How Can We Reform America to Make It Healthier?

With a new health care policy in the news, and the usual track of obesity declared as the nation’s number one threat, I wonder, as I drive home after another day sitting at my desk, how we can actually change American society so that we are healthier.

Aside from the constant stream of new drugs on the market, and the new movement for locally grown food, how can many Americans—sitting in front of screens all day and all night—actually change their habits? It’s one thing to constantly carp on “calories in, calories out”, that you need to eat less and exercise more, but that’s a simple statement for a complicated problem. How can American society truly change? How can we structure work, our way of life, so that this is feasible?

I’m not talking about better health insurance, less availability of junk food, even funky workplace amenities like gyms and treadmill stations, although those things will help. But how do Americans, with their time-strapped, hectic lives, actually go about to make changes?

Many workplaces now offer incentives, or wellness initiatives, to get their employees healthy. And that’s a start. But so many people get up, drive to work to sit at a desk for too many hours, then drive home and watch TV, because that’s what they need to relax. Fitting in even a 30 minute workout (it’s never just 30 minutes), is tough when you don’t have the space, it’s cold, rainy and dark outside, and you have to make dinner and take care of the kids.

Working out during the day isn’t often feasible either, and while riding bikes to work is the hip green thing to do, it’s largely impractical for a huge number of people. There is, simply, usually too much work to do to tear yourself away from the computer for a large enough amount of time, and then we add in our own leisure reading of the news, checking emails, and doing our banking that brings us in front of the computer for more time.

People talk about changing corporate culture, but that is often very difficult to do and based on a lot of factors outside of a person’s control, especially if they are a junior employee. If everyone eats at their desk, and you don’t, it can look like you’re slacking, even if they are just checking Facebook.

A lot of the initiatives to change Americans' working habits will take a lot of time, especially if that includes redesigning the country’s transportation system. And while I am all for a reorganization of the country’s priorities regarding food subsidies, that doesn’t necessarily mean that things will change all that much (especially as fruit spoils in a vending machine). But how do we put in place things that make it easier for people to move more during the day?

The key is to make it natural, not forced, and not mandatory, because people should feel free to eat a hamburger, smoke, or sit in front of screens all day long if that is what they want. But institutional, societal changes are what needs to happen, and often in America, it is policy that pushes the rest of the country in a direction.

Even if, over time, better quality food is more equitably distributed and the country becomes less dependent on cars as a main form of transportation, we will still be captive to the screens. And yes, of course there are plenty of people who do not have to sit at a desk all day to work—teachers, construction, retail and restaurant workers, to name a few—but more and more of our jobs are sedentary, physically rote. What will happen in the future? How can we stem this tide? How can we change our environment?

I had these questions in mind when I read Megan McArdle’s interview with Paul Campos, the author of The Obesity Myth. He argues that much of what is perceived as current wisdom on obesity as the country’s leading healthcare crisis is wrong, and that the focus on obesity is harmful and ill-effective when it comes to reforming care. McArdle’s interview is partly prompted by a recent study in Health Affairs (of which I am familiar) that says that a growing number of our costs is due to obesity; prevention is understood to be by a lot of leaders one of the ways in which healthcare costs can be reduced.

At first read, a lot of what Campos says sounds blasphemous. Of course there is an obesity epidemic! How can you argue that? Just look around! Costs have soared, the rates of people on chronic medications have gone up, there's an ongoing debate about making airplane seats bigger...every day there's new evidence of how heavy and unhealthy America is.

One of his major issues is the destructive mistake people make between failing to distinguish being healthy and being thin. Despite the perception that getting thinner is being healthier, that is not the cause, and often is a form of disordered or disruptive eating, merely a symptom of a real problem and not a (truly) desired result, and that that being healthy or thin has morphed into a true moral panic.

I wonder when this started. There’s long been a historical association, at least within Western Europe, regarding body type and the availability of food, as it is with cultural perceptions of beauty—when food was scarce, being plump and voluptuous was the height of fashion (as was being pale, since it showed that you did not have to physically toil for your livelihood), whereas now not being thin is a measurement of self-control and class. “Thin” all too often equates to healthy, but many people (especially young people) have no conception that this will not last forever, and that they will eventually pay for it.

Campos is right that BMI is a flawed system, a fact that has not infiltrated the popular consciousness yet. Just like the old food pyramid, it is a distortion that is widely accepted and can actually be harmful.

Too much media coverage focuses on fitness and being healthy as losing weight, and it infiltrates down to become fact. Everyone is under constant assault about the nature of their bodies. Why are you eating that? Why are you doing this? It’s not enough/it’s too much/you’re too thin/you’re too fat/and on and on and on.

As we get older, our bodies change—as a result of age, pregnancy, stress, the environment, hormones, medication, lifestyle—and there’s only so much we can do to prevent it. It’s silly for the media to point to celebrities or athletes, because they have the resources—time and money—to afford the best care, the personal attention, the babysitter, chef, housekeeper, trainer, assistant. We can’t be Madonna, and honestly, most of us wouldn’t want to be, because we don’t want to be a slave to some figure that’s close to impossible to attain (and maintain). Even shows like "The Biggest Loser" don’t return to the contestants afterward, because it’s exceedingly difficult to go back to a normal life and sustain a major change without the help afforded to them on the show from trainers and chefs, without the unlimited time to only focus on their body and their health.

But I do question Campos on one thing about this obesity myth: What about the soaring rates of diseases like diabetes? That’s not the result of a newfangled calculation or the overprescribing of medications, and this is serious. We can argue about whether or not all those statin drugs are necessary, but I know that I do not want to be on these thirty years from now.

Public health remedies have focused on incentives to get people to adopt healthier behaviors, and that is where the idea to tax junk food and unhealthy substances like tobacco took root. But while this may work in theory, it seems counterintuitive for those windfalls to go back to merely preaching and prescribing the proper healthy behaviors, constantly reinforcing the cycle. Some smokers in particular find this galling, targeted as a result of behaviors they engage in; others welcome it as a deterrent. But as the population of smokers dwindles, it seems like a good bargain to the rest of us, because it doesn’t affect us. But widespread taxes will.

Campos returns several times to the point that the culture, with the government behind them, demonizes fat people, that the government is “abusive” when it puts these conditions in place. But we, as a society, demonize all weights. How do we stop doing that? It’s an essential part of human nature: we criticize, we gawk, we comment.

Likewise, he also makes excellent points on physical activity as it’s tied to weight. While it’s true that most publicized success stories do feature lines about feeling healthier, stronger and energized, it’s usually accompanied by other major (physical) changes. A success story that didn’t involve much, if any, weight loss isn’t interesting, because the change wasn’t physical.

McArdle does point out that no one encourages Americans to get married, get religion or move to the country, though that’s not true; it's just on a small scale, and nowhere near as pervasive as the confluences of weight, body image, and health.

It’s sadly true that fatness has become associated with “poverty and lack of self-control”, even though we are all powerless when it comes to certain foods. But self-control is too prized, and too tied with restrictive eating, so that it becomes less about discipline than deprivation.

And that’s where food porn comes in.

As I finished reading Megan McArdle’s post, I was lured into the living room where my father and brother were watching “Best Places to Pig Out” on the Travel Channel. They were calling for me, but since I heard “New Brunswick” and “food”, I was already on my way. The segment was on Rutgers University’s famous grease trucks. These sandwiches (which I’ve never had the opportunity to taste) are monstrous concoctions of fried foods stuffed in a sub: chicken fingers, eggs, bacon, burgers, gyro meat, mozzarella sticks, and of course, French fries. They are meant to give you indigestion, and are only supremely palatable to college students, who do not have to fear an upset stomach, which my father was getting just by watching. This was followed by The Heart Attack Grill, where burgers are named after coronary procedures and the waitresses are hot “nurses” who will wheel you out if you finish a triple or a quadruple. If you weigh over 350 lbs., your meal is free. (They have a scale.)

The restaurant was actually started by a nutritionist. But while the amount of lard used horrified me (I ate half a potato chip fried in lard last week and it tasted like an industrial metal), I was more annoyed with the senior patrons, who commented on their meal by merely announcing they will take an extra cholesterol pill that night, as if these pills would neutralize the effect a 1600 calorie lunch will have on their arteries.

These meals are ok once in a while, but these giant-sized gastro gymnastics are a reaction to what’s seen as a cracking down on pleasurable eating (despite the many such outlets for anyone who’s interested in food). But to say that Americans are getting healthier when a lot of evidence points to the contrary is misleading. Americans might have more pressure, more awareness of what they should do to be healthy than ever before, but they are also thwarted by both human nature and their own environment to be in optimum shape.