I need some new glasses

Systemic glasses. Like 3-D, only better. Something to help me "see the forest for the trees". If I only knew how to invent them, I'd patent them and call them Pandora Glasses, after the planet in Avatar. They would be soooo cool, because for the first time ever, we'd be able to see the connections between things, like the Na'vi do. They could be a handy way to reveal how our individual actions and small projects impact the gargantuan engine at the heart of a system, say for example, the "the food system".

Being a generous person, I'd give the first pair to our president. He could be a beta tester. I'm thinkin' he could really, really use these gizmos. It's clear that he's having a very hard time with the forest-seeing thing. I have to believe that his eyesight is the problem, or I'd have to impute some really ugly qualities to him, and I'm trying to give him the benefit of the doubt. So, operating on the assumption that his vision is poor, maybe my glasses will help.

I'll stop beating around the bush, or in this case, the field. Let's begin with a post I wrote right after the election (the site referenced is dead -- which says something ). This post was part of a national grass-roots effort to get the Obama's to install an organic garden on the White House lawn. Check. Done. Most of us who care about food, were also hoping the USDA would get deep reform. A highly credible Kathleen Merrigan, a veteran of the sustainable agriculture movement, was named deputy secretary. She oversees the National Organic Program at the USDA among other initiatives, and under her guidance the agency is beginning to flex its muscles. Check. Another victory. There are more gains to catalogue, but let's take a moment to put on those sexy new glasses I just invented (mine are purple, in case you're wondering).

Hey, look at that! The Big Picture! The connections, if you will, that are well-laid out in the cover story of the latest issue of The American Prospect -- Slowed Food Revolution. You can read it online here (but you'll need to take off your new glasses). With the help of Heather Rogers, who must have her own cool glasses, you'll see a USDA that is a revolving door for Big Ag, much as Goldman Sachs is for the government's economic advisors and the Interior Department has been for the gas, oil and mining industries. Big surprise, though we voted for "Change We Can Believe In", U.S. ag policy, the engine that drives what food we get and what it costs, is still being deeply influenced by industrial agriculture interests, especially Monsanto. Obama has done almost nothing to change that. If fact, the Secretary of Agriculture, Tom Vilsack, epitomizes the Big Ag man. So we find him proselytizing for biotech and biofuels. He encourages greater subsidies for commodity crops headed for export while neglecting the needs of small American farmers, who are continuing to go broke. Our policies still encourage farmers to plow land for biofuel crops that earn them less in the long run and yield a fuel that is more polluting. So not only is food/ag policy impacting what we eat, but it's distorting our energy policy too.

Yes, there are a few trees here and there that are growing and looking good. But that sickly forest is going to soak up all the resources, leaving nothing of value in the end. If you can't see that forest -- the connections between the policy, the greed, and the absence of resources for real farmers and eaters -- you will continue to congratulate our government for doing too little, too late. Putting on those glasses will at least force you to see what is and not just what you hope for.

As for me, I'm switching from rose-colored glasses to Pandora glasses ...and I'm going to stop accepting cosmetic change as if it matters. What about you?

Just Put Down Your Fork! Obesity and the Health Care Debate

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?

Dig It!

OK, I know ...it's been forever since I posted. Life has gotten away from me. The election, holidays, work ...you know how it is. But I'm home sick so it seemed like a good time to post something that I discovered on Facebook today. Yup, Facebook. I was badgered into getting a page there by one of my sons.

So, I'm checking out "Causes". The younger generation seems to have invented a way to proselytize one another about favorite charitable causes and other activist attention-grabbers. I found one that resonated and signed a petition, which I'd like you all to consider as well. This particular initiative is one that has been pushed by Michael Pollan and Alice Waters, two people I respect immensely.

Here it is: Eat The View!




The goal is to get President Obama to dedicate a portion of the White House grounds to growing an organic garden. It would feed the White House and any leftover produce would go to food pantries in the Washington, D.C. area. Seems that Eleanor Roosevelt insisted on a Victory Garden during WWII ...which became a model for all Americans. Given the current economy, people could certainly save money by growing some of their own food ...and they would likely be healthier as well.

So if you have the time and inclination, please sign the petition and push for this great idea. Spring is nearly here. Let's push for full employment for gardeners!

Lap Bands R Us

The Diabetic Quick Fix

Here it is. The lap band. The billboards advertising them, the TV ads, they never actually show you one. Cute little suckers, aren't they? You just pinch them around the stomach, fill them full of water to restrict the space you can dump food into, and you're good to go.

I'm a nurse practitioner. I have patients with them. Yup, they work. At least, for awhile. Diabetes improves. But in my experience, diet, nutrition, and lifestyle are unchanged. Same with other types of obesity/bariatric surgeries. I have patients who had gastric bypass 10 or more years ago, a more drastic approach to weight loss. Guess what. They are obese -- again. They are chronically ill. Some of them have even had a second procedure, to no avail.Without personal change, will improvements gained through surgery be sustainable? I have my doubts.

Typical of Western medical approaches, we do not address the underlying issues. Maybe we're sick because:

1- Our food supply is polluted and nutrient deficient
2- Our eating knowledge base -- how to cook, what and how much to eat -- is full of holes or empty
3- Our culture values quantity over quality -- in food, in housing, in income, in material goods -- which in turn leaves us fat, stressed, chronically time-crunched, in debt, and unhappy

As everything and everyone around us grows larger, as we feel less and less control over our lives and health, passive solutions like a lap band offer the ultimate cure. Good grief.

We're facing an election. Health care reform is on the top of the agenda. So a study like this that promises relief for millions of people, can provide a peek into what needs to be reformed. While this was an Australian study, American doctors and health care institutions (who stand to make a shitload of money off surgical solutions) are lining up to extol the virtues of this possible 'cure'.

If lap bands can be a solution to diabetes, then let's take a closer look at the study, OK? On the face of it, people who had surgery did much better than everyone else. Here's the glitch: the study compared a lap bad to 'usual care'. For you non-medical people, 'usual care' is the fucked up management you get in the current health care system. What you get when you go to the doctor and s/he tells you, "sorry, you have diabetes". Right this minute, in clinics and doctor's offices across America, "Usual Care" is handing you a pamphlet on diabetes (usually written by a drug company), a glucose meter for 'free' (provided by the folks who want your money for supplies), writing you one or more prescriptions, signing you up for an hour with a diabetic educator (maybe), and wishing you luck. In other words, 'Usual Care" is crappy care, plain and simple.

In the world of the lap band-aid, no one pays to teach people who have diabetes or who are at-risk, how to eat. No one shows you how to shop for and cook healthy food. No one works with individuals and families long-term to help them sustain changes or develop healthier eating habits. Obesity is a family problem, not just an individual one. It's also a food-chain problem, where we subsidize high-fructose corn syrup and processed foods at the expense of fruits, vegetables, and healthy grains. The recently passed farm bill did almost nothing to encourage the growth of locally grown, affordable organic vegetables or healthier school lunches. We're going to grow the same junk and rave about how lucky we are to have cheap food.

The cost of a lap band is at least $15,000; other obesity surgeries cost even more. Sometimes health insurance covers it. Sometimes not. When is the last time an individual or insurer invested this kind of money in a 2 yr program to reduce obesity, diabetes and heart disease? Short answer: never.

In the NBC video the lead researcher states that an adult cannot lose over 20 pounds and keep it off. Unless of course, a surgeon puts in a lap band (wanna bet he's a surgeon?). Bullshit. Granted, it is much, much harder for morbidly obese adults to lose weight and keep it off. But the study participants were overweight, not morbidly obese. We, as a country, have made no effort from a public health perspective, to look at the system that creates and nourishes obesity (no pun intended). That system includes schools, family farms, industrial agribusiness, processed food purveyors, the goddamned Food Pyramid ...I could go on, but you get the idea. This is a cultural, societal problem and while lap bands may be a stop-gap, and necessary for some, we're in a world of hurt if we don't invest in systemic solutions. At the least, we need to help families learn how to feed their kids to fend off the obesity epidemic. How 'bout that?

As for classifying a lap band as 'first line treatment for diabetes', God help us.