Health Promotion? Here's the Thing...

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There is no shortage of health promotion efforts in our world. Everyone hears about them all the time, and those inclined to tune in here to what I have to say may be better informed in this area than most.

We have health promotion programs in schools, and at worksites. We have health promotion programs for churches, and supermarkets. We have health promotion efforts directed at the very young, and the very elderly, and championed by people in high places.

We have programs to help people lose weight, avoid diabetes, get fit, recover from a heart attack, or avoid one. We have free programs, incentivized programs and commercial programs.

And yet, all the while, we mostly just keep getting fatter and sicker overall. Admittedly, rates of obesity may have plateaued recently, but that's very cold comfort. At some point, you are pressed up against the ceiling, and can't keep going up; but you can remain squished there. We seem to be squished.

Besides, how many of us are fat is only one metric, and others may matter more. Another is how fat the many of us are, and that, alas, is a trend that has not yet found its ceiling. Rates of severe obesity continue to rise alarmingly. If the impact of the obesity epidemic is a product of both prevalence and severity, and it is, then the situation continues to deteriorate.

But obesity matters only because it is a canary in the coal mine of chronic disease. This is not about matters only skin deep, however important those may be to each of us when looking in the mirror. Where there is more obesity, there is more heart disease. There is more cancer. There is more dementia. There is more arthritis. There are more strokes. And most indelibly, since obesity is a principal cause of Type 2 diabetes, there is more diabetes.

In that area, we are looking right down the barrel of a loaded gun. The most recent formal projections by the CDC indicate that if anything resembling current trends persists in the United States, roughly 40 percent of our population will be diabetic by the middle of this century.

I would ask you to consider two things about the scope of that calamity. The first is, given the difficulty we are having paying the health care bill right now, it is a not-very-distant death knell for the economic viability of our country. Not vitality -- viability. If we go from the 28 million or so diabetics we have right now to the 128 million or so we would have when 40 percent of us have the condition, there is probably no way for this nation to be solvent. Just try to imagine a society in which every other person has a chronic, costly, potentially disabling disease -- and beginning at ever younger age into the bargain.

Bleak though that is, it's not the worst. I care about money like everybody else; and like everybody else, I've got bills to pay. But I would never have gone into public health in the first place if that were my primary motivation. I care about people a lot more.

Who will be those Americans in or around 2050, among whom nearly one in two will be diabetic? Not you and me; our day will have come, and our day will have gone. We may still be here, but it won't be our world. It will be our children's world and their children's world. We will have bequeathed to them this blighted future.

I'm sorry folks, I realize this is a bit lugubrious. Reality is, sometimes. It rarely helps, however, to look away and simply wish it weren't so. It is so.

So what?

So we need to fix it, and we absolutely can. We have known for literal decades how to eradicate roughly 80 percent of all chronic disease in the world today. So, instead of going from 28 million diabetics in the U.S. to 128 million, we could -- if we ever got around to using what know -- reduce that 28 million figure by some 90 percent. And because of the inherent synergies and ramifications of the lifestyle practices conjoined to genuine health promotion, were we to do this, we would ameliorate climate change, better conserve environments, produce food far more sustainably, and stabilize water supplies. We are beginning to see just how much these are going to matter to the quality of life we will our children. Health promotion must encompass both people and planet, and we know how to do that, too.

But so far, we have not. And unless we change our approach, we will not. As Einstein famously pointed out, "we cannot solve our problems with the same thinking we used when we created them."

We created epidemic chronic disease, worsening for decades, and the environmental costs of business as usual, in the very same world populated by all those health promotion, weight loss, disease prevention programs with which we began. Something is awry, and it is the most blatant and obvious of somethings.

We don't know where "there" is.

Actually, we know exactly where there is -- we just don't acknowledge it. We act as if every opinion about how to be healthy carries the authority of every other; we act as if we can fixate on one nutrient at a time and fix our diets and the food supply; and we perennially fail to learn from the follies of history.

In our culture of confusion, collusion, and benighted befuddlement, it makes perfect sense to wring our hands about rampant obesity and diabetes in our children, even as we keep runnin' on Dunkin, and marketing multi-colored marshmallows as part of a complete breakfast. It makes perfect sense to devise new health promotion programs, even as we compete to add unprecedented doses of bacon to pizza.

Unlike Blue Zone cultures where everyone eats well and lives well in sensible, traditional, time-honored patterns and no one can sell a fad diet book because no one would buy it, here we have an endless competition among self-proclaimed Prophets of health for the... profits of never-ending illness. In our culture, what is supposed to be "health promotion" can be displaced by cutting carbs, and eating badly; or cutting fat, and eating badly; or avoiding gluten, and eating badly; or avoiding GMO, and eating badly. When it comes to being inventive about pretending to promote health, while actually devising new ways to eat and live badly -- we win.

And so we lose. Tragically, calamitously, and unnecessarily.

This need not come to pass. All missions involve a concerted effort to get there, from here. And so prerequisite to all missions is acknowledging where "there" is. We have been skipping that step.

We will never reach the Promised Land of true health promotion, where 80 percent of all chronic disease has gone away, and people routinely live longer and better -- if we just keep going in the same circles. If we do so for another 40 years, as we have for the past 40, it will be 2050, 40 percent of us will be diabetic; and it may be too late.

All opinion is not created equal; expert opinion matters more. That might still be a problem if experts disagreed about how to be healthy as much as our culture pretends, but they don't. There is massive, global consensus among experts about what matters most to eating and living well, carefully concealed by the forces of profit. That veil can be lifted -- and will be.

Health promotion programming is all about helping people get there from here. But here's the thing: It's prerequisite to know where there is. We do, and have for the last 22 years at least -- but have wandered in aimless circles all that time. We don't have another 40 to spare.


David L. Katz, MD, MPH, FACPM, FACP is President of the American College of Lifestyle Medicine and founder of the True Health Coalition, an unprecedented, global assemblage of experts and influencers willing to look past the differences that matter less, rally around the consensus that matters more, point to the Promised Land of health promotion, and say in one voice: this way! If only guys were willing to get directions...