Question: What’s wrong with our health?
David Katz: We have a society that monumentally conspires against the pursuit of health. We have wave after wave of labor-saving technology that says don’t ever use your muscles for anything, along with messages that you should be more physically active. We have, every year, the introduction of hundreds, if not thousands, of new highly processed foods, the majority of which glow in the dark. At the same time we’re telling people: eat foods closer to nature. And we have crazy hectic routines that wear everybody out without doing any of the physical exertion that would actually good for them. We have schools where we teach children to sit still all day long so they can become adults we can’t get off couches with crowbars.
So there’s an awful lot about our society that is at odds with the basic message of “don’t smoke, be active, eat a healthy diet, and by the way control stress and get enough sleep.” We don’t make those things easy. We ideally would make health lie along the path of least resistance. But if not the path of least resistance, there at least needs to be a path so you don’t have to bushwhack your way there.
Question: How can policies and programs improve our health?
David Katz: If we look at sort of the emblem of our current problem with the lifestyle at odds with health as epidemic obesity and the related metabolic disorders, we can ask the question: How do we fix this? What is the way to fix this? And recently I was asked to give some commentary to a committee of the Institute of Medicine convened to address epidemic obesity and their question was very similar but not quite the same. They asked me how we use evidence to confront the epidemic of obesity. And my answer was: by thinking of a levy.
If we are facing-- and we are-- a flood tide of factors into our daily lives and the lives of our children that conspire against weight control, and for that matter, health, any single policy or program we use to turn the tide is like a single sandbag. You put down the sandbag on the banks of the river. You could ask the question: Have we held back the flood? Well the answer of course would be NO because the question is silly. A sandbag isn’t designed to hold back the flood. A sandbag is designed to be part of a levy to hold back the flood. It doesn’t matter if it’s a good sandbag, maybe a perfectly good sandbag. By itself it can’t fix the problem.
What we need to do now is recognize that it is the sum total of human ingenuity that is responsible for the epidemics of chronic disease. Throughout most of human history, calories were scarce and hard to get, and physical activity unavoidable. Calories are now abundant, and physical activity is hard to get. Why? Because we fixed those problems we always had before. We took an unstable, uncertain food supply and fixed it. Human resourcefulness, human ingenuity has created a stable, reliable food supply. We just overshot. It’s far too big, far too diverse, far too stable. Everywhere we go, we have tasty calories. We used to depend on muscle power for everything. What now passes as exercise and requires specialized footwear used to be called “survival.” You had to do it. Now you never have to do it. We solved the problem of excessive demands on our musculature. We solved it too well. Now we don’t need our muscles for anything.
But that’s an enormous problem. We’re confronting the sum total of human ingenuity over millennia. It’s a pendulum that’s swung too far. We have to swing it back. So it should come as no surprise that solution must be built from the ground up on the banks of this flooding river and it must be raised to a height higher than flood waters. Now what does that look like? It looks like policies and programs that cultivate healthy levels of physical activity, healthy dietary patterns in homes, in schools, in supermarkets, in neighborhoods, in clinics, in churches, in workplaces, throughout our society, every place we can reach people.
Recorded on: July 06, 2009