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.

Spotlight on Children and Healthy Eating

I read the Well blog frequently; I have to for work, but I read most of it because I’m genuinely interested in its content. In the past few days, Tara Parker-Pope has written two entries that deal with children and food, one of her many pet topics.

Friday’s “Slowing Down School Lunch” featured a short interview with Dr. Arthur Agatston, a cardiologist who has done studies on elementary schools and children’s eating, seeing how the shortened school lunch period negatively affects students’ eating habits. “Children in America today are often overfed and undernourished,” he said, and cites the positive turnaround that antismoking campaigns have done for children’s health, hoping that a similar initiative can be put in place to foster healthy eating.

I spent every day in middle school bitching about how short my lunch period was. The time did not change in high school, but by then I was used to it and resigned to the fact that there was nothing I could do. Lunch was twenty minutes, which included time from the bell to get out of the previous class to the bell that announced the next class begin, and in that time you had to fit in walking to and from your locker, exchanging books, walking to the cafeteria, possibly buying lunch (something I did approximately once a week), and using the bathroom. I also tried to squeeze in some homework or socializing in addition to eating my lunch.

That’s not enough time. I’m a slow eater—always have been, always will be—regardless if I’m doing anything other than eating. I just am. Inhaling my food has always been problematic, and I spent many lunch periods still choking down food as everyone exited, packing up my books with a banana in my mouth.

What Parker-Pope discusses goes hand in hand with the post from the previous day, how you can teach your child to eat healthy. Having quick meals encourages fast food of all stripes—frozen dinners, breakfast bars, a bag of chips. Eating an apple takes time, especially when your mouth and hands are small. And shorter lunch times, especially when faced with a ridiculous long line, bullies, and a Spanish test to study for guarantee that a trade-off is made, and that trade-off is usually to disregard lunch. And with meal times so out of whack (10:30 am, anyone, when school starts at 8), it’s often hard to eat too, especially if your body is severely sleep-deprived.

I am a big believer that children need to be exposed to lots of different things, and that includes food. They may not appreciate some of it until they are older, but sometimes children are more willing to try things than adults are, and they at least have the knowledge to recognize that they don’t like something for a concrete reason that’s not “because it’s green”.

Too many kid-centric entertainments consider children’s food the lowest common denominator, and as such perpetuate the horrible nutritional value and bad reputation of food that children like. There are children who like vegetables and healthy meals, and they don’t all live in San Francisco. Going to a McDonald’s party (do they still do those?), a Chuckie Cheese, or a movie theater is a recipe for a toothache and a stomachache, and really poor quality of pizza. It’s distressing to see children—even adults—who are reduced to chicken fingers and French fries, and their version of a salad is the basic “chicken ceasar”, nothing but some iceberg lettuce, cheese, three croutons, and creamy dressing. Gross. It also fosters children to be very narrow-minded food consumers as adults, and will balk when presented with anything different or fancy—even if a common dish’s preparation is altered. This viewpoint leads to finicky, picky people who often have poor habits and an even poorer diet, which can lead to problems down the road…which leads to higher health expenses, less mobility, less options, and a crappier quality of life. Sold?

I’m getting ahead of myself. My original intention was to highlight part of Parker-Pope’s interview with Tom Colicchio, the head judge on Top Chef. He discusses how hard it is to teach children good healthy habits in regard to food, and his experience with his son. I agree with a lot he says, and love that he points out the positive feedback his show has gotten. Food and cooking shows can be great family entertainment, and it’s encouraging to hear that Top Chef has changed viewers’ habits positively.

Does having a father who is a chef make a difference in your son’s eating habits?

I don’t think having a father as a chef makes you any more or less susceptible to eating unhealthy food. If he’s out with his friends he’s going to do what his friends are doing. He’s like most kids. He’s not a chicken finger kid, and we’re not big fast food eaters. But it’s still a struggle to get him to eat healthy food. He’d rather grab a Sprite. But he enjoys good food. His idea of a great meal is seafood.

What do you think is the most important thing you’ve done to shape his eating habits?

We’re eating healthier food at home, so he’s eating what we’re eating. For us the challenge is he likes soda and he likes sweets, so we have to limit that. I think the patterns are set very early when the kids are young. But at the same time, there are some flavors kids just don’t like. For him, he’ll eat peas, but he doesn’t like broccoli. Green was always an issue. For a while he wouldn’t eat anything with chopped parsley. He still doesn’t eat raw tomatoes, it’s the goop inside. I had the same issue when I was a kid. But there are also things he loves that he probably wouldn’t if he hadn’t been exposed to them. For instance, he loves caviar.

Do you talk to him about healthy eating?

Giving him a choice between something that is unhealthy and something healthy, that’s not the choice. It’s between good and bad, well prepared and poorly prepared. He used to complain that the school cafeteria food was so bad he wouldn’t eat it. He used to like boxed mac and cheese, but once he got the real stuff, he said he didn’t want the boxed stuff anymore.

Does it surprise you how popular your show is with kids?

I travel around and hear from so many kids. Their parents say they were always very picky but they watch the show and they want to try stuff. The show is entertainment, but I think it has done so much for the public perception of what food can be.

Should restaurants be doing more to promote healthful eating?

What chefs can do when it comes to getting the word out is have people understand food differently. If food is well sourced and well prepared, I don’t think the word healthy needs to be brought into it. It’s healthy because it’s wholesome. That’s what we should focus on. You can buy a box of low-fat macaroni and cheese made with powdered nonsense. I’m not worried if I’m using four different cheeses and it’s high in fat. It’s real food. That’s what’s more important.

What do you say to parents who work all day and rely on packaged foods for convenience?

I want to feed my kid something that is real and not processed. It’s hard to do. People are working and busy. The question is: Is it worth it? Is it worth stopping at the farm stand or supermarket to buy fresh ingredients? Even just choosing whether to buy a head of lettuce. Do you buy fresh or the prewashed lettuce in a bag with the nutrients leached out of it? That’s what’s more important to me.