Heartfelt with Dr Melissa Walton-ShirleyView all posts »
A new message from American cardiologists: Eat responsibly, live long and prosperMay 15, 2009 02:26 EDT
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.