If I was Surgeon General…

I would follow the lead of our country’s first Mom.

This is serious folks.

We, as an American society, need to solve the obesity crisis.  Not just for our physical health, but for our country’s financial stability.

Reducing the spiraling costs of health care is wanted by all.  So far, prevention of the diseases which contribute most to our health care costs, (heart disease, cancer and orthopedic issues, to name just a few) has been given only lip service, by our future supplier of health care–the American government.

It turns out that the mechanisms to reduce our most costly ailments are the same as those that mitigate obesity. It is like simple math. (If a=b, and b=c, than a=c.)  If lifestyle choices reduce obesity, and less obesity means less consumption of health care for heart disease and cancer, than better lifestyle choices means less health care consumption.  Bunches less.  It is for this reason, that I believe the most productive way to reduce health care expenditures is to reduce obesity.

Right now, the government and third-party payers are using other means to wrestle the rising costs of health care.  Dr Berwick and his like-minded academics from cocoons like Cambridge plan to reduce costs by rationing care.  Presently, we have the increasingly used covert rationing techniques, like using “doctors in cubicles” who, without seeing the patient, deny tests and procedures.   But soon, there will be no way to avoid overt rationing.   Others think that reducing doctors’ compensation will reduce costs. It will, but the price of this strategy will be reducing access to care for the majority. WItness the VA healthcare system. 

My vision is that we can conquer the obesity epidemic.  Doing so will improve our country’s health, productivity and likely lead us out of the health care morass.

Here are a few components of my plan…

First, some important assumptions:

  • High calorie food and drink are not going away.  Fast-food restaurants with drive-thrus are here to stay.  Coke, Pepsi and the infinite concoctions of sweetened fluids are staying as well. Very easy access to high-calorie inexpensive food is a certainty in the future. 
  • Automation in the work place will continue to make it more difficult to burn calories at work.  The professor and the judge are right about this. 
  • We will continue our evolution into a car-dominated society.  Outside of the unusual places where vegetarians and granola-munching dominate, like Boulder and Bend, it will become increasingly harder to navigate by foot or bike.
  • Society is unlikely to tax junk food like we do for cigarettes.  Although, the benefits of financially discouraging junk food consumption seems obvious, implementing such a tax is implausible and politically untenable.  For example, which foods get labeled junk and which do not, would prove to be a circus.  Baked chips versus regular chips, dark chocolate versus milk chocolate are just two of many vexing examples.  Further, the influence of our snack-food companies, like Coke, Pepsi and Frito-Lay would surely unleash their political fury against such a “regressive” tax, as they would call it.
  • Public education campaigns can work.   The benefits of eliminating smoking in public places has taken hold even in the heart of a tobacco growing community, Glasgow, KY.  I believe with enough effort, reducing fat-creating behaviors is achievable.   

These assumptions provide the background in which we will have to work out solutions.  A multi-prong attack on fatness will be needed.  (Please, feel free to add another prong.)

Prong 1:  Hit em early.

Generational change will be needed.  As such, changing fat-creating behaviors needs to start early.  Pediatric leaders will need to make obesity education and treatment as high a priority as vaccinations.  Excessive calorie intake needs to be targeted at a young age, like measles mumps and other infectious diseases. Surely, obesity is worse than pink eye.  For example, kids naturally stop eating when they are full–this behavior needs to be carried forward, aggressively.

Prong 2:  Educational reform.

Educational leaders need to passionately move forward in teaching children about the new world of available calories and challenges to finding places and time for exercise.  No longer should lip-service be paid to gym and nutrition classes.  Physical education should morph into exercise time.  Invoking the excuse that there is not enough time in a school day for exercise needs to be banished.  Oodles of data show that exercise actually enhances learning.  Junk food should be removed from schools.  There is plenty of room for fame and fortune for those who can make inroads here.  Maybe even a Nobel prize.

Prong 3:   In treating obesity, adult doctors are guilty of passivity.

Simply saying to a patient, “try and lose weight,” is woefully inadequate.  Adult doctors need to be much more aggressive in their approach to fatness.  A high BMI is a high BMI. It is hard data that should be frankly discussed, like blood pressure, blood sugar and testosterone levels.  And, I am not just talking about Kentucky-level obesity, even “bike-jersey” fatness needs to be discussed.  Are you fat?  Put a bike jersey on and look in the mirror.  The answer will be obvious.

Lowering the threshold of discussing fatness is critically important, as catching any disease in its early stages makes therapy easier.  Obesity is no exception.

Prong 4:  A massive public-service campaign needs to emerge.

So far, we have the pediatricians, educators and adult doctors on board.  Now we need the government.  Give the rationing a break for a moment, and let’s work on preventing the diseases which really impact our medical system. With the fury of the “got Milk” campaign, healthcare leaders need to convince Americans (especially in places like Manchester, KY) that drinking sugary drinks, eating fat-laden snack foods and not finding a place and time each day to exercise is dangerous. “You don’t exercise?…Holy cow, that’s bad,” should be our country’s new mind-set.

Here would be one slogan,  “Exercise every day you eat!” 

Prong 5:  Reward objective evidence of wellness and fitness.

Although it would be controversial, it seems self-evident that thinness and fitness should be rewarded.  Twenty years ago, I remember that the sponsor of the Indy half-marathon–an insurance company–offered a discount for those that ran a certain time.  Drastic times call for drastic measures, and so it seems that those with normal BMI’s should pay less.  Sorry if this sounds prejudicial or caustic, but incentives are an important motivator, and none better than money.

Prong 6:  Not finding a place or time for regular exercise needs to be unacceptable.

The message is that we no longer live in a world where kids walk to school and people burn calories at work.  It is a new world, where food is available everywhere. We are not devolving our cities backwards for pedestrian or bike traffic. Therefore, like brushing our teeth and hair are societal norms, so should finding time and a place to exercise.

Implementing such a radical new paradigm will require children.  Children can mold adult behaviors.  They brought us old folks Facebook and texting, so surely they can bring us the new social norm of daily life with exercise.  Our new America will need to look at those that run, ride or walk as the mainstream rather than the fringe.

Business leaders can also help with this new norm.  Forward thinking companies should encourage such a new paradigm.  Many already do.  Our new paradigm of exercise and eating right is good for business as well.

Such a message will take time and persistence, but it is possible.  Isn’t it? 

JMM

Comments

  1. Anonymous says

    Right on. In practice, though, prevention is the only answer that can possibly work on a large scale…UNLESS someone comes up with a mind-altering drug that is wonderfully effective but free of side effects. Bwaaahahahahaha.

  2. AM says

    There's a total disconnect in how many people view food, and it's due largely to TV commercials. Children are trained to want the soup with Dora on the label, never mind what's in the can. Restaurants sell lifestyle as much as the food, and never mind what's in the food, either. Food is fuel, it's not a friend, it's not comfort, it's not solace for life's disappointments. Education on how to evaluate a commercial needs to start early to resist the brainwashing.

  3. Sam says

    Here here! You aren't dreaming, John, just hoping. We can make it happen.

    "Outside of the unusual places where vegetarians and granola-munching dominate, like Boulder and Bend, it will become increasingly harder to navigate by foot or bike." – don't forget the Highlands (sort of)!

    Jamie Oliver is on board with a lot of this and is making things happen: http://www.jamieoliver.com/campaigns/jamies-food-revolution

  4. Steve Parker, M.D. says

    I like #5 in particular. If someone objects to a health insurance discount based on body mass index, let them qualify for it if they can perform in the top 25% on a treadmill exercise test.

    Money is indeed a great motivator. Many people have tried and failed lots of different diets and then conclude they just can't lose weight and keep it off. I wonder how many of them would succeed if offered $100,000? I bet most.

    [This is not an offer. Just a thought experiment.]

    -Steve

  5. Anonymous says

    Food is such an amazing social concept. We eat when we're happy, sad, depressed, to celebrate, to grieve and to be social with each other. Try to think of something social that doesn't involve food and it's pretty hard to come up with any. Two years ago I became unable to eat by mouth and it was devastating. It led to depression and I really thought the end of the world had come. I searched for a magic pill to make it better, but it wasn't to be. Here I am two years later and I am able to say "it's just food people!". It's just fuel for me at this point – I run it through a tube. It wasn't a choice I would have made on my own, but it's not the end of the world and it isn't even awful. I still have cravings and "taste" things occasionally but even that is losing it's appeal as time goes on.

    People who say they "can't" lose weight certainly would lose weight if they were suddenly in my shoes. It's a choice…plain and simple. I know that there are those who would argue this fact. If they had to choose to either eat really great food or die (immediately), most people would choose to live. We're kind of wired for self preservation.

    Thanks for the thought-provoking post.

  6. DrJohnM says

    Thank you all for such really cool comments.

    AM: We can add another prong: Hollywood. Hollywood people seem to like good causes. Surely fixing our country's most pressing health problem could get some traction.

    Anony: Wow. Your story is amazing. I believe in the simple two-sided equation:calories in<calories out=weight loss.. Your story illustrates this notion with clarity. But…and it is a big but, it is hard to say it that simply and not be dismissed as insensitive–even in the blogosphere.
    I am really grateful to hear your story. Be not surprised if it is seen again in the future.

    You are right Steve. 100,000k and I might look like a Tour de France rider.

    JMM