Wednesday, February 27, 2013

Excerpts from The PRH (Personal Responsibility for Health) Chronicles by David Katz, M.D.

Like other species, ours lives in the modern world with prehistoric genes and prehistoric tendencies.

Pronghorn antelope that race across the plains of Colorado and Wyoming are beautiful to watch, but to zoologists, they pose something of a mystery. They can run up to 40 miles per hour, and sustain their top speed for more than four miles, even though no existing predator can come close to catching them.

Thousands of years ago, however, such predators -- long-legged wolves and a North American hyena -- did exist. So the pronghorn continue to run for their lives -- from ghosts. They share the genetic makeup of their ancestors, and thus remain what their past required them to be. And so do we.

We, too, have a natural environment. And a world of fast-food drive-through restaurants, fax machines, escalators and email is not it. The nutritional environment we live in is toxic to us. The effects of that toxicity are rampant chronic disease and epidemic obesity. In trying to choose fruits and vegetables over chocolate and cheese, you are fighting your own metabolism, engineered to preserve you through periods of famine.

Epidemic obesity and chronic disease is, like a perfect storm, the product of massive and protean forces. It is an emergency in slow motion, but an emergency just the same. Whereas a hurricane devastates one part of our country over the span of a few days, obesity and attendant chronic disease have been battering at our entire population over a span of decades. The consequences are concisely epitomized by noting that what was "adult-onset" diabetes less than a generation ago is now routinely diagnosed in children under age 10. Other chronic diseases -- heart disease, stroke, and cancer -- are following diabetes down the age curve.

Like any other storm, these threats call for a brisk and well-coordinated crisis response that has yet to materialize fully. Instead, as our bodies expand and our health deteriorates, the body politic has divided into opposing camps claiming personal responsibility, or environmental factors, as the mutually exclusive explanations for our plight. Such polarity translates into partial paralysis, forestalling the cooperative actions needed to curtail this relentless scourge.

That an "obesigenic" environment trumps personal choice, tends to prevail among public health advocates, and with good reason. In 2005 and 2006, the Chicago Tribune highlighted food industry practices, including the use of functional MRI scans of the brain, to determine flavor combinations most conducive to endless eating. An updated overview of food industry efforts underlying the addictiveness of snack foods is the most recent New York Times Magazine cover story. The links between industrial profits and prevailing pandemics is elaborated in a current issue of The Lancet, a prestigious international medical journal.

Realistically, we must invoke both environmental reform and personal responsibility to promote health. After all, if in our enthusiasm for environmental determinism we renounce personal responsibility altogether, we risk both ineffectiveness and irrelevance for failing to consider that you can lead people to carrot juice but you can't make them drink -- any more than you can make them use stairs instead of elevators, rakes instead of leaf blowers, or soccer balls rather than video games.

On the other hand, any fair-minded person must recognize that the playing field of opportunity for weight control is not level. Implying that people struggling with poverty, unsafe neighborhoods, and resource-poor environments are personally "responsible" for their weight can be the literal addition of insult to injury, a blame-the-victim mentality that ignores access, affordability, and social privilege.

What we need, and have thus far mostly failed to pursue, is a diligent attempt to base policies on data rather than reciprocal disparagements. Questionnaires can test what behavioral science calls "self-efficacy," the capacity to take personal control.

Who does, and who does not, have the knowledge, skills, and resources to compensate for the obesigenic modern environment? We can, and should, find out, and devise means of providing personal control and empowerment where they're lacking, making environmental changes -- such as the elimination of junk foods from schools, or the addition of sidewalks to a suburban neighborhood -- where necessary.

At some point, the interaction of environment and behavior does come down to choice, and we can ask individuals to make good ones -- just as we can ask them to make personal preparations for a dangerous storm. But the levees will remain our collective responsibility.

To read the entire series, go to:

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