― Hippocrates (c. 460 – c. 370 BC)

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL (ret.), MC, USA

Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

Like too many Americans, I eat too much. If eating were a professional sport, I would be considered an accomplished athlete with an impressive career. My best memories of family and friends tend to be associated with eating.

Food is essential to our existence, stimulates all the senses and is usually a component of our most meaningful social interactions. Something has happened to our diet in the United States, however, that has turned this most basic human function into a health problem. Statistics provided by the Centers for Disease Control (CDC) state that more than one-third of Americans are considered clinically obese (body mass index of 30 or higher).

Obesity contributes to heart disease, stroke and type 2 diabetes, which are some of the leading causes of premature death, and higher medical costs for caring for obese patients was estimated to increase healthcare costs by $147 billion in 2008.1 Obesity is second only to cigarette smoking as the leading cause of death. Obesity rates from 1960 to 1980 were below 15% of the population and only increased about one percentage point a decade. The upward slope of the trend became very significant after 1980 with the percentage of obese Americans doubling from 15% to more than 30% in only two decades.1 What happened that can explain the sudden explosion in obesity?

Many experts blame the food industry and marketing. Others have postulated that circumstances attributable to our evolution have also contributed to the current predicament. As is so often the case, no single explanation will suffice; rather the reason for this complex problem is, well, more complex. I believe few would disagree that the taste of sweet is a deep-rooted and ancient craving for most humans. From our ancestral hunter-gatherer’s perspective, the taste of sweet in a potential food product was a good thing. Nothing sweet in nature would kill you and therefore was safe to eat.

Richard Johnson, a University of Colorado medical professor and author of “The Sugar Fix,” has noted that, when humans eat sugar, the body is stimulated to make fat. Ice Age humans lived when food was scarce and calorie sources inconsistent at best. Under these environmental influences, having a genetic predilection for storing fat when calories were plentiful was an advantage, not a health risk.2 As any student of Darwin would now point out, it is plausible that the Ice Age sugar-lovers and fat-storers might have had a survival advantage (i.e., they made more babies) which explains the almost ubiquitous sweet tooth of modern humans. Of course, this sweet fetish has been around for some time, so why the relatively recent problem of obesity?

Some blame our relatively sedentary lifestyle today, compared to humans past. Others opine that the overall abundance of access to food today is unparalleled in our collective history. Certainly these are factors. I believe something more sinister is at work, because it involves humans making money.

Our modern food industry is a marvel in its ability to feed the nation and the variety of foodstuffs offered. Imagine the joy of Ice Age humans walking into a modern supermarket today. The food industry knows what we like, know how to package and preserve it and how to exploit our emotions to sell more of it than we need. Fact is, the taste of sweet in the Ice Age diet was likely a rare delight. Finding calories at that time necessitated a significant expenditure of calories far greater than pushing the shopping cart of today. Finally, portion sizes were necessarily limited by nature. By manipulating sugar content, portion sizes and our emotions, the processed unnatural “stuff”’ that is marketed to us as food today is slowly killing us.

Yes, as a responsible adult I have considerable culpability in this conspiracy. I appreciate not having to pin my next meal down with a spear, being guaranteed a successful hunt by just going to the supermarket, the convenience of modern food sanitation and packaging, as well as the simulating taste of processed food. That said, I do not forgive the food industry’s marketing of sugar to children through TV and cellphones. Bad food habits established in childhood are carried into adulthood and likely explain much of our current obesity epidemic. The manipulation of sugar in soda and processed foods is no less insidious than the tobacco industry’s manipulation of nicotine in cigarettes. Sadly, the results of both monetarily lucrative schemes are the same for the American public: higher morbidity and premature mortality.

As usual, we have met the enemy and, once again, it is us. Attempts to improve food labels so we have a better understanding what we are actually ingesting has been met with fierce opposition by the food industry. Should we really consider the highly processed and modified high fructose corn syrup (a sweetener in many processed foods) a “natural” food product? As usual, the answer to this food situation was provided thousands of years ago by Hippocrates.

As federal providers, we need to educate ourselves more about the importance of nutrition in health and the consequences of eating a highly processed diet so we can educate our patients. Just as we admonish our patients for smoking, we should be pointing out the real dangers of the American diet. Finally, we should be holding the American food industry accountable for the health risk it is peddling to the public, just as has been done with the tobacco industry. As healthcare providers, this is our issue; a patient’s diet quite literally is their life.

1 http://www.cdc.gov/obesity/data/adult.html

2 http://www.businessinsider.com/evolutionary-reason-we-love-sugar-2014-4. Accessed Dec. 7, 2015