Big, Fat, New Meaning to “Red State”

Big, Fat, New Meaning to “Red State”

David Katz 14/09/2018 2

I have quipped wryly for years that the relentless rise in obesity rates would eventually exhaust Crayola’s supply of colors. That’s because the CDC has long tracked the rising prevalence of obesity by state using color-coded maps of the U.S.

The latest update to those maps is now hot off the presses, and shown above. Apparently, Crayola (well, whoever supplies the font colors in question, actually) hasn’t run out yet.  The new map from CDC shows 7 states with obesity rates above 35% in red. It’s not a Scorsese red; more of a Harvard red. I suppose we may as well just call it “CDC-red.” But red just the same. One can’t help but wonder about subtle, cartographic political commentary.

I will defer those considerations to others, pausing here just long enough to note that obesity, public policies, politics, and poverty all do track together. The states that are now CDC-red, representing unprecedented levels of obesity, are disproportionately red in other ways, too.

If we focus, though, only on the relentless rise in obesity rates in these states, and the comparable if alternatively tinted version of that same trend in all the other states, too, we are still left with a very provocative tale, and a set of profound implications.

First, variation in obesity rates by state shows that this is much more a problem of populations than individuals. Individual humans are the same everywhere. But environments vary; economies vary; policies vary. Significant variation in obesity in response to all of these reminds us that preferential focus on will-power or personal responsibility is misguided. Homo sapiens have the same basic endowment, on average, of personal responsibility either side of a given state line. The mapping of obesity lays out in black, and white, and now red - the reminder that the choices any of us makes on a daily basis are subordinate to the choices we have. Those do vary by state: geographic, circumstantial, and experiential alike.

That perspective matters, because it reminds us we are likely only to accomplish so much (not much, really) admonishing people to make good choices in environments that peddle mostly bad ones. Sometimes, no matter one’s responsibility, the best defense of the human body resides with the body politic. That’s true everywhere we station lifeguards or rip tide warnings along beaches; it’s true for the relentlessly rising tide of obesity as well. Sure, there’s personal responsibility in the mix at both beach and buffet; but individuals need a fighting chance, rather than the snowball’s chance in hell we give them now. If we treated beaches like the food supply, we would systematically obscure the reality of rip tides with “come on in, the water’s fine!” signs.

This crimson tide also shows us starkly that we are not fixing the problem of epidemic obesity; we are still making it worse. This is not because the problem is so complicated; it is not. It is not for want of solutions; they are rather obvious. It is for want of will. However we may wring our hands, the power centers of our culture are perfectly happy with this status quo because they are profiting mightily from it. We carry on as if we have tried to fix obesity and failed. Let’s at least be honest.

Rather than doing so, we turn instead to reprising past forays into failed, quick-fix, fad dietsunder new names. Even as we have illustrious medical journals telling us why we can’t trust epidemiologic studies that reach sweeping conclusions about diet and health, we get epidemiologic studies in other illustrious journals reaching sweeping conclusions about diet and health, further amplified by media hyperbole. No, dairy fat is not suddenly a magical solution this week. No, the premier nutritional epidemiologists at Harvard are not peddling “carbs,” whatever exactly that would mean.

And all the while, we have somehow created a culture where alternatives to truth get to impersonate it shamelessly in broad daylight, yet speaking actual, blunt truth is politically incorrect. I am going to chance it anyway, as I am wont to do. We carry on about the challenges and complexities of epidemic obesity, noting that our efforts to date have failed to curtail it. The truth is our efforts to curtail it are vanishingly less substantive than our efforts to propagate it for profit, and we are reaping just what we have been sowing. We have thus far failed to fix epidemic obesity for the most obvious of reasons: we have never actually tried.

We tell one another we can’t trust nutrition science, and then proceed to amplify junk science into wildly silly claims we certainly should not trust, and then say: “see! Told you so.” The reality is, we certainly could trust nutrition science if we interpreted it the way those actually trained to conduct it, apply it, and interpret it do. We do not detonate our understanding built up over decades, or cry “EUREKA!” with every news cycle and hyperbolic headline, and neither should anyone. But if we are substituting the term “nutrition science” for inane, dysfunctional reactions to distorted news about nutrition science- well, then, yes: we certainly can’t trust THAT.

Teams keep picking the nutrient they want to revere or revile, all the while ignoring the massively more meaningful evidence about dietary patterns and their implications for the health of people and planet alike. The set of choices that represents the overlap between healthful, nourishing, palatable, ethical, and sustainable is dwindling fast.

Silly, pseudo-debates put saturated fat and sugar head-to-head as if there is just one thing wrong with the prevailing, modern diet. Excesses of both are injurious sure, but far more so is the stupidity (I warned you about blunt truth…) involved in thinking the indictment of one exonerates the other. Obesity down here? We’ve got plenty. Intelligent life? Not so much.

Let’s put it this way: we bicker, as we have for decades, about who’s found the better tree, as the entire forest burns down. By the light of that fire, rest assured that ever more states will turn…red.

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  • Nicholas Scott

    No wonder that healthcare costs are unaffordable......

  • Victoria Blackburn

    Great read, thanks for writing this.

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David Katz

Science Guru

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.

   

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