Tuesday, July 2, 2013

The Obesity Odyssey: Tie Me to The Mast, Wire My Jaw Shut, Rewire My Guts Into a Roux-en-Y

In the last post, I was titillated by the JAMA authors' observation that, as prescription opioid overdose deaths have quadrupled, people and their physiology have not changed - their exposure to opioid drugs has changed.  Is there any more apt an explanation for why obesity and overweight rates and associated complications have swelled like 10 pounds of sugar in a 5 pound sack?

One hundred years ago, there was precious little obesity.  We have not changed physiologically since then.  Two things have changed:
  1. How much fuel (food) we're putting in our tanks (bellies) (and it's "octane level" - how many calories it has per unit volume); and
  2. How hard/far/long we're running the engine (i.e., the manual work our bodies perform daily)
It's utterly amusing that the obesity epidemic is viewed in any other terms.  It's quite simple - 100 years ago, we did not have processed, ready-to-eat, high caloric density, cheap, easy, convenient foods that required little or no preparation time.  And we did not have leaf blowers, washing machines, elevators, 3 cars per family, power mowers, pressure washers, desk jobs, televisions - you get the picture.  In short, we ate fewer calories and we burned far more calories performing just the basic tasks of life, let alone actual manual labor performed as members of the workforce.  We are exposed to much more food, and much less physical work.  It's a dose-response issue.

So this article in the NYT today about the total flop of obesity drugs is interesting, if only as a piece of amusement in the dog and pony show that constitutes modern talk about obesity, its causes, and it's possible remedies.  It turns out that weight loss drugs are not selling well.  And that's because a monthly prescription costs 5 to 10 times as much as a gym membership, and you lose only 7% of your body weight if you take it consistently and ignore the side effects.  That's just 20 pounds if you weigh 250.

So, as the article alludes, it is ultimately a question of willpower, and willpower must be considered in the context of the environment the person is exposed to.  Willpower is easier to exercise if the liquor store is closed.  But the Twinkie store (Walmart and the cupboard that it fills) is always open,  (so is the gas station) and everybody has the means to avoid manual labor in just about every instance of daily existence.

Thus, people should regard certain foods as they regard addictive drugs: worthy of regulation that begets avoidance - taxes, restrictions, withdrawal of farm subsidies.   But they don't want these things, which fly in the face of an inner libertarian streak, beholden by liberals and conservatives alike.  They don't want Big Brother telling them what to eat and what not to eat.  They want to exercise free will.   Even if that will is weak, and its freedom is compromised by the environment in which it would be expressed.

Instead, they would like to express their "free will" in more bizarre ways.  Such as the free will to take a pill, promulgated by an opportunistic and profiteering Big Pharma that will castrate the ability of the supposed free will to take in excessive calories laden with the key ingredients of fat, salt, and sugar.  The free will is perhaps not so free after all.  Or, they would like the free will sign up to undergo a grotesque and profitable surgery (for the surgeon and the hospital) that makes it physically impossible to take in excessive calories and digest and absorb them - a form of controlled mutilation and usurpation of the normal anatomy of the body, initiated by the free will in order to account for its own inadequacies when tasty food is within reach .

So, we are back to Ulysses, tying himself to the mast to prevent himself from responding to the sirens' call; and Thomas Schelling's game theory strategies in Choice and Consequence.  Wire your mouth shut, don't buy crappy food and make it available in your home, forsake fast food, relinquish electric appliances when manual ones will do, ride your bike, walk, choose city living over suburbia, take the stairs, walk your dog, take your family for a stroll around the park, prepare your meals painstakingly from basic ingredients, grow a garden, raise your own animals, grind your own coffee, use a broom rather than a blower, push a reel mower......or sign up for controlled mutilation ("gastric bypass"), toxic quasi-efficacious diet pills, fad diets (Adkins), and every other manner of convenient obfuscation of the underlying problem:  exposure and acquiescence to an environment which is rife with excessive and easy-won calories coupled with escape from the basic work of daily living via modern carbon-producing conveniences.

But you can't have it both ways - you either want to restrict your options, or you want someone else to restrict them for you.  Think carefully about which path shows true respect for your free will and the sanctity of your body, which the mystics claim is your temple.

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