I like Bill Maher. I do. He supports PETA. He encourages vegetarian diets. He's rich. OK, so the last one is no reason to like him, but it's important to this post.
Recently on "Real Time", he got into a rant with Arianna Huffington about the role of personal responsibility in fueling health care costs. I'm sympathetic to the argument. It goes something like this: Obesity is creating an alarming rise in health care costs. Where there is obesity, there is diabetes, heart disease, kidney disease among others. We can lower health care costs by lowering our forks, giving up junk food, and using some old-fashioned will power to control our eating. The underlying premise is that obesity is primarily the result of overeating. As a health care practitioner, I like the simple elegance of that solution. A lot.
But there's more here than meets the eye. Really.
We're flooded with obesity statistics every day, usually accompanied by photos of fat people with their eyes conveniently covered by black bars. Or we get only their backsides. But if you want to see how large we're all getting, you don't need the media to tell you. Stroll through your workplace, the mall, your local grocery store. Look around at your fellow movie-goers. We are surrounded by fat people. What's worse, we don't even know who is fat any more. May I direct you to Match.com? Check out people's descriptions of their body type. Pay special attention to those who self-identify as "about average" or a "few extra pounds". Now look at the pictures. Often they are substantially overweight ("average") or morbidly obese ("a few extra pounds"). Uhhh, I thought average meant that they were not fat, not "toned", not "thin" ...just kinda in the middle, you know? Average. Then again, recall your stroll through your familiar haunts. What do most people look like? Yup. Big. Bigger than they used to be. Obesity is the new "average".
I'm biased. A "weight-ist", if you will. You probably are too, but won't own up to it. I absorbed a distaste for overweight people from my mother who had strong opinions about such things. I'm in my 60s. I remember when significantly overweight people stuck out in a crowd. The Conventional Wisdom of the time was that "those people" had no self-control. They were the poster children for the Deadly Sin of Gluttony. We felt little guilt for deriding them.
More than 50 years later, the belief still sticks: you're fat because you can't control yourself. Like every belief, this one is partly true. I overeat. Sometimes, I'm compelled ...like many people, I can slip into "emotional/stress eating". But is the secret to conquering obesity just exercising more willpower? Getting a grip? Perhaps, for some of us. But I don't think an epidemic emerged from a sudden inability to put down our forks. Especially among the poor, minorities, and the middle class.
Which leads me to three broader food-related issues that undermine our health and cost us money: 1) the poor quality of our food supply, 2) the near absence of people's ability to cook from scratch, and 3) the unavailability in most families (especially elderly and one-person families) of someone who has the time and/or energy to make a fresh, healthy meal. If we can't address these three, complex systemic issues we won't get very far trying to impose incentives for "healthy behavior" or for providing more efficient care to large numbers of people who have chronic conditions.
"Food, Inc.", a documentary on how our food is raised, concocted and engineered, is currently playing in our area. Go see it. It presents a visually compelling link between our consumption of food-like substances and the cost and quality of our health. I came to tears watching a lower middle class working Hispanic family shop for food. Two bottles of soda were cheaper that a bunch of broccoli. They had two children to fill up and with the cost of the father's medications, not enough money to buy the food that would avert further deterioration. One young daughter was perilously close to a diabetes diagnosis. The mother knew what she should be eating, but she couldn't afford it. They all worked 16 hour days, with no time or energy left for cooking at the end of the day. Three out of four of them were overweight or obese. This is not their fault. They want to do the right thing. The system conspires against them.
If you think this is a problem of poverty alone, you're wrong. While obesity declines as income and education climb, it remains higher than we can afford. And all those lovely kitchens in McMansions, are for show, not daily use. Those families eat out. A large proportion of adults my age are on multiple medications for high blood pressure, high cholesterol and depression (which is linked to poor cardiac health). Most of these illnesses are partially fueled by the hidden, unhealthy ingredients in food, the things we didn't eat 50+ years ago because they didn't exist. As an example, this week a study was released that revealed that the average American woman eats 22 teaspoons of sugar a day, almost all of it "hidden". Her healthy limit should be, at most, 6 teaspoons -- half that if she is sedentary. Flavored fat-free yogurt, a common health and weight loss food, contains the entire sugar budget for the day. Yogurt, for crying out loud.
So as you ponder your position on the health care reform debate, perhaps you need to challenge your biases. That's hard. For me, for you, for Bill Maher, who unlike most of us can afford to play the food game by "New Rules". But think about that Hispanic family, your co-workers, maybe your own family members ...and how difficult it is for all of them to buy, prepare or eat a high quality diet. Think about the cost of our heralded cheap food. Face the dirty secret that the decline in food costs almost directly mirrors the increase in health care costs. Then ask yourself who's to blame. Not so simple, is it?
No comments:
Post a Comment