What would you call the following scenario: a nation of families spends a portion of their income on poor quality food that routinely makes them sick and kills them prematurely.
Employers, insurance companies, and the government help most of them pay for the drugs and treatments necessary to treat the conditions caused in large measure by “bad” food. The costs of treatment for conditions hardly anyone needed to get in the first place routinely exceed the costs of the food largely responsible for engendering those conditions.
Perhaps “crazy” comes to mind? Bizarre, nuts, outrageous? Absurd, ridiculous, preposterous?
I would call it: just another day in America. Just another day in much of the modern world, for that matter, because the substitution of disease-inducing junk where food ought to be is not only a substantially American invention, but a very lucrative export. We have done our utmost to sell the amalgam of food as an assault on public health, and medicine as remedy, to anyone remotely capable of buying it.
There is a better way.
In rebuttal to this massive outrage hiding in plain sight- an outrage that has made “adult onset” diabetes a quotidian diagnosis in our children- that is a seemingly quite bland statement. That almost any way would be a better way all but screams at us.
But we are seemingly blind to the outrage, and deaf to the screams. So, perhaps a bland statement may better serve the urgency, just as a whisper is at times better at attracting attention than a yell: there is a better way.
First, let’s revisit my use of “bad” as a descriptor of food, above. The case has often been propounded by ostensible authorities that there is no such thing. I beg to differ; ultra-processed concoctions willfully engineered to be addictive are, in a word, “bad.” And, let’s take it further: bad is as bad does. Whenever a given assembly of foods is saliently implicated among the causes of chronic morbidity and/or premature mortality, as the typical American diet most assuredly is, then it is…bad. This is not a moral judgment, it is a verdict predicated on consequences. The flight path is in substantially slower motion, but this is “bad” in just the way that a bullet hole through the chest is “bad.”
Bad outcomes of eating per routine in America prevail. And thus, ipso facto, bad food prevails.
Food is not supposed to ravage organ systems, propagate degeneration of body parts, or accelerate our surrender to senescence. We will eventually succumb to these forces no matter how well we eat and live, but the Blue Zones show us how vibrantly and how long a well-nourished, well-tended body is apt to defend itself. There is nothing genetically special about Blue Zone populations; the “blessings” they enjoy- a greater bounty of years in life, a far greater bounty of life in years, unencumbered by the chronic diseases they routinely avoid- are courtesy of lifestyle. In principle, a salutary diet and lifestyle is an option for all.
In practice, however, that is not the case. The choices people make -whatever our level of personal responsibility and self-discipline- are subordinate to the choices people have. Aggressively peddle willfully addictive junk food, and normalize the notion that chronic disease is a societal rite of passage, polypharmacy an inevitable consequence of reaching mid-life, and the good choices people otherwise might make reside on the remote side of a bridge too far.
The SNAP program, directed at helping nearly one in seven American families struggling to put adequate food on the table, might be considered the highly visible tip of the same iceberg threatening to sink us all. I fully support SNAP as a partial remedy for a culture that cultivates massive socioeconomic disparities and preferentially markets obesity and chronic disease for profit to those who can least afford the toll.
But a dispassionate appraisal shows how deranged this status quo is. We, the American taxpayers, spend tens of billions of dollars to subsidize SNAP, and thereby help relatively poor people secure access to horribly poor food, and thus- achieve dreadfully poor health. We then spend many more tens and hundreds of billions of dollars through Medicaid to treat that poor health, and all too often, do it poorly.
If you can spot the winner in this scenario, the golden jellybeans are all yours.
We might, instead, provide easy-to-understand guidance to better quality foods, financial incentives to choose it- and nip this whole noxious bloom in the bud.
A drum beat has long been reverberating to tell us of the profound dysfunctions of eating in America. We have cause to hope the agents of a recent crescendo may overcome our complacency: Nestle, Pollan, Bittman, Moss and others. We have cause to hope the entanglements of our fate with that of the planet may do the same.
We have cause to hope, as well, that there may indeed be a silver lining when the dark clouds of the COVID pandemic finally part: a bright light shining on the acute liabilities of chronic cardiometabolic ill health. Among the pandemic’s lessons is this: there is an acute case for chronic vitality. Those opposed to delayed gratification, take note, and take heart. The benefits of food as medicine - rather than as preamble to the need for medications – confer gratification right away, before turning into the gift that keeps on giving.
The powers that be- Big Food, Big Pharma- may not like this, but it is merely an expression of a free market mantra: adapt, or die. There is no reason Food can’t be both big and good, and no reason why the assets of Pharma cannot diversify to investment in the right kinds of farms- just as Big Energy must now diversify to green, or suffer the fate of the obsolete.
Whether ill or well, nearly everyone who can, eats- nearly every day. The costs of eating - something- are thus fixed costs. The costs of food to nurture rather than degrade health are limited accordingly to the cost difference between “bad” and “good” food. The incremental cost, already apt to be vastly less than the costs of ill-health as usual, would decline further with time as our food supply shifted its emphasis to the production of good.
We could, if so inclined, monetize a revolutionary transition from our current “disease care” system to a system of literal “health care.” We could, more readily, transition from the dual costs of medication to fix only partly all the parts of us food keeps breaking. Food as the medicine long ago invoked by Hippocrates could save lives, vitality, biodiversity - and a vast fortune into the bargain.
The drum beat tolls of necessity in the guise of diabetes, heart disease, obesity, cancer, dementia, climate change- and the acutely calamitous toll of COVID as well. We may, whenever so inclined, invoke the will to invent the better way.
Dr. David L. Katz is a board-certified specialist in Preventive Medicine/Public Health and author, most recently, with Mark Bittman of How to Eat: All Your Food and Diet Questions Answered. He is the founder and CEO of Diet ID.
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.