Drowning in Calories
David L. Katz, MD, MPH
CMO, Tangelo. Founder: Diet ID; True Health Initiative. Founding Director, Yale-Griffin PRC (1998-2019). Health Journalist. COVID Curmudgeon
Among the more contentious issues regarding health and weight control- perhaps surprisingly, contentious among professionals and the general public alike- 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!
There is, of course, a better way: listening to one another. Considering that the truth might be somewhere in the middle, informed by insights from both corners. And suddenly, then, we are in opposing corners no more- but on common ground, with common cause, and making what has become all too uncommon: actual progress.
In that spirit, I would like to suggest - as I have other times, in other places, including most recently the peer-reviewed journal where I serve as editor-in-chief – that obesity may be likened to drowning.
Before making that case, let’s pause long enough to 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 we don't goad our neighbors’ children into the deep end of a pool before making sure they can swim.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?
Now to my principal argument: obesity is just 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.As a species, we have no native defenses against caloric excess in the first place, never having needed them before.Couple that with a food supply engineered to ensure that we “can’t eat just one,” and we all are primed to drown in calories.
Similarly, we have no native defenses against the lure of the couch, either.For the most part, animals in nature will lounge when they can; the demands of survival limit how often that is.But the demands of survival are mostly met with technology now, so we can lounge all but limitlessly.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 exactly analogous to holding people accountable for their own swimming, yet actively encouraging them to try out those riptides.It is, in a word- idiotic.And in another 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 (i.e., drowning type 1= in water; drowning type 2= in calories and labor-saving technology) also solves the problem of according it medical legitimacy without the need to label it a disease.That, in fact, was the focus of my editorial in Childhood Obesity.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 underwater 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.
And finally, 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.We could throw one another to the sharks while we’re at it.
Come on folks, do we really want to be as dysfunctional as our Congress?Let’s meet in the middle, and acknowledge that bodies fare best when self-care and the actions of the body politic are aligned rather than in battle.
Obesity is, in many ways that matter most, analogous to drowning.Individuals can, and for the most part should, 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.
-fin
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
Author, Disease Proof
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Collage: NOBUHIRO ASADA and gameanna / shutterstock and LinkedIn Pulse
Director of Clinical Services
10 年Wow, what a powerful analogy--both visually and philosophically! One difference between swimming/drowning and eating/health effects in the U.S. is that there are so many conflicting agendas related to how we eat. Food manufacturers want to sell their products, so they'll tell us whatever it takes to get us to buy their products--be it true or not. (We're getting into testing season in the public schools, so Cheerios will roll out it's perfectly timed annual commercial that claims that Cheerios increases concentration.) Anyway, back to my list...Congressional representatives want to get re-elected, so many of them will serve as the mouthpiece for whatever corporate constituent is likely to give the largest campaign donation. Health and fitness product manufacturers and workout video folks want us to buy their goods and/or services, so they'll say whatever it takes to get us to shell out the dollars. People want to lose weight, slim down, torch fat, build muscle, eat healthy, boost metabolism, and whatever other marketing phrases you want to add, so they sometimes seek out or accept information from some of the above-listed entities. And we all know where that leads.
Medical Practice Professional
10 年I REALLY AGREE WITH YOU. EATING LARGE QUANTITIES OF CALORIES IS A BIG PROBLEM FOR OUR HEALTH? WE MUST TAKE WHAT OUR BODIES NEED SINCE OBESITY CAN LEAD TO MANY ORGAN COMPLICATIONS IN OUR BODIES,LIKE THE HEART,BRAIN, KIDNEYS,TO MENTION BUT A FEW !
David Evans email [email protected]
10 年As a recent visitor to the US I noticed the unhelpful new food labeling. It is not possible, it seems, to assess the perecentage of sugar in a packaged food in the US. Instead, the labels refer to sugar in a standard serve, or similar. That is not helpful.
Retired Doctor enjoying family and hobbies including Rotary and walking
10 年I have always been aware of the effects of excess dietary sugar because of a very strong family history of type 2 diabetes, and managed to get it much later than my mother or grandmother. Even so, following the diagnosis I was horrified to find that the low fat foods I have always chosen contained more sugar. Everything seems to have added sugar.
International Marketing Director at The Juice Plus+ Company
10 年To the comments on microbes in our gut that are causing obesity......the microbial flora is fed by what we are putting into our bodies. If we are eating junk foods, the microbial flora will be affected in a negative way..people are not obese because of their microbial flora...I believe it makes sense that the gut flora is compromised because of a poor diet. Eating lots of whole foods and plant foods feeds a healthy gut. Exercise and plenty of pure water will contribute as well. They also found in the study that the obese subjects had more inflammation....fresh plant foods are very anti inflammatory while junk foods cause inflammation in the body.