Today the New York Times reports that federal health officials are disappointed as Americans continue to get fatter despite all the effort to demonize fast food, soda, and sugar, as well as the continuous harping everyone to eat less and exercise more. The report stated that, “Ab0ut 38 percent of American adults were obese in 2013 and 2014, up from 35 percent in 2011 and 2012.” Surprised? Not me, for two reasons.
First, too much of the weight loss propaganda out there sets people up for failure. Basically the energy balance equation is dead, yet most diets pivot on some angle to get people to eat less without adequately addressing hunger, satiety, and a multitude of other lifestyle factors that can effectively help their body burn fat for fuel.
Over decades, Americans have navigated mostly on their own in a quest to lose weight, mostly because we never made nutrition counseling a cornerstone of conventional medicine. In addition, just about anyone who eats thinks they are qualified to offer nutrition guidance.
From doctors, nurses, therapists and most health professionals, to fitness trainers, coaches and health teachers, and now the ubiquitous but less than adequately prepared life coaches and food bloggers, everyone wants to believe that they have the goods to offer food and nutrition counseling. To add to the confusion, anyone who has ever lost weight has a story to tell and advice to offer. I don’t blame all these well meaning people, they’re just stepping into a void created by a medical establishment that failed to acknowledge the central role of food and nutrition in both health and disease. Dietitians and qualified nutritionists have never been adequately staffed nor reimbursed in formal medical settings such as hospitals, clinics, and doctor’s offices.
Second, we measure a completely unreliable metric, weight–or its evil twin, body mass index (BMI) and pretend we are measuring health. Why? Because it is easy. Period.
Weight is a poor measure of health, but try telling that to the legions of health care providers, public health workers and policy wonks that insist on measuring a notoriously unreliable number and pretending it is a valid indicator of anything.
Ideally we would measure true bio-markers of health or more reliable measures assessing risk of disease. But even with better metrics, we may still lose the war on obesity because we have failed to commit adequate resources. We want to believe that lives and eating habits change with enough information, with enough cheer leading, or just because it is the right thing to do. Good luck with that.
If we were to get serious about improving the overall health of Americans, we have a lot of work to do. Here are a few suggestions:
- Stop subsidizing crops used to produce the junk (think corn and soy)
- Subsidize fruits and vegetables, as well as animal products grown in a biodynamic fashion, allowing for the efficient nutrient cycling in nature to work for us
- Fund every school lunch program to build or open a kitchen and cook whole foods from scratch–and then make sure the kids have enough time to eat.
- Eliminate use of antibiotics in food animals
- Ban use of artificial pesticides, herbicides and other agents that compromise life: human, animal and microbial and the health of the planet. We know what we need to do; stop waffling and pretending we need more studies.
- Establish a moratorium on genetic engineering and genetic modification in the food supply until studies can assess potential risk to all life forms, not just humans. We are interdependent and connected to all.
- Reward farmers and ranchers for employing sustainable and regenerative methods that restore soil ecology, minimize use of chemical inputs, enhance water flow and increase organic matter via carbon sequestration.
3. Simplify dietary guidelines and make them meaningful
- Stop making calories the enemy. Let’s teach people how to honor hunger and satiety. People want to feel good and enjoy good energy. Effective nutrition counseling can help consumers connect the dots between what they eat and how they feel.
- Emphasize whole foods and stop demonizing animal foods. There is no good data for current recommendations to limit saturated fat and red meat.
- Most critically, step away from the idea that there is one best way to eat, and more specifically one best way to lose weight. There are too many factors that influence energy metabolism, hunger, satiety, and energy partitioning for any one approach to work for all of us. Ideally we support each consumer as they figure out what approach to food works best for their personal metabolic needs and fitness goals.
4. Make meaningful nutrition education and counseling available to all
- Require all health care plans to reimburse nutrition counseling by qualified professionals to their members right along with other preventative screening and treatment. Current underwriting for most insurance companies routinely covers only diabetics.
- Require Medicare to reimburse RD’s and qualified nutritionists for nutrition counseling for obesity and all other conditions influenced by diet and metabolic health–and reimburse the professionals adequately. Why are we asking doctors and other primary care providers–the most expensive people in the room– to provide counseling to obese patients in 15 minute time slots with an abysmal $27.50 of reimbursement? To make matters worse, most PCP’s admit they don’t have the counseling skills, subject matter expertise, nor time and capacity to do the job in the first place.
5. Reset expectations: We don’t value the skills required to eat well, and then ridiculously assume that people are just going to figure it out on their own. Even if one learns all there is to know, knowledge is not the same as behavior.
We need to come clean and acknowledge the time required to plan and shop regularly for fresh food, cook from scratch and clean up. Pretending it is simple or takes no time at all sets up everyone except the dedicated foodies. If we are truly serious about tackling poor metabolic health, we need government, private industry, non government agencies, and educational institutions to demonstrate a value for the time, energy, and skills required to eat well.
- Integrate life skills education in the classroom–including budgeting, savvy food shopping, food preparation, and eating mindfully– both in middle and high school, and college, too. There is no greater skill set to enhance one’s quality of life as an independent adult.
- Re-establish a more modest work day so that consumers can enjoy food’s rightful place, along with adequate physical activity, recreation and a better quality of life
- Require that institutions and extracurricular activities honor time to prepare and consume regular meals and healthful snacks.
It’s times like this I think we need to revisit the notion of nuclear families. Does every household need to dedicate the resources, time and energy to do what could be accomplished so much more efficiently –and maybe more enjoyably– together?
Maybe tribal culture could teach us a bit about tapping into community resources so the benefits of eating well reach everyone, regardless of means or circumstances. Until then, it will be up to each of us to dedicate the time tending to one of our most basic needs, and hopefully appreciate what it takes to eat well every day.