A new message from American cardiologists: Eat responsibly, live long and prosper

Reporting for Heartwire from the 2009 Congress of Obesity, Fran Lowry's piece screams the headlines "The obesity epidemic in the US is soley due to increased food intake".  It was enough to make me skip my movie popcorn.  I'd premeditated to have some later that evening as my husband and I met for our Friday night date to see the new Star Trek movie. I guess I'm a closet Trekkie fan.   I'm coming out because the approach to our obesity woes will be manditorily rooted in the the very Vulcan -like philosophy that "logic must prevail".   Until we admit that a century's worth of emotional eating has begun to kill our population with the same efficiency that any alien supervirus could engineer, we will continue to die at an alarming rate.    The American public must learn to replace emotional eating with the ability  to select adequate fuel to drive our physiologic processes efficiently.  American healthcare providers must grasp the notion that the American diet is truly the final frontier of Primary Prevention.  Until these two ideals are grasped firmly and implemented thoroughly we can expect the ravages of obesity to be both costly and lethal for our population.        

We can start by learning something from the alcohol industry's advertising approach.  As much as I disagree with the notion that we must “drink responsibly”, (why chance behaving irresponsibly by drinking at all?), I DO appreciate that the industry at least gives lip service to the need to imbibe in a responsible fashion. The food industry has historically NEVER adopted this notion. As a result, Americans harbor a bizarre OBSESSION with food instead of a healthy APPRECIATION of it.  Commercials depicting portly men with “real” meals consisting of a gazillion trans-fat-grams worth of fried chicken (plus two large sides) command our subconscience to scoff at portion control.  Our obsession with overloaded plates of value- meal goodies has lead to an epidemic of diabetes, sleep apnea, hypertension, stroke, heart attack and death while the American medical community as a whole has largely stood by and done nothing. I don't think it is intentional.  I think it's a combination of benign neglect and lack of knowledge. The extent of my medical school education on nutrition consisted of five 1/2 day sessions on food biochemistry presented while we all blinked and yawned and prayed for someone to put us out of our misery.   Now that we have beautiful studies on such entities as the Mediterranean diet, the downside of carbs, the pathology of transfats, we just need to roll up our sleeves and boldly go where few American physicians have gone before.  

Dietary instruction is the golden opportunity to shift our focus from treatment to prevention. When it comes to the end result of poor nutritional habits, we prefer to “put out the fire” instead of practicing “fire prevention”.  We unabashedly admit that we’d rather cath it, stress it, or medicate it than provide instruction on how our patients should properly fuel their bodies. We lament pharmaceutical compliance rates of only 50% but secretly loathe having to encourage even a 50% dietary compliance rate with life saving nutrients.  It’s high time we made the nutrition talk a mandatory part of every office and hospital visit. We should consider the lack of nutrition instruction just as much a part of self described medical malpractice as forgetting to subscribe a beta blocker, statin or aspirin.  We should also insist that America should infiltrate every level of education for our children with information on nutritional choices so our office visits are made more expedient in the future.      

When it comes to food ingestion, we (Americans) do EVERYTHING WRONG.   It’s HOW MUCH we eat, WHAT we eat, HOW WE PREPARE what we eat and even HOW QUICKLY we eat  that's all wrong. Skinny Americans have become extinct among the hoards of obese individuals in our country.  Drive –thru’s are conveyor belts for gluttons who super-size breakfast, lunch and supper and complain that they eat practically nothing but have packed on 100 pounds in a single decade. Mystery abounds in our every day lives, truly clueless as to how we became so obese and even more clueless as to how to correct it.  Beginning with McDonald’s and barreling on into the Kraft OREO era, Americans have been bombarded with images of smiling curmudgeons downing happy meals or unscrewing OREOs and  dunking them into tall crystal glasses of velvety white milk while smiling grandparents look on with approval. To our horror, the smiling curmudgeons of yesterday have become the sickly angina riddled frequent fliers on our cath tables today.  Thanks to slick marketing in the early 1980’s, withholding a happy meal or offering an apple instead of an OREO became grounds for contacting child protective services.   Our consciences have been seared by deep friers and baker’s ovens to the point that the definition of obesity has shifted upward a full 50 pounds from where it was 3 decades ago. 

There is reason to be hopeful however.  The transfat fight in America is taking off.  Places like New York City, Philadelphia and the state of California have finally forged successful legislation to cut the trash out of our foods.  Even Kraft jumped on board only 24 hours after a legal challenge to their recipe for Oreo Cookies outlined that the 7 fat grams in the standard three cookie serving included 160 calories, 1.5 grams of saturated fat and 5.5 grams of “unidentified” fat.  Rapidly and without protest, Kraft changed their 3 cookie serving to a healthier 7 fat grams consisting of 2 grams of saturated fat, 1 gram of polyunsaturated fat, 3 monounsaturated fat grams and only “1 unidentified fat”. If Kraft can do it to an OREO, anyone can morph unhealthy artery damaging chemicals into something beautiful. It was like the first culinary "extreme makeover" in America.   Not only “CAN” it be done, it “SHOULD” be done.

Some Americans have stubbornly fought legislation to make our food preparation healthier.  They protest by siting “governmental interference” and fear the lack of  "freedom to choose” to die by lethal INGESTION.  However, the majority of the public is beginning to demand protection from tainted food substances. Polls prove that up to 69% of the population has started to really care.   In my city of Glasgow, Ky.,  Kentucky Fried Chicken just premiered its new Kentucky Grilled Chicken products to the satisfaction of hundreds of customers. If one of the unhealthiest cities in the world can embrace it, so can anyone. All other restaurants should follow suit. 

I subscribed to Bon Appétit for a couple of years. I guess I liked looking at the glossy pictures of bountiful meals and fantasizing that I could become a marvelous chef in the old European tradition.   My husband laughed. He knew the truth:  He was about as likely to catch me in the smoking hut at my local hospital as he was to catch me in the kitchen. However, I’ve slowly matured into someone that appreciates food more than I’m obsessed with it .That appreciation has spilled over into my every day practice life. I tell my patients that I really don’t care whether they like their diets right away or not. (Gasp)  Food should be viewed as fuel and we should forage for what our bodies require.(double GASP)  I tell them to eat what they NEED, not necessarily what they LIKE and soon, need and preference will become one and the same. (I'm sure I"m viewed by some as a pointy- eared Spock- like, liberal heretic,.... set phasers to stun.)   I laminate copies of the Mediterranean diet and place them in every single exam room.  I mention diet at almost every visit with every single patient. I write a million dietary consults per week for my nutritionist .  Even folks referred merely for stress testing at our hospital do not escape without the iconic Mediterranean Pyramid.  Enough already????........never.

As cardiologists and health care providers, our message to our patients should be clear and ever present:  Treat our diets with as much or an even greater importance than we do our medication regimens.   Like medication, we should take in the food we need daily and consistently.  As physicians, we have a responsibility and a duty to become politically involved in such a way that the culture of American cuisine changes swiftly and certainly. It also helps if we, the advise -givers try to be good examples for our patients and maintain a normal body weight, exercise and make healthy food selections ourselves. ......(and downsize the movie popcorn)

 In an era where advice is liberally thrust onto the American public to drink responsibly, go green,  curb global warming, practice safe sex, recycle,  drive responsibly and  exercise consistently, it’s high time we promote a  new Vulcan like message to our patients. As Mr. Spock would say, "Eat responsibly", then he would punctuate it with a single raised eyebrow ,  head tilted slightly to the left, fingers spread, adding the  infamous words: " Live Long and Prosper."

Now, Take us out Scotty,......at warp speed toward a healthier and more prosperous America.

Your comments

	A new message from American cardiologists: Eat responsibly, live long and prosper
	# 1 of 13	May 22, 2009 08:02 (EDT)
	Missy	We need a lot of people like you who see the ugly side of 'oversized' food in a dialy basis.  Go for it.  It will never be enough for all of us to hear it.  Never!!!!! Thank you.
	# 2 of 13	May 23, 2009 03:05 (EDT)
	Val Fitzgerald	Dear Melissa: You cannot see the average patient today, and not wonder somewhat as to how they (sic!) got that way.  Yes--by shoving food into their mouths, with (it sometimes seems) ten fingers on each hand, while sitting in rush-hour traffic and calling their spouses "Don't hold dinner! Expressway's backed up again!--I"LL CATCH SOMETHING ON THE WAY..." Yup: I'll catch a nice blocked LAD...or maybe that pain in my elbow doesn't quite originate in my elbow; but rather in the massive coronary that I'm fixing to have--I'LL CATCH SOMETHING ON THE WAY, all right... But one hundred and fifty short years ago, the one single cause of death for most people, was STARVATION; linked to lives of unproductive, underpaid overwork. Bodies so improperly nourished that the first bug that came along, killed them. Might that not have something to do with the wholesale obesity that we're seeing today? I'm no psychologist, but still...?
	# 3 of 13	May 24, 2009 07:00 (EDT)
	Scott Miller	Melissa, Super impressed with your overall message in this article. The next step is for institutions like AHA and ADA to stop recommending the very foods that lead to heart disease and other chronic disease, like grains (whole or otherwise), processed vegetable oils, and fructose. Sadly, we're decades aware from this all-important step.
	# 4 of 13	May 25, 2009 06:10 (EDT)
	Melissa	Thanks guys for all of your commentary.  I just returned tonight from a 3 day celebration of my 25th wedding anniversary.  I must confess to daily dietary indiscretions (deserts if you must know!!!).  However, I must brag that my husband and I worked out daily in hopes to help boost our metabolism PLUS played golf, walked, etc.  We also vowed to get back on the frozen yogurt kick that seems to really always keep our weight in check (as we count that as our "healthy" desert!) I'm saddened by the fact that many obese individuals never work out and give up at the first "indiscretion" while trying to watch their intake,  but I try to provide encouragement to my patients by telling them that even when I over-do-it on occasion, I still get back on that pony......er elliptical runner and ride!!! Missy, thanks for your encouragement!!! Val, I think you make a great point in that the psychology of overeating is driven by many diverse issues.  For a cousin of mine, she subconsciously ate so that she would be unattractive to men because she was so hurt by her first husband.  For older folks who lived during the depression in large households, there was never enough food, so I think they have tried to make up for it in latter years.  An acquaintance of mine was a huge man and a holocaust survivor.  He weighed just under 40 pounds at age 12 so I guess he vowed to never be hungry again.  Scott, don't give up.  Let's make nutrition a priority in our offices and encourage our fellow physicians to do the same.  Like smoking cessation and smoke free legislation, we will finally make it to the tipping point on this issue as well!!!  Encourage our patients to NEVER give in to that very American notion that "big is beautiful". Big is UNHEALTHY...........period. Melissa
	# 5 of 13	May 27, 2009 07:10 (EDT)
	Laura	Well written article by Melissa.  Thank you for touching on our "emotional eating" diagnosis as Americans.  Perhaps while revising the new version of the DSM, we can broaden the food addiction section and expound on it.  I have had limited success getting people to truly change and lose weight, because they are in denial to the problem of WHY they overeat.  Loneliness, isolation, boredom, lack of physical comfort/contact/pleasure.  Fear of being attractive, etc. etc.  I encourage many many patients to seek counseling and at least explore possible reasons they have become obese in the first place.  And bariatric surgery should not be the answer so readily.  It is an extreme example of lack of personal responsibility.  "I can't do it myslef so I'll let the doctor make my stomach really tiny so I won't be ABLE to eat!"  The fact that this is endorsed wholeheartedly by the medical community is, to me, appaling.
	# 6 of 13	May 27, 2009 07:11 (EDT)
	Laura	Scott, Can you elaborate on your theory that grains and vegetable oils are unhealthy?
	# 7 of 13	May 28, 2009 06:46 (EDT)
	Melissa	Thanks Laura.  I firmly believe that the more we talk about it, the more we can do about it.  As for bariatric surgery, I try to discourage it all that I can, BUT there are some folks who have gotten themselves into such a terrible downhill spiral and poor state of health that they cannot exercise, so for them, I do recommend they consider it as a last ditch effort.  I'm appauled however that the bariatric candidates seem to be getting smaller .  I'm not just seeing the 350 pound folks  anymore. Melissa
	# 8 of 13	June 12, 2009 04:31 (EDT)
	Michael Kretz	Perhaps just a couple of simple action items.  (1) To calculate the average daily number of calories a moderately active person has been taking in, simply take their weight in pounds times 13.  Knowing this number is critical to basic behavioral change. (2)  Patient's can be instructed to go to www.cdc.gov/bmi.  They can then learn to track their own BMIs or the BMIs of their children.  Again, this is feedback (empowement) needed for behavioral change.
	# 9 of 13	June 12, 2009 09:04 (EDT)
	Melissa	Michael, Thanks for the tips!  We can use all we can get. The simpler the better! Melissa
	# 10 of 13	June 22, 2009 11:11 (EDT)
	Lowell	Melissa, Your passion for responsible eating is comendable.  As physician-advisers, as well as consumers, we should know more about "what is responsible" eating.  It has been very confusing to the average physician, and obviously epidemically disastrous for our patients. I recommend a book, "Good Carbs, Bad Carbs" by Gary Taubes.  It helps to put into perspective what has been learned, what we have been taught, and what we think we know about nutrition, obesity, and heart disease. Regarding information on cereal grains in our diet, one reference might be worth looking at for a start:  Cereal Grains: Humanity's Double-Edge Sword, Loren Cordain, In Simopolous AP(ed); Evolutionary Aspects of Nutrition and Health. Diet, Exercise, Genetics, and Chronic Disease.  World Rev Nutr Diet. Basel, Karger, 1999, vol 84, pp 19-73. Melissa, please let me know your thoughts after you read these, and let our interested colleagues know your opinion as well.  Those of you who see my comment here, and choose to take the time to look into this, let us all know your perspective. I enjoy the spectrum and content of your offerings for those of us who are at the bedside and in the clinics.
	# 11 of 13	June 22, 2009 05:54 (EDT)
	Melissa	Lowell, Your comments made me smile.  I've had a rotten day at the hospital butting heads with those who seek to prevent culture change in our area.  Thanks for making my day a little better!! Melissa
	# 12 of 13	July 21, 2009 10:09 (EDT)
	Carolyn Thomas	Hello from Canada "...Drive –thru’s are conveyor belts for gluttons who super-size breakfast, lunch and supper ..."     I'll never look at those cars lined up at the Drive-thru the same way again! Brilliant essay!  I've recently read Michael Pollan's "In Defense Of Food" in which he talks about processed "edible food-like products" that we are scarfing down in dangerous amounts. He advises "never buy any food that has been advertised", adding that "real" food like broccoli doesn't have a marketing team or an advertising budget to help push it.  He advises shopping only at the perimeter of the supermarket where the 'real food' lives.  I'm a heart attack survivor and a 2008 graduate of the 'WomenHeart Science & Leadership Symposium for Women with Heart Disease' at Mayo Clinic in Rochester, Minnesota.  What we learned at Mayo was shocking, even to all 45 of us heart attack survivors.  We had an intense half day lecture on 'Heart Disease & Nutrition' by Dr. Sharonne Hayes of the Mayo Women's Heart Clinic - who echoed much of what you wrote. Since my heart attack, I have completely changed my eating habits (as well as my kitchen pantry - tossing everything with added sugars, sodium and bad fats). I've become an obsessive label-reader in the grocery store as I embrace a heart-smart diet.  Thanks for this - I plan to put a link to your excellent article from 'Heart Sisters', my blog about women and heart disease at http://www.myheartsisters.org Carolyn
	# 13 of 13	July 21, 2009 12:55 (EDT)
	Melissa	Carolyn, you are too kind. Thanks so much.  I'm glad you found the piece enjoyable and certainly hope others do as well.  I wish you the best of health in the future.  With your efforts, you certainly deserve it!! Melissa

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