RFK Jr And A Nation Of Fatties - Lifestyle Changes? Phooey...Give Me My Ozempic

RFK Jr, nephew of a former President and now Donald Trump's new Secretary of Health, has vowed to Make America Healthy Again, and has taken aim at the food industry responsible, he says for the continued rise in obesity.  If it weren't for all those sweet breakfast cereals, salty, fat-laden snacks, and gallons of soft drinks, we would be trim, svelte, and healthy. 

Hold your horses there, Bobby, easier said than done.  Obesity is a complex psycho-social, genetic, and economic issue, and no president, no WHO or CDC expert, no citizens' lobby group has been able to stop the progression from negligible in JFK's day till now. 

A more sedentary lifestyle - a good thing, moving workers from fields to desks, from manual labor to knowledge industries - and the limited disposable income for sports clubs, gyms, and private trainers, has been a principle cause of overweight.  The configuration of most American cities, unlike those of Europe, is car-dependent suburban.  Americans walk less because shops and small businesses have moved to megamalls. 

Poverty has always been a limiting factor - poor people living on the margins will necessarily eat satisfying fat-rich foods and eschew the higher cost fresh fruits and vegetables.  Working two jobs doesn't leave a lot of time, energy, or interest in walking or running. 

A map of the poorest districts in the United States is perfectly congruent with a map of obesity; and the worst affected are in the Delta region of Mississippi, Arkansas, and Louisiana.  Poor families who used to eat a home-cooked unhealthy diet of cornmeal, fatback, and fried everything, now complement it with the cheap, equally unhealthy foods from the millions of fast food restaurants in the area.  On the commercial strip outside of Columbus, MS with a population of 25,000 and a per-capita income at $16,700 (2010), there are over 25 fast-food restaurants and all the major chains are represented.

People eat fast food because even though for a family of four, the cheapest meals are not cheap, time constraints for a two-earner household often with more than two jobs do not permit eating at home.  The poorest families will still cook traditional Southern-style meals laden with fat and calories and with little healthy diversification. 

Fast food has an additional payoff-  it is psychologically satisfying.  A father who takes his children to McDonald's and all leave sated after eating the calorie-rich supersized portions can feel responsible and the children never grumble.

 

Poverty limits exercise.  Most people who work at one or sometimes two tedious jobs are tired at the end of the day, and leisure does not include running, cycling, or swimming – even if they had access to the clubs, pools, and cycles of the more well-to-do. 

It is difficult enough for wealthy, educated parents to supervise their children; and even harder for poor families who lack the experience, the training, and the will (given their often desperate situations) to exercise the parental guidance and restraint necessary to improve their children’s diets.  Moreover, if the parents are overweight because of an improper diet, they are unlikely to demand better of their children.

Human beings have a natural affinity for salty, sweet foods - both necessary and often hard to find in the earliest human settlements - and the food industry's supply meets the demand.  It is a pas de deux, it takes two to tango affair. 

The food lobby is very, very strong. Suggesting that consumers reduce fat consumption from meat by eating smaller portions, leaner cuts, or moving to fish as an alternative can run counter to the Cattlemen’s Beef Association.  Reducing fat consumption by decreasing the amount of dairy products runs afoul of the National Cheese Institute, the National Dairy Foundation, and the Milk Industry Foundation. Reducing fat and salt consumption by eating fewer processed and junk foods and saturated fat French fries runs into the buzz saw of various lobby groups.

The government is complicit in this phenomenon.  There are no direct subsidies for vegetables, but potatoes receive generous US dollars. Potato subsidies in Maine alone totaled $535,858 from 1995-2010.  Idaho, Washington, North Dakota, Wisconsin, Colorado, Minnesota, California, and Michigan are also recipients.  Cheap potatoes allow McDonald's and other fast-food restaurants to offer huge portions for relatively nothing. 

Studies on obesity have shown that there are two principal culprits other than poverty – snack foods and sweetened drinks.  Hundreds of non-nutritional calories are ingested every week by most adults and children, and the foods that provide them are ubiquitous.  Not only are they available in stores and supermarkets but in vending machines in offices, schools, and public facilities.  Airlines, having eliminated proper meals, now give salty snacks like pretzels or chips.  Media advertising is relentless.

When asked why they snack, the responses are varied but consistent.  Boredom is most often cited.  People who work at boring, repetitive jobs with few rest breaks are likely to snack to relieve the monotony.  People snack while driving for the same reasons.  Others cite associations such as watching TV and snacking.

David Kessler, former Commissioner of the Food and Drug Administration (FDA) wondered why people were so addicted to snack foods:

Kessler was on a mission to understand a problem that has vexed him since childhood: why he can't resist certain foods.  His resulting theory, described in his new book, "The End of Overeating," is startling. Foods high in fat, salt and sugar alter the brain's chemistry in ways that compel people to overeat. "Much of the scientific research around overeating has been physiology -- what's going on in our body," he said. "The real question is what's going on in our brain." 

The Dorito is the perfect storm of a bad food – the corn gives it sweetness; it is cooked in fat giving calories; and it is loaded with salt.  Many snack foods provide this tempting and addictive combination.  Not only do we reach for snack foods because of psycho-social reasons, once we start in on them we cannot quit.

There is a genetic predisposition to obesity.  This does not mean that a predisposed individual must be fat; but that additional weight is likely if he/she does not take care and watch what they eat.  In addition to individual genetic profiles, human beings are programmed to store fat.  In caveman days this was important.  Hunters who had to run for miles to find, track, and haul game needed sufficient energy; and if there were drought, scarcity of game, or famine, the stored fat kept them alive.  

Women in particular put on weight to assure that if they became pregnant during lean times they would be able to have the resources to bring the baby to term and to breastfeed it.  We are no longer under those severe constraints; but not only have we stopped caveman exertion, we have stopped most exertion.  Our sedentary lives are perfect complements to the fat genes which are there for survival. 
Recent studies have shown that truly sedentary activities – i.e. sitting – have a peculiarly odd effect: 

Studies suggest that sitting results in rapid and dramatic changes in skeletal muscle. For example, in rat models, it has been shown that just 1 day of complete rest results in dramatic reductions in muscle triglyceride uptake, as well as reductions in HDL cholesterol (the good cholesterol). And in healthy human subjects, just 5 days of bed rest has been shown to result in increased plasma triglycerides and LDL cholesterol, as well as increased insulin resistance – all very bad things. And these weren’t small changes – triglyceride levels increased by 35%, and insulin resistance by 50%! 

It is notoriously difficult to lose weight once it is put on, largely because of the same genetic programming that enabled us to survive the Stone Age.  When we severely restrict our diet, our bodies rebel, and noting the decrease in calories, slow down the metabolism, thus consuming fewer calories, making weight loss even more difficult.  There has also been considerable research done on ‘set points’ although much of the theory is still being debated.

According to the set-point theory, there is a control system built into every person dictating how much fat he or she should carry – a kind of thermostat for body fat. Some individuals have a high setting, others have a low one. According to this theory, body fat percentage and body weight are matters of internal controls that are set differently in different people (MIT Medical)

Since it is impossible to determine one’s own set-point, it is impossible to know exactly what your ideal weight would be. Furthermore:

The set-point theory was originally developed in 1982 by Bennett and Gurin to explain why repeated dieting is unsuccessful in producing long-term change in body weight or shape. Going on a weight-loss diet is an attempt to overpower the set point, and the set point is a seemingly tireless opponent to the dieter.

It is easy to see, therefore, why it is difficult for people to maintain a normal weight and even more difficult to lose it.  The psycho-social, economic, and political factors affecting weight are so complex, that policy-makers don’t know where to begin.  Poverty-reduction, for example, is not only a goal for nutritionists but for the country at large; and it has itself been resistant to change.  Fighting the food lobbies is no less challenging  today than 40 years ago.  

The political polarity in today’s Congress prevents aggressive action.  Republicans refuse more government intervention on principle, citing an aversion to the ‘Mommy State’ where individual responsibility is superseded by government intervention.  Democrats refuse to admit that in the end, food choices are individual choices.

The attempts to improve nutrition in institutional settings have been overly simplistic and academic.  When children are in elementary school, yuppie parents fill their lunchboxes with raw carrots and worse, raw broccoli and cauliflower.  Just as it takes thought, planning, ingredients, and execution to make a good vegetarian dish, so it takes serious consideration to come up with cost-effective, tasty, nutritious and especially appealing meals for children.

Simple information about good nutrition or the consequences of obesity is not enough – even if public finances and political compromise permit honest media spots.  Decades of preaching about The Four Basic Food Groups has resulted in little.  The explanatory charts on the sides of food packaging – The Food Pyramid and now The Food Plate – are largely ignored and hard to decipher.  No matter what, even if you look at these charts, you still have to do some nimble calculations to determine what you should eat.

Enter Ozempic, the appetite suppressing drug that has in just a few years on the market, had a significant impact on obesity.  It is what Americans, long dependent on quick fixes and easy solutions, have always wanted - a silver bullet.  With no effort, no will power, no moral discipline, pounds are shed as easily as water down the spout.

 

RFK Jr sees this not as a solution but simply another problem - increasing Americans' dependency on drugs and decreasing their interest in healthy lifestyles.  Ozempic may well decrease appetite and lessen craving for fatty foods, but there is no incentive to address the underlying causes of obesity.  The increasing dependence on Ozempic is no different than that on Ritalin, the drug to address ADHD.

Parents who should be raising their children to be well-behaved, disciplined, socialized children have failed because of the demands of work, pressures on free time, and indifference.  Ritalin has made their job and that of teachers far easier. 

'We are a drug-addled society', says Kennedy, addicted to prescription and illegal drugs. This phenomenon is even more dangerous than obesity.  Returning Americans to a healthy life style, he says, will both reduce obesity naturally and reduce our overall drug dependency. 

Good luck, Mr. Secretary but you may just be whistlin' Dixie.  High-tech is the future, whether AI, virtual reality, genetic recombination, immune therapy, or miracle drugs.  Your best bet might be to try to lower the cost of Ozempic and similar drugs and bite the bullet on healthy lifestyles.