Preventive Medicine Column
Dr. David L. Katz
A crisis, it’s said, is a dangerous opportunity. But among the dangers is that this adage is just wishful thinking. The danger in a crisis asserts itself with no help from anybody; the opportunity must be recognized, seized, and cultivated- or it just sails by.
The newly released White House Task Force on Childhood Obesity Report to the President (http://www.letsmove.gov/tfco_fullreport_may2010.pdf ) does a fine job of characterizing the relevant danger, and highlighting opportunity. The panel convened under the banner of the First Lady’s “Let’s Move” campaign generated recommendations to reduce childhood obesity rates from the current level of roughly 20% (I think that an underestimate) to 5% by 2030. The 120 page report addresses actions in every setting from living rooms to cafeterias, and broaches topics from breast feeding to re-engineering the built environment.
While welcome, and fundamentally solid, I see some important limitations to the report. It is focused on what to do, but offers very little guidance on how the proposed actions actually get done; in its defense, it promises a sequel on this topic.
I think, as noted parenthetically above, that the prevalence of childhood obesity is underestimated in the report, as it is underestimated in national statistics that rely on exclusive, rather than inclusive, criteria for the diagnosis. Thus, the goals of the task force may be unrealistically optimistic.
A work of the government, the report routinely invokes government standards- for such matters as the quality of school lunches- that in my view often fail to go far enough. Perfect should not be made the enemy of good, but ‘just adequate’ should not be made the enemy of genuinely good, either.
And finally, the report is too true to its stated focus on “childhood” obesity. No man, woman, or child is an island, and children don’t live on one, off by themselves. They live in families. Better diet, more activity, and better health will take hold of all members of a household, or they won’t take hold at all.
But these reservations notwithstanding, the report is a valuable guide and an even more valuable indication of commitment to this vital cause. The quick summary of its 120 pages is this: everything is broken, and everything needs to be fixed. The slightly embellished version is that what we do each day with our feet and our forks represents the proximal cause of epidemic obesity, the root cause is modern living- and our solutions must be comprehensive, and directed there.
My personal fear is that among the dangers in this particular crisis is the peril of rejecting its opportunities. While better use of feet and forks may be a matter of personal responsibility, the environment that dictates our daily options, that empowers or disempowers our personal pursuit of health, is a matter of public policy. Much of the most crucial defense of the human body resides with the body politic.
And so, working against the goals of the First Lady’s task force, which depend greatly on collective action, is the currently prevailing societal sentiment against just such cohesion. Threats to the opportunities before us abound, from parents who defend cupcakes in classrooms or oppose soda taxes on principle, to school systems that oppose raising nutrition standards or carving out some time for daily physical activity, to restaurants that still lure customers with the false bargain of an “all you can eat” buffet. The “what I do with my feet and my fork is up to me, so bud out” response will reliably cause the agenda in this report to fail.
So, perhaps the dangers intrinsic to a different crisis may serve to illuminate the evasive opportunities in this one.
Imagine that you and I, and our children, are on the Titanic on the fateful night of April 14, 1912.
Anticipating the calamity that looms, what comfort would you derive from knowing how to swim- or having dutifully taught your children? What reassurance would be imparted by your judicious packing of warm clothes?
Or in the aftermath of the disaster, how satisfied would you be with a plan that called for the addition of one or two lifeboats to the ‘next’ Titanic, or a reduction in its top speed by one knot per hour? If the ship still crashes and sinks, and countless people needlessly die, we might as well have added window treatments.
Prevailing diets of highly processed foods and prevailing levels of physical inactivity- and the forces that conspire to make such patterns prevail- are the ship we now sail. Obesity, diabetes, heart disease, stroke and cancer are the icebergs that loom. The most salient of differences between our crisis now and that of the Titanic is that this ship sails us toward doom in relative slow motion, and…there are a great many more of us aboard.
If the only adequate response to the Titanic disaster is a response that prevents the ship from hitting the iceberg; or prevents it from sinking if it hits the iceberg; or prevents people from dying if the ship sinks- why should half measures do for the current, larger menace?
The new Task Force report tells us more about where to go than how to get there; I eagerly await the sequel. And, if anything, I think the report should go further, push us harder, and ask us all to go faster. That said, I certainly support the full scope of actions it espouses, and hope you will, too.
The dangers of childhood obesity are clear, and omnipresent. The opportunities will require our collective effort. As we contemplate that, we may do well to reflect on past crises. For now, as then, we are all- men, women, and children alike- in the same boat.
Dr. David L. Katz; www.davidkatzmd.com