We can't afford to be fat

Philip J. Goscienski, M.D.

November 2011

No nation can afford optimum medical care of a progressively obese, diabetic population. These two conditions are not inevitable accidents of nature. With very rare exceptions they are entirely avoidable. Neither problem exists in modern hunter-gatherer populations. Physicians only occasionally encountered them less than a century ago in America, yet modern hospitals are filled with patients who suffer from the myriad complications of obesity and type 2 diabetes.

These are genuine epidemics. From less than 10 percent little more than a century ago, fully one third of Americans are obese in 2011. Childhood obesity has quadrupled since 1970. Type 2 diabetes is the handmaiden of obesity. The American Diabetes Association states that there are more than 23 million persons with the disease in the United States. Together these maladies and their complications drain nearly a quarter trillion dollars from the economy every year.

Even apart from medical expenses, our fatness increases the cost of living. Airlines estimate that in 2000 the cost of extra fuel to keep ever-heavier customers aloft amounted to $275 million more than it did in 1990. Automobiles get fewer miles per gallon of fuel carrying heavier passengers.

The battle over healthcare financing would diminish to a skirmish if prevention, not treatment, were to become the primary goal of the medical community, a higher priority within government and a prominent element at every level of the education system.

The word doctor means teacher, not healer; M.D.s should put more emphasis on that role. Rather than advising his or her patient to "eat less and exercise more" doctors should offer specific, detailed guidelines to follow, as a teacher would. In modern medical practice, however, there is no time or adequate compensation for that even though there is plenty of evidence that a 15- or 20-pound weight loss (or to be more precise, fat loss) can significantly lower blood pressure and the risk of type 2 diabetes.

For the cost of one physician's salary it would be possible to hire two or three nutrition counselors who could take the time to give advice on nutrition, weight loss and exercise. Between doctor's appointments, visiting nurses could ensure compliance with nutritionists' guidelines, monitor prescription drug use and observe patients' overall health.

It has been said that "genetics loads the gun, lifestyle pulls the trigger, physicians stop the bleeding." Wouldn't it make more sense to put a lock on that trigger?

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.