Refuse To Regain

Life on the Island

by Barbara Berkeley, MD

No man is an island entire of itself; every man is a piece of the continent, a part of the main….. John Donne, 1572-1631

As John Donne famously observed, each of us is connected to the other and to the larger world.  In free societies, our belief in personal liberty often obscures this point.  We are free to choose, or so we believe. But our freedoms are enormously affected by the influence of the culture in which we are immersed, by the very connections that make us human.  Are we choosing or are we being led?  At no time is this question more pertinent than in an election year.  Our political choices are based on the information we learn from PACs, Super PACs, newspapers, TV pundits, the opinions of friends, and finally...our own observation.  How free is our choice?  Pure freedom of choice depends on the degree to which we want to unearth and establish the unvarnished, un-spun truth.  This kind of fact-finding requires a serious amount of focus, time, and commitment. 

And so it is with our dietary choices.  We may feel that we have the freedom to choose how we eat.  We are certainly told that we do.  If we choose to eat badly, it’s our own fault isn’t it?   But I observe a quite different reality.  In fact, our freedom is severely tested and influenced by the enormous weight of a food culture that condones, encourages, and normalizes a quite different message.  Eating is a sport, a right, an ultimate enjoyment to which we are all entitled.  Further, modern food is not bad... it’s GOOD.  It is only our choice that is poor.  Swimming away from that cultural current can be like opposing the force of the ocean.   The water looks calm, but we are actually caught in a rip tide.

This is the reason that making an analogy between successful maintenance and life on an island so appeals to me.  In order to avoid the influence of the food culture, we have to absent ourselves from it.  We have to live, to some degree, outside of it.

How is this done?  Some do it by becoming fierce proponents of diets that don't look anything like the modern American plate: vegan, vegetarian, paleo.  Others become immersed in the world of nutrition and fitness.  They blog, take courses, become trainers, write books, become experts.  But for the vast majority of maintainers, it's a matter of applying a set of mental blinders.  They doggedly focus on the road ahead, follow their plan, and try not to be overwhelmed by the flood of food messaging.

Maintainers can feel both proud and lonely.  They sit on an island while the rest of the world swims in a sea of food all around them.  Often, it’s hard to avoid jumping back in the water.  It looks like so much fun that it’s easy to forget what it took to get up on dry land.  It's hard to remember that we once felt like we were drowning. 

Since we are social beings, connected to one another whether we want to be or not, it’s easier to stay on our island if we know that we are not alone.  Those who belong to a diet subculture (like the vegans, vegetarians and primalists referenced above) have websites, books, and mentors to follow.  But for all maintainers, a vital task is finding other people who live on the island.

As you know, I run a monthly group for maintainers in the Cleveland area.   After a couple of years of meetings, those of us who participate have discovered that we never run out of things to say.  For many in the group, the maintenance of a significant weight loss is the defining challenge of their lives.  They never tire of discussing the process.  They also enjoy sharing their observations of what’s going on off-island. Viewed through the eye of the group, the behavior of the rest of the world seems nonsensical at times, almost incredible.

Month after month we repeat the truth to one another.  It’s the truth of our island culture, not the truth of the world according to the Food Network.  We congratulate each other, support each other when we venture a bit to close to the water’s edge.  It is an enterprise that I highly recommend to those of you who are maintaining out there on your own.  I offer my support if you would like to try starting a group in your area.  Email me and I'll help as much as I can. 

Form a group.  Define your culture.  Meet your neighbors.  An island can be a pretty beautiful place to live, as long as you are not alone.

 

Chris Christie's Weight: We Have Met the Enemy and He Is Us

by Barbara Berkeley, MD

The past week has seen a (dare I say it?) feeding frenzy around the issue of New Jersey Governor Chris Christie's weight. With a possible presidential bid in his future, Christie's size has become the topic du jour. Is a corpulent candidate less fit for office than a lean one?  Does an overweight president better reflect who we are as a country in 2012?

While you'd have to be blind not to notice that Christie is a big guy, no one had called particular attention to it until Eugene Robinson of the Washington Post launched the first salvo this week.  Robinson's article, which linked Christie's weight with a lack of discipline and ended with the advice to "eat a salad and take a walk" was roundly criticized...even by fellow liberals.  Guests on MSNBC's Morning Joe who are normally sympathetic to Robinson piled on.  "This crosses the line", one complained.  But while Robinson's piece might be interpreted as a partisan low blow, it actually raised important questions about our perceptions of obesity. It also exposed the deep ambivalence we have about our growing national waistline.

In yesterday's New York Times, the admittedly weight-challenged food writer Frank Bruni added his voice to the Christie controversy.  Bruni vigorously wrote that a person’s size should not factor into decisions about his capabilities. “Girth doesn’t equal character”, he said.  Human beings have foibles after all.  Did Clinton’s womanizing or Obama’s smoking make them less effective as leaders?  If your answer is no, you can’t assume that Christie’s obesity will have any impact on his ability to act as President.  

A third, and more dismissive view of Christie’s weight came from Michael Kinsley writing for Bloomberg View.  Christie should be discounted, he wrote, “unless he goes on a diet and shows he can stick to it.”  What about the argument that all humans are imperfect?  He’s willing to forgive Obama and Clinton, but when it comes to Christie’s big belly he is less sanguine. 

So why should Christie’s weight be more than we can bear in a president?......One reason is that a presidential candidate should be judged on behavior and character, not just on policies

Controlling what you eat and how much is not easy, and it’s harder for some people than for others. But it’s not as difficult as curing a chemical addiction. With a determined, disciplined effort, Christie could thin down, and he should -- because the obesity epidemic is real and dangerous. And the president inevitably sets an example.

Spoken like someone who has never tried to lose 50 or 100 pounds.

More importantly, Michael Kinsley deployed the C-bomb: character.  Kinsley is not alone in believing that being overweight is a character flaw.  This is an awfully tough position to voice aloud.  To begin with, it defines 70% of America as weak-willed, food-obsessed incompetents.  Yet this is the guilty, politically incorrect belief of many people who have been lucky enough to avoid obesity.  Believe me, I know. As someone who is of normal weight but deals with obesity, I hear the voices on both sides of the divide.

Three very different voices.  Three different views.  Or are they?  What is most interesting about the Christie debate is the degree to which all parties agree.  It is within this area of agreement that we can find the true nature of America’s beliefs about obesity.  It is also within this area that tragedy lies.  The tragedy is that we so completely clueless about how to deal with such a major threat to the health of our country. 

All three authors use perjorative or dismissive language when describing obesity.  This includes Bruni, who defends and sympathizes with what he calls Christie’s “evident gluttony”.  Gluttony?  Isn’t that one of the seven deadlies?  Having Christie sit in the middle seat on a crowded airplane, says Bruni, “would be cruel to the people on the window and aisle” and “many voters aren’t going to want to look at him as often as they must look at a President.”  After recounting his own torturous experiences with weight control, Bruni concludes that the whole weight control thing is just too shallow and he’d rather have “a big, fat President”.   He mentions the possibility that morbid obesity could impact Presidential health only as an afterthought. I suspect that Bruni is like so many of my patients.  He understands the extreme difficulties of dealing with weight and hates people who are prejudiced against  the obese.  A guilty part of him, though, harbors the same feelings.  This uncomfortable truth is the topic of many of the discussions that take place in the group I run for weight maintainers.  They felt awful about being heavy and after losing the weight they often feel even worse when they find themselves judging people who are still obese.

All three authors believe that obesity is caused by a weakness.  In the case of Robinson and Kinsley, it’s a weakness of will; the inability to “just say no”.  In Bruni’s case, it’s a weakness caused by addiction and compulsion.  Whatever way you look at it, the obese are somehow flawed. 

All three authors buy the usual nonsense about obesity.  “Take a walk and eat a salad” is just another way of saying that anyone can control weight by eating less and exercising more or that moderate changes to lifestyle work.   According to Robinson: 

…. the science of weight control now takes into account the role that genetics might play, along with psychological factors that lie outside our conscious control. There are new options, including gastric surgery, beyond the dieting roller coaster — lose 40 pounds, gain it all back — that Christie says he has been riding for years.

What science is that?  The obesity epidemic is only about 30 years old, no where near long enough for 70% of America to undergo a genetic change!  And to which new options is he referring?  Could he be talking about the 3 or 4 new medications which the FDA declined to approve for physician use?  Or to the gastric bypass surgery which often fails to provide a permanent solution while exposing patients to significant operative and post-operative risk?

On the other side of the fence, Bruni is no better.  Remember his gluttony comment?  Here is his amplification:

Let’s talk as well about that gluttony. It may say much more about his (Christie’s) allotment or early rearing than his resolve. Over recent years, there has been more and more scientific consideration of obesity as an expression largely of hereditary and environmental factors beyond a person’s ready control, and there has been evidence that one person’s fatness versus another’s thinness may to a significant extent be foreordained.

I guess Bruni is reading the same science journals as Robinson.  I wonder what the Pima Indians would think of this.  Completely lean and without modern disease until they began eating sugar and flour and living on the reservation, the Pimas now have one of the worst health profiles of any ethnic group.  Were they genetically pre-ordained for obesity or did their perfectly functional genes run afoul of a sick and clueless food world?

Our 24-hour-a-day news cycle and our tabloid approach to politicians  is perfectly designed to make Christie’s corpulence the target of gossip, character assassination and schadenfreude.  But what if we lived in a  more perfect world? What if Christie turned his blunt, honest-to-a-fault style on his own weight problem?  What if this became the opportunity to discuss new and more effective solutions for our growing problem with fat and fat-created illness?

Here’s what I would tell Christie..or any politician (or columnist) who is willing to listen. 

We need to stop repeating the same old nonsense.  We won’t lose weight or become healthy again until we return to something close to our original eating patterns.  This will take a national effort that includes incentives and disincentives to major food producers and a simple and oft-repeated message.  In particular, we have to vastly decrease the amount of sugar and starch in our diet.  Apart from their extremely deleterious affect on fat storage, these foods are addictive. If we worked relentlessly on this message alone we would do more good than the past twenty years of telling people to eat less and exercise more.

We also need to educate our kids and ourselves about how our own bodies work.  We need to show people the graphic details.  How does sugar tear up our blood vessels?  How does the food we eat wind up as a gummy clot inside a major artery and cause a piece of our brain to die in a stroke?  What exactly is diabetes and why is it that we really, really don't want to get it? We can’t know this unless we know ourselves and right now, we understand our cars better than our own bodies.  Basic physiology and pathophysiology (the study of disease) should be a mandatory part of the curriculum of every grade school and high school in America.   

The obesity problem is not easy to solve but no one benefits from the advice to just be more disciplined.  If we all understood what is at stake---from a disabled and depleted population to the bankrupting effects on our medical budget---perhaps we could get serious.  Lest we forget, Chris Christie is us.  

 

Foods That Control: Mile Markers on the Road to Our Tech Future?

by Barbara Berkeley, MD

Are you an optimist or a pessimist about the future of mankind?  There's a question to start your day.

In May, the Gallup Poll announced that optimism for the future of American youth had reached an all time low.  When asked whether they thought that young people in the US would have a better life than their parents, 55% of those polled answered no.  Pollsters commented: 

The large majority of Americans expressed optimism about the future for U.S. youth when Gallup first asked this question in January 2008, as the recession began to take hold. They continued to do so even as the economic crisis unfolded and unemployment ballooned. Hopes for U.S. youth declined to the 50% level in October 2010, however, before dropping to a new low in the April 20-23, 2011, USA Today/Gallup poll.

Of course, this pessimism reflects doubts about our economic future.  But what about the larger future of our species?  Is there a connection between the helplessness many of us feel politically and the general trends happening in our world?

On my recent trip to southeast Asia, I had approximately 60 hours of enforced down time (travel and layovers).  It was a great opportunity to read, catch up on missed movies, and watch The Godfather, (Parts I and II for the hundredth time ...still fabulous!).  One of the movies I watched was a documentary called Transcendent Man.  This is a film about futurist Ray Kurzweil, a brilliant, eccentric scientist who has predicted something called "The Singularity".  The Singularity refers to the point at which humans and technology will effectively merge, changing the course of human evolution.

 As Kurzweil points out in this film and in his written work, the pace of human techological advancement is moving so quickly that we will soon have artificial implants that will enable us to access the internet and other sources of the world's knowledge. Our bodies may soon be enhanced by injectable mini-computers and chips, making us into the bionic man. Essentially, we will eventually cease to be competely human, at least as we define that state today.  While this could lead to wonderful improvements in health and longevity, the asymptotic growth of technology has more sobering, and ultimately more frightening, aspects.  These relate to the seemingly inevitable development of artificial intelligence.  In the not too distant futures, computer intelligence will multiply itself to the point where it exceeds out own. Once computers become smarter than man, the future looks nothing like any we might have envisioned and the place of man in the universe becomes uncertain.  While many scientists believe that Kurzweil is incorrect in the timing of his predictions, no scientist who is quoted in the film doubts that we are headed in this direction.  

When we imagine a world of endlessly expanding intelligence, we realize how limited we humans are and how vulnerable these limitations make us. If we look at our behavior, our literature, our art, we are fixated on a few basic themes: tribalism (war), love, and the search for spiritual meaning are the most obvious.  Similarly, we are highly motivated by one very simple thing: our brain's system of rewards.  Endorphins, endocannabanoids, and other brain chemicals are what keep us coming back for more.  And more. Whether it's the pleasure created by food, the colors and noise of a gambling casino, the smell and feel of a cigarette, the rush of alcohol, sex or drugs, we are led around by these ancient responses, often to the point of our own destruction.  Advances in technology have already shown how vulnerable we are.

Modern science has made it easier to deliver hits to our pleasure centers.  Whether these come from the bright colors of video games, the instant access to pornography, or destructive foods masquerading as wonderful fun, we are easy to lure.  It is not hard to imagine a future in which many of us will opt to live in a virtual world, full of colors and sensations that cannot be obtained on good old Earth.   This tendency to give in to the enjoyable without regard to consequence is what gives me grounds for pessimism.  Just today, for example, I saw a new patient who had been uttterly destroyed by food.  He weighs over 300 pounds, is riddled with pain, is losing function in his eyes and kidneys, has had several heart attacks, is injecting insulin multiple times a day and yet he describes an utter passion for junk food, fast food, and sweets. Perhaps it is judgemental to say that this is a tragedy.  We all have the freedom to pick the way we want to live.  But my worry stems from a suspicion that we aren't choosing so much as being manipulated by ever-heightened pleasure experiences.  The modern production of food may be one of the best examples of this unfortunate phenomenon. 

Our inability to see that our country is being weakened by tehnologically enhanced food and our sheer willingness to embrace these products as harmless fun makes me worry for our greater future. If we are willing to be killed by food, how easy will it be to offer us other kinds of pleasurable "enhancements"?  How simple we will be to control.  Unless we start looking at our changing world critically, it will take no more than a sweeter, brighter, more colorful drug to destroy us completely.   Now that's pessimism. 

The Politics of Fried Butter

by Barbara Berkeley, MD

Has anyone been watching the coverage of the Iowa Straw Poll?  This early indicator of national election trends is held in conjunction with the Iowa State Fair.  If you have been following reports on CNN or any of the news networks, perhaps you've noticed that political reporters feel it necessary to make continual (and completely gratuitous) references to the junk food at the fair.  It seems that nary a reporter can deliver his lines without describing the deliciousness of the fried Oreos, fried Snickers or Fried Butter!  And each time, the conversation revolves around how bad-for-you but really great this all is and how everyone at the Fair and all of their kids are chowing down in the good old American way. 

As someone who has to mop up the medical damage created by our ha-ha attitude toward bad food, it's easy to see that toxic foods are no different than cigarettes.  They kill just as many people in this country and take an awful toll in non-fatal misery.  Just in fun you say?  Well, perhaps in the 1940s a similar reporter might have enthused about the pleasures of a tent that offered multiple kinds of yummy tobacco. In those days, anyone who suggested that a smoker quit might be laughed off or called a killjoy.  We've gotten past that today for the most part.  Killing yourself with cigarettes is no longer PC.   But we still think that eating Fried Butter is cute.  

For me, it's particularly galling to see this kind of reporting coupled with political commentary. Our continued blindness to the link between poor health and our national fiscal dilemma is unfathomable. We have the highest per capita health care spending in the world, and health care costs currently account for 16% of our GDP, a doubling of expenses over the past 30 years.  If things go unchecked, projections suggest a further doubling to 31% in the 25 years to come.  While these costs have many sources, practically no one is willing to look at the responsibility that we, the American public, bear for failing to take better care of ourselves. We've become a country where diabetes, hypertension and high cholesterol are the norm and where we've bought into the belief that pills can fix everything that ails us.  They can't.  And they don't.  And as a result we are being bankrupted by an ever increasing health care bill.  

The fact that we can still enthuse about deep fried Twinkies in a world so filled with obese and diabetic citizens shows us that we are very far indeed from correctly indicting unhealthy food as we have tobacco.  In a way, we shouldn't be surprised.  The current motto of our country-in-crisis is "Give Nothing Up."  No one appears willing to give up his or her pleasures even if it means sacrificing for the greater good.  The rich want to keep their tax cuts, Congressmen choose to re- ensure re-election rather than take the bold steps needed to get us out of our fiscal mess, liberals want to preserve funding for every known social program, and the citizenry wants to pretend that it's still ok to eat whatever and wherever they want.  

The world is changing and it seems that we don't want to know.  I just returned from Asia where the airport in Singapore looks like a 5 star resort complete with orchid gardens, movie theater, Rodeo Drive style shopping and ponds full of gorgeous, fat koi.  The people are slender, the airplanes sleek and new, the roads seamless, the buildings spectacular.  I then flew home to New York, where the airport was decayed, the roads lined with garbage, the people overweight and wheezing, the bridges rusting and the buildings along the way covered with graffiti.  

Once upon a time, in the lean and healthy years of America, Fried Butter was fun.  We wish it still could be.  But, sadly, it's time for America to grow up and take responsibility for itself.