As readers will note, I’ve been blogging a lot about the situation of obesity recently and so I read Mark Bittman’s recent op-ed in the New York Times, “How to Save a Trillion Dollars,” with special attention.
I agreed with a lot of what Bittman said about how changing our diets is one of the keys to reducing healthcare costs in the United States, including his ultimate conclusion:
The best way to combat diet-related diseases is to change what we eat. And if our thinking is along the lines of diet improved = deficit reduced, so much the better. If a better diet were to result only in a 10 percent decrease in heart disease (way lower than [Dr. David] Ludwig[, author of “Ending the Food Fight,] believes possible), that’s $100 billion project savings per year by 2030.
This isn’t just fiscal responsibility, but social responsibility as well. And the alternative is not only fiscal catastrophe but millions of premature deaths.
However, I thought that Bittman seriously undermined his message by referring to obesity-related afflictions, like diabetes and heart disease, as “lifestyle diseases.”
It seems like a minor point — and it’s true that the term has been adopted by certain individuals in the public health sphere — but I think we all need to be more careful about our word choices because the terms we use can have a powerful impact on our policy debates (e.g., are they “freedom fighters” or “terrorists”? are they “taxes” or “dues”?).
The term “lifestyle disease” implies that obesity boils down to personal choice—people choose to be skinny, just as they choose to live by the beach or own dogs.
This has been the mantra of big food companies trying to avoid regulation and litigation for over a decade, but it is contradicted by a growing mountain of evidence that our obesity epidemic is the product of a toxic food environment. If the incidence of Type 2 diabetes is characterized as the product of bad lifestyle choices then it is hard to advance the case for intervention at the societal level: people should just exercise personal responsibility and if they chose not to, they get what they deserve.
By way of comparison, imagine if Bittman had written an op-ed calling malaria and Guinea worm “lifestyle diseases.” Technically, he would have been right: “they’re preventable, and you prevent them the same way you cause them: lifestyle.” If you don’t want to get malaria, you should choose to live in an area of the world that doesn’t have malaria-carrying mosquitoes or you should choose to never venture out of your air conditioned home. If you don’t want to get Guinea worm, you should only drink water that has been piped from fresh sources. Change you lifestyle and you can greatly reduce your likelihood of getting these debilitating diseases.
But, of course, that frame is misleading and problematic. Many of the people who suffer from malaria and Guinea worm have no meaningful control over their situations — they are trapped in communities where clean water and mosquito nets are in short supply.
Could the same be said for many obese people in the United States who suffer from heart disease and diabetes?
Don’t they, too, face significant situational constraints? And if we actually want to reduce the incidence of obesity-related diseases shouldn’t we acknowledge that fact?
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