Part VI. The Public Health Solution
20. The “Nanny State”: Personal versus Societal Responsibility
21. What Hath Government Wrought?
22. A Call for Global Sugar Reduction
Epilogue: Not a Top-Down but a Bottom-Up Movement
INTRODUCTION: Time to Think Outside the Box
“We just eat too damn much.”
—Governor Tommy Thompson (R-Wisc.), U.S. Secretary of Health and Human Services, Today, NBC, 2004
Indeed we do. That’s it, thanks for buying this book, you’ve been a great audience, I’m outta here.
Well, that’s what the U.S. government would have you believe. All the major U.S. governmental health agencies, the Centers for Disease Control (CDC), the U.S. Department of Agriculture (USDA), the Institute of Medicine (IOM), the National Institutes of Health (NIH), and the U.S. Surgeon General, say that obesity results from an energy imbalance: eating too many calories and not getting enough physical activity. And they are right—to a point. Are we eating more? Of course. Are we exercising less? No doubt. Despite knowing this, it hasn’t made any difference in the rates of obesity or associated diseases. More to the point, how did this epidemic happen and in such a short interval of just thirty years? People say, “The food is there,” and it is. But it was there before. People say, “The TV is there,” and it is. But it was there before, and we didn’t have this caloric catastrophe. There’s more to this story, way more, and it’s not pretty.
Everyone blames everyone else for what has happened. No way is it their fault. Big Food says it’s a lack of activity due to computers and video games. The TV industry says it’s our junk food diet. The Atkins people say it’s too many carbohydrates; the Ornish people say it’s too much fat. The juice people say it’s the soda; the soda people say it’s the juice. The schools say it’s the parents; the parents say it’s the schools. And since nothing is for sure, nothing is done. How do we reconcile all these opinions into a cohesive whole that actually makes sense and creates changes for the better for each individual and for all society? That’s what this book is about.
Food is not tobacco, alcohol, or street drugs. Food is sustenance. Food is survival. Most important, food is pleasure. There are only two things that are more important than food: air and water. Shelter’s a distant fourth. Food matters. Unfortunately, food now matters even more than it should. Food is beyond a necessity; it’s also a commodity, and it has been reformulated to be an addictive substance.
This has many effects on our world: economically, politically, socially, and medically. There is a price to pay, and we’re paying it now. We pay with our taxes, our insurance premiums, and our airline fares—nearly every bill we receive in the mail has an obesity surcharge that we underwrite. We pay in misery, worsening school scores, social devolution, and we pay in death. We pay for all of it, one way or another, because the current food environment we have created does not match our biochemistry, and this mismatch is at the heart of our medical, social, and financial crisis. Worse yet, there is no medicine for this. There is no edict, ordinance, legislation, tax, or law that can solve this alone. There is no quick fix, but the problem is resolvable if we know what’s really going on—and if we really want to resolve it.
In his 2004 book Food Fight, Kelly Brownell of Yale University talks about obesity and the “toxic environment” we now live in, a euphemism for our collective bad behaviors. I am going a step further. I’m interested in whether there is something actually toxic, I mean poisonous, going on here. Even laboratory animal colonies have been getting fatter over the past twenty years!
Every good story needs a villain. While I am loath to reveal it this early in the book, I won’t keep you in suspense. It’s sugar—the Professor Moriarty of this story, a substance that now permeates nearly all food and drink worldwide. It’s killing us…slowly, and I’ll prove it. Every statement throughout this book is based on scientific study, historical fact, or recent statistics.
I’m a physician. We take an oath: primum non nocere (first do no harm). But there’s a paradox in this statement: when you know the final disposition—that the outcome is going to be bad—then doing nothing is causing harm.
I certainly did not start out as an advocate. I wasn’t looking for a fight. I didn’t come to this controversy with a preconceived agenda. Indeed, I was fifteen years into my medical career before I stepped up to deal with obesity as an issue. Until 1995, like my medical colleagues, I did my best to avoid seeing obese patients. I had nothing to tell them except “it’s your fault” and “eat less and exercise more.” At that time, seeing an obese child with type 2 diabetes was an anomaly. Now it is an almost everyday occurrence. The problem of obesity is now inescapable in medical practice. You can’t avoid it any more.
The concepts elaborated here didn’t just wake me from sleep one day in a divine revelation. This book is the culmination of sixteen years of medical research, medical meetings, academic discourse with colleagues, journal clubs, policy analysis, and a whole lot of patient care. I have no conflict of interest in espousing the information here; I am not a pawn of the food industry or a mouthpiece for any organization. Unlike many authors addressing the devastation of obesity, I don’t have a product line designed to enrich my bank account. I came by these views honestly and through rigorous data analysis. And the data are out there for everyone to examine. I’m just putting them together somewhat differently.
As a scientist, I have personally contributed to the understanding of the regulation of energy balance. As a pediatrician, I get to watch the interaction between genetics and environment that causes obesity play out in my examining room every day. And now, as a fledgling policy wonk, I have seen how the changes in our society have sprouted this global pandemic. It is this panoramic view that allows me to connect the dots for you, and they don’t connect in the way you’ve been told.
To blame obesity on the obese is the easy answer, but it is the wrong answer. The current formulation of gluttony and sloth, diet and exercise, while accepted by virtually everyone, is based on faulty premises and myths that have taken hold in the world’s consciousness. Obesity is not a behavioral aberration, a character flaw, or an error of commission. When we think about the ravages of obesity, our minds often go first to adults. But what about kids? One quarter of U.S children are now obese; even infants are tipping the scales! Children don’t choose to be obese. They are victims, not perpetrators. Once you understand the science, you realize what applies to children also applies to grown-ups. I know what you’re thinking: adults are responsible for their own choices and for the food they give their children. But are they?
An esteemed colleague involved in the obesity wars once