Tales of the Bizarro World: The American Response to the Obesity Epidemic

Howard Markel, MD, PhD

Disclosures

Medscape Pediatrics. 2006;8(2) 

Fast food giants, such as McDonald's, Burger King, and Wendy's, are now serving dressed-up (but not necessarily healthy) salads to the hungry customers who they attract to company-sponsored yoga classes and fitness events.[1]

Major medical centers across the land are opening the doors to these same fast-food joints so that they may sell their high-caloric, cholesterol-rich, trans-fatty fare to our patients and their families.[2]

More recently, former President Bill Clinton clinched a deal with the major soda pop manufacturers to get their sugary-fizzy concoctions out of the mouths of millions of American school children who guzzle them daily — but not until, at least, 2010.[3]

Huh?

All of these examples of how American society and, more pointedly, its medical profession are tackling the obesity epidemic suggest a brilliant feature of the old Superman comic book series called Tales of the Bizarro World.[4]

Bizarro, it will be recalled, was a planet shaped much like a sugar cube — a place where nothing was quite right and everything off the beam. Most memorable was "Bizarro Superman" who, in keeping with his world's ethos of cognitive dissonance, routinely entered a room saying "goodbye" and, upon leaving, hailed everyone "hello."

Alas, this popular cultural artifact uncomfortably characterizes our profession's inattentive and, at times, oppositional approach to this burgeoning public health exigency.

Of greatest concern are our nation's youngest citizens. Today, more than 20% of all American preschoolers are overweight — more than double the number in 1970 — and 1 in 10 is considered clinically obese.

During the same period, obesity rates have tripled for children aged 6-11. Pediatricians routinely see patients with hypertension, obesity-related apnea, and high cholesterol levels. Educators are witnessing a growing wave of teasing and bullying endured by heavier kids. Newspapers decry the cuts in school budgets dedicated to physical fitness and vigorous play activities.[5]

Since 1990, schools have welcomed the soft drink and junk food companies with open arms, trading "pouring rights" and vending machine space in exchange for hefty fees to help their ailing budgets. The business plan worked. The average 11- to 14-year-old now drinks almost twice as much soda as water; 15- to 19-year-olds consume an average of two 12-oz sodas a day, amounting to a sugar consumption of 1.5 lb per week! (Each 12-oz serving of soda, incidentally, contains about 10 teaspoons of sugar and constitutes 150 calories.) Today, in more than 98% of all American high schools, students can purchase name-brand fast foods, soda, candy bars, potato chips, and other high-fat, sugary snacks without ever leaving the campus. As a result, it does not take too much imagination to figure out the breakfast and lunch menus for the majority of American kids — especially the ones who already have weight problems.[6]

Perhaps the greatest reason why childhood obesity has become such a national cause celebre is the excellent evidence that the overwhelming majority of overweight children tend to stay that way. Also, all of these overweight adults are at much higher risk of suffering from heart attacks, stroke, hypertension, diabetes, and a slew of other deleterious conditions.[7,8,9,10,11] Worse, studies now predict that if we do not drastically change the course of our collective eating habits, we can expect a reduction in the average life span by 5 years and an annual bill for $79 billion or more in healthcare costs.[12]

Ethnicity and poverty also play a disturbing role in this tale of conspicuous consumption: Forty-five percent of non-Hispanic blacks and 36.8% of Mexican Americans over the age of 20 are obese, as opposed to 30.6% of non-Hispanic white adults. African Americans and Hispanics are also more likely to suffer from obesity-related diseases. Blacks are 1.8 times more likely to have type 2 diabetes than whites and Mexican Americans; the largest Hispanic subpopulation is 1.7 times as likely. Almost 43% of blacks have cardiovascular disease compared with 33% of whites in the United States. Most troubling, African Americans and Hispanics, particularly those in the lower economic classes, make up the core customer constituency of the major fast-food restaurant chains that, not coincidentally, offer large portions at affordable prices.[7]

There are, of course, many villains in this mortality play: Big Food, the very purveyors of supersized portions and a plethora of snacks that we ought not to be eating; big Eaters, who line up to purchase these products, demanding more food while assiduously avoiding anything resembling exercise; and let's not forget Madison Avenue and the media, which bombard kids and adults alike with appealing images of junk food.

However, when it comes to how we doctors have approached the obesity crisis, the biblical proverb, "Physician heal thyself" (Luke 4:23), should immediately spring to mind.

To be sure, there are many fine doctors and clinical researchers devoting their careers and talents to ameliorating the risks for obesity. However, those professionals make up a scant minority of the medical community. For example, most of the recent efforts to get junk food out of schools have almost exclusively been a grass roots effort. Worse, several surveys indicate that many American physicians, like the patients we treat, are overweight, eat poorly, and do not exercise regularly.[13]

Paradoxically, most of us simply do not know how to give sound nutritional and dietary advice. Even after decades of heated debates among those guiding medical school curricula, many, many more hours of a medical student's education continue to be devoted to coronary artery disease, stroke, hypertension, and type 2 diabetes than on how to prevent the obesity that often leads to these maladies. Similarly, a fraction of time during one's internship and residency training is aimed at advising patients about weight-loss options when compared with the time spent dialing up or down a diabetic's insulin doses or sending patients off for cardiac bypass surgery. However, in a world where disease prevention is no longer a hopeful pipe dream, why are our young physicians still taught to focus primarily on acute diseases and intensive care at the exclusion of the principles of sound eating habits and exercise?[14]

We doctors also need to admit that most of us do not like treating obesity. Any physician who has attempted this ornery task will freely admit that it is frustrating, takes a lot of time, often does not work, and is poorly reimbursed by the insurance companies that most of us rely on to buttress an ever-shrinking "bottom line" of clinical revenue.

In the end, none of these excuses "cut the mustard." What we have on our hands is nothing short of a national life and death dilemma.

Such an emergency demands that we step up and begin acting like doctors in the truest sense of the word, as advisors and counselors to our patients; as role models, practicing what we preach; as investigators searching for new ways to treat and prevent obesity; as teachers instructing our students how to go about recognizing and halting bad eating habits in their patients; and as activists working to get junk foods out of our schools and hospitals and the insurance companies to cover treatments and counseling for obesity.

At long last, it is time for all health professionals, no matter what their specialties or clinical interests, to reverse a deleterious trend that Hippocrates recognized 2500 years ago: "Those who are constitutionally very fat are more apt to die quickly than those who are thin.[15]"

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