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Knowledge, so the saying goes, is power. But even a cursory chew of the prevailing state of diet and health is cause for doubt about the power of knowledge, our knowledge of power, or maybe both.
When my career in Preventive Medicine began some 30 years ago, we already knew that poor overall diet quality- fundamentally, everything other than “[real] food, not too much, mostly plants” – was among the top three causes of premature death in the United States. Maybe it takes a while to translate knowledge into power? Perhaps, but three decades should more than suffice to indict multicolored marshmallows of crimes against breakfast- but here we still are. Actual Causes of Death in the United States was published in JAMA in 1993. Now you know.
In late 2005 and early 2006, The Chicago Tribune ran a four-part expose entitled “The Oreo, Obesity, and Us.” This series culminated with “Where There’s Smoke, There Might Be Food Research, Too”- informing us that the same functional MRI machines were being shared between tobacco scientists and food industry scientists tasked with ever better formulations to propagate our addictions. If you missed that memo 15 years ago…now you know.
Also in 2006, courtesy of the International Congress on Obesity, we learned that the world had crossed a Rubicon of energy balance: for the first time in history, there were more total humans afflicted with overweight and obesity than with hunger. If unaware of that historical milestone, now you know.
It was, believe it or not, more than 14 years ago- in January of 2007- when Michael Pollan told us, with signature lilt and panache, that our sequential fixation on one nutrient or another would doom us to miss forever the forest of eating well for the trees of silly titillation. Put another way: there is more than one way to eat badly, and we were apparently committed to exploring them all. To have missed Pollan’s admonishment against this folly you would likely need to be living under a rock left behind by receding glaciers. Should you happen to be among those rarefied few…now you know.
Among the many studies demonstrating the power of dietary fundamentals to shift both years in life and life in years, “Healthy Living is the Best Revenge,” published in 2009, is among my favorites. That study- in over 23,000 adults- associated the venerable trifecta of feet, forks, and fingers - not smoking (renouncing bad use of “fingers”), being routinely active (making good use of “feet”), and eating well as defined simplistically yet adequately by habitual intake of vegetables, fruits, and whole grains (making good use of “forks”) – with an 80% lesser incidence (or risk) of all major chronic disease. If you didn’t know already, now you know.
In 2010, the promise of lifestyle as medicine was put on vivid display with a view of the Blue Zones, courtesy of Dan Buettner. We learned that across an expanse of diverse geographies, ethnicities, genetics, and cultures- the fundamentals of eating well and living well translated reliably into more years in life, more life in years, and robust defense against the slings and arrows of prevailing epidemiologic misfortunes, from diabetes to dementia. If, per chance, you are new to the Blue Zones blessings, well- now you know.
Michael Moss reprised and embellished the earlier revelations evinced in the Chicago Tribune in Salt Sugar Fat. The book was excerpted into a New York Times Magazine cover story entitled “The Extraordinary Science of Addictive Junk Food” in 2013. Here, for those who missed the news nearly a decade earlier, was our second bite at the ultra-processed apple(jacks). Once again, we were apprised of the willful manipulation of our food supply to maximize the eating required to feel full, and in effect, the intentional propagation of obesity in deference to profit. If this missive missed you both times, now you know.
In 2017, we were told that “dietary factors”- and we might simply reference those factors as “the usual suspects” – were “estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes.” In 2019, we learned that “suboptimal diet is responsible for more deaths than any other risks globally, including tobacco smoking;” that “our food is killing too many of us;” and that “improvements in dietary quality have the potential to reduce mortality rates substantially.” Now you know.
Finally, in 2021, we learned that the staggering, chronic sequelae of eating poorly were massively compounded by the acute liability of elevated risk for adverse COVID outcomes, mediated by (mostly) diet-induced cardiometabolic disease. For that matter, boondoggles in the sourcing of human food likely account for the origins of this pandemic, most others in recent history, and…the next. On the off chance all of this were not yet enough to deliver a powerful kick to our seemingly complacent backsides, we learned as well that the same dietary practices cooking our personal goose are doing much the same to the planet.
If at a loss what to label our miscellaneous adulterations of sustenance spanning production, distribution, preparation, and consumption- sowing devastation from biomarkers to biodiversity, social equity to aquifers - my friend Mark Bittman recommends: suicidal. Now you know.
To sum up, then, the ravages of dietary intake at odds with the health of people and planet alike – exacting a massive, perennial cost by every measure that matters- are neither covert, nor inadvertent. They are exposed, understood, and in no small measure- imposed by profitable design.
Gertrude Stein told us “a difference, to be a difference, must make a difference.” If the knowledge at our disposal now about diet and health - what’s broken, why, and how to fix it - is insufficient to empower our routine, corrective action- to say nothing of outrage- what would be? What difference does it make to know so much when doing so little with it?
I’ve been battling these forces for 30 years, and quite frankly- I wish I knew.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former 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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