’s not complicated. As we look out at an expanse of bodies sinking beneath the waves of aggressively marketed junk and pervasive inactivity, wring our hands and contemplate forming more committees- I can’t help but think we’ve gone right off the deep end.
Dr. David L. Katz; www.davidkatzmd.com