Every year Americans get larger. We are getting fatter, and we care less about the health risks. As a physician, I can see the effect on health, but societal pressure is going opposite to the medical evidence. The science is being ignored to spare the feelings of the obese.
As we spare the feelings of the obese, we are doing several things that will harm us all. We are making obesity socially acceptable and have gone further to pretend that highlighting obesity is the same as racist speech. It is not. As obesity increases in prevalence, the conditions that create obesity are becoming normalized. In the long term, this impacts our children and leaves them with a lifetime of obesity. Obesity may become socially acceptable, but it is not medically sustainable. We need to take better care of our citizens and start by telling the truth. Obesity is the most destructive disease to Americans. We will be paying in ways not yet foreseen.
The science is clear. The medical observations are in, and obesity is not an acceptable fashion statement. It is a disease state. Like smoking, no amount of obesity is without consequence. All obesity will cause medical damage. The only question need is, how much. Many will have long lives in spite of their obesity, but the facts are clear. They could have had better lives. The sad news is that obesity is not a personal disease, it is a societal disease. We have an epidemic.
The epidemic is that of the whole organism. The organism is humanity. As the maldistribution of food resources leads to obesity all over the world, the entirety of the planet will suffer. There is a need to clear and plant; rare and kill more animals. This race to produce more food is destroying not just our bodies thru obesity but is destroying the biosphere.
As we destroy our planet’s ability to sustain us, we are killing ourselves. How we handle food is not a personal matter, it is a species matter. The capacity of our planet is finite. We live on a rock covered with a small volume of air and water in a giant vacuum. If the potable water runs out, or the breathable air disappears we have no place of refuge.
All of us can directly impact the planet. We can eat less. The science is clear. If we eat organic or non-organic, there is no difference. We need to eat less. There is no superfood. There is food. No matter the nutrient content, excessive quantity has the same result, obesity.
Eat less and leave a healthier planet for our children. Teach our children to eat less and save the planet for our grandchildren.
Life has both a tenacious and fragile grip on our flesh. Acceptance of its challenges is the beginning of enjoyment. The rose bush comes with her thorns, and her flowers are much less fragrant than we expect. Her flowers are beautiful and surrounded by sharp barbs. How we deal with the thorns is all we can pretend to control. Life is the struggle.
I will push on. I will not allow the pain to prevent me enjoying the fragrance and the beauty. I will enjoy the jabs and chant the reminder. Life is the struggle.
I will allow the breath of life to penetrate deep into my soul and catch the fragrance of the flower. The struggle is life as the scent of a rose is fleeting.
As I slide down the backside of life, I will not forget that life is the struggle. I will hold tight and breath deeply as I traverse the thorns. I will lick my wounds and recognize the magic of my bleeding. I will affirm that life is the struggle.
On that day when the struggle becomes too much, I will exit on my terms. My exit may be your thorn. Feel the pain, breath deeply and remember, life is the struggle. The rose is less fragrant that you remember and the view from the mountaintop is only as beautiful as the struggle to get there.
Enjoy the struggle until the enjoyment is gone. Exit without any apologies.
I can still remember my first time cooking a full meal. It was summer-time and we wanted soup. Soup was what we had for dinner every Friday. For months I had observed. It was mine time to repeat what I had observed. I followed the recipe as I had seen. I made what I thought was great soup. We enjoyed to the last drop. Since then I have enjoyed cooking. I enjoy cooking and would love my girls to have the same joy from cooking. Cooking is an excellent way of learning science and may help us eat better. By better I mean great tasting food with lower caloric density.
Making breakfast for my girls this morning was a wonderful expression of my love for them and my indirect way of passing unto them great eating habits. I suggest we all cook more. We all should eat more home cooking. Eat more home cooking for better health and family unity. I made what the girls requested, one fried egg with two strips of Turkey Bacon and blueberries. What is on your breakfast menu this morning?
I could feel the heat of the morning sun sneaking through the crack in the heavy curtains keeping my room dark and cool. As I tried to hide from the heat the cacophony of bird chirps irritated my ears. I was usually an early riser but I had a little too much fun before going to bed. I dragged myself out of bed and pulled the curtains open and my eyes were assaulted by the brightness of the early morning sun. Ben was still asleep, neither the light nor the audio assault of the many birds stirred him. I could not sleep anymore. It was time to start my day. There was only one problem. My head was paying the price for the excessive of the night before. It came on slowly but I was definitely nauseous and the room was spinning faster and faster the longer I stood. My stomach felt like it was lodged in the back of my throat. My salivary glands oozed increasing quantities of fluid. I had not felt this poorly in many years.
I slowly backed up and rolled back into bed. I closed my eyes tightly, but there was no relief. Suddenly my stomach blew up like a tense balloon followed closely by the release of its contents up my esophagus and through my oropharynx and out my mouth onto the floor. The taste was not as bad as I thought it would have been. The back of my throat relived the bitter taste of the IPA I had had too much of the night before followed by the saltiness of the fries. I was happy not to locate the taste of the fish, it was not that good. It was a very fast review of my last meal followed by another quick reminder. After the third time I had had enough reminders. The bed had collected the last two explosions and the smell had gone from beer to unbearable.
The room was spinning and the light of the sunrise was burning my cornea. I closed my eyes tightly and remained still. I was not rewarded. The room continued to spin and the volcanic activity in my stomach continued. I lost count of the explosions, but the worsening taste did not escape me. I was certain that my stomach was empty but the expulsions continued. It seemed as if my duodenum was collapsing under the force of the attempts to pull the fluids from my small intestine. Closing my eyes did not stop my world from spiraling down the drain. Ben did not move a muscle. I felt as if I were dying a long slow death. I was too weak to get up and was now laying in foul-smelling cold vomit. All I could remember was my grandma, Mama, quoting the bible “Wine is a mocker, he so deceived is a fool”.
Next time, I will not deceived.
The encouragement to take a daily multivitamin continues to be strong. However, the accumulation of data suggests strongly that daily supplementation is not necessary. The reasons for fortification of specific foods with specific nutrients starting in the early twentieth century was deliberate and with good reason. The indications for Folic acid, VItamin D, Iron and Iodine were clear and scientifically proven interventions using prevention as treatment for neural tube defects, Ricketts, iron deficiency and goiter. For these diseases the scientific connection was clear and proven. Forward to today and vitamin and micronutrient fortification is touted as a panacea and treatment for all that ails. The evidence for the addition of most supplements is weak at best. Frankly, it is without merit and almost totally baseless.
The extrapolation that since we need small quantities larger quantities will be better is short-sighted and potentially dangerous. The evidence does not support that view. The industrial production and addition of vitamins to every conceivable food item is primarily a marketing tool. It is a waste of money for consumers. If we look at nature we can see a better paradigm to extrapolate from. The concentration of vitamins and micronutrients are small and very large quantities of whole foods would need to be consumed to approach the quantities in many of the marketed items. If there is not a proven deficiency there is no need to add to our foods. The proven need is for small quantities that is more than adequately supplied by a balanced diet. The evidence for benefit beyond that is none existent.
Although, the evidence for potential harm is small we must ask the question. Will super sizing the quantities we ingest be harmful in the long run? Like with the craze for copious quantities of bottled water we have been marketed a hook and we have bitten and are drowning in a sea of misrepresentation. Improve your diet. Make fruits and vegetables the base of all meals and stop wasting your money on bottles of urine coloring.
There is a curse that inhabits the American work place. We have become slaves to profitability and not to best outcomes. The primacy of profits has led us to misunderstand the nature of work and the importance of worker satisfaction. Making ever-increasing profits is the goal but how we get there makes a difference. Some employers have lost their focus. Sustained profitability is about worker satisfaction. In many fields lip service is paid to the worker, while they are trapped under inhumane work conditions. Fortunately work conditions in the developed world are better than they were. However, we still have a way to go before we can claim victory over poor working conditions. The severity of the impact of poor conditions is dependent on your industry. In health care the impact can be life threatening.
Our culture for too long as valued hard work over smart work. We seem to believe that the worker that workers longer hours is more noble and deserving of praise. This misplaced praise has led to continued poor choices and has led to the misery and burn out of the American middle class. The depth of the problem continues to go unnoticed and unacknowledged. Poor outcomes continue to be placed at the feet of poor training and individuals are blamed. I too have a tendency to blame the individual. The truth is that sometimes the individual is to be blamed, but we too often neglect to evaluated the conditions under which mistakes are made. The systems under which most of us work are archaic, inefficient and are undermining our ability to be the best we can be.
I will be attacked for my stand but the truth needs be told. I love my work because it gives me the opportunity to help my fellow humans at a time when they are most in need. From my limited experience that help is best delivered when I am well rested. Some may consider me weak for insisting that adequate rest is required for best productivity and patient safety. I, however, would rather follow the evidence that suggests that efficiency and safety are best attained with a well rested and optimally trained work force. The conditions of many operating rooms where staff can work full daytime shift and take overnight call then work a full day shift is putting our patients at risk.
The unfortunate problem is that when a staff member makes a mistake that harms a patient she alone is blamed. The idea that she needs to take personal responsibility for her mistake is commendable , but essentially is a cop-out. Her bosses are just as culpable, because they have put in place a system that does not allow her to work at her best. The continued scapegoating of individuals is a sickness in our system that needs to be driven into the grave. Our success is dependent on the balance and efficiency of the systems we construct. Spending money on technology is commendable and necessary but alone will not improve patient outcomes.
Better pay is a great place to start, but is a poor quality band-aid when one works under mentally oppressive conditions. Improving the system starts by focusing on the best assets of the system. Our human capital is our best asset and must be treated as such. We are not robots, we are better. We may not be able to work as long hours and we get bored easily; but until robots can think intuitively and problem solve on the fly we will continue to be the best part of the workflow equation. Functioning at maximum efficiency must be out foremost goal. For humans to be focused and efficient we must have adequate rest and distraction. If we would focus on those areas many of our problems would be resolved without the need for expensive investments in equipment.
Let us invest in our best and most productive assets, our people.
The cycle of war and peace continues like the flow of water. Unlike the processes of nature, it is not inevitable. The process of life is about choice. We have the ability to choose the path we take. The decisions we make are not preordained, we are our life’s directors. As we direct our life we must take care of the vulnerable among us. War is a selfish act, resulting from the disregard for the many. It is the result of disordered thinking, that justifies killing as a means of protection. The incongruity of that argument is evident if we would reflect on it. Our reflection must consider the social nature of our species where we will follow those among us that profess caring and loyalty to the group. Unfortunately, the malicious and selfish among us have and will continue to exploit the majority, until the majority decides to be as concerned about the stranger as we are about the ones closes to us.
The more important question that needs examining concerns what will our future be if we do not break the cycle. War may bring a temporary peace, but the underlying discord will resurface. The cycle must be broken, if humanity expects to survive. The cycle can be broken when we address the root causes. Where the root of war is usually the exploitation of the many for the benefit of the few. We must reconsider our use of the planet’s resources. It will be painfully to many, but will be beneficial to the most. We may not think that we are exploiting anyone, but if we examine our life it will become clearer that many of us are consuming excessive quantifies of the available resources.
If we all consider and re-order our life’s the great masses of the deprived on our planet could have the possibility to improve their lives. The cycle of war with interludes of peace could be broken by each of us say no to exploitation. We all have a responsibility to our species. Our care needs to extend further than down the street. We need to extend our care and concern to the father thousands of miles away that cannot feed his family, while we dump more food that we eat.
War is and always will be about resources. Let us all take a stand and share.
The epidemic of morbid obesity engulfing the world is a testament to mankind’s greed and lack of insight. We continue to devour the planets resources without any close examination of the consequences. Some are so greedy that we think we should have a right to plunder without regard for the other creatures that share the planet with us. This gross lack of understanding of the ecosystem that we are apart is expressed as our expanding waist lines.
As we continue to grow later in number and individual size we complain about over crowding and stress. We complain about obesity associated diseases but still have giant food parties at work and home. We want what we want and will not change. This lack of insight to connect our greed with our continuing illness is continuing to kill us. We continue to teach our kids to eat empty calories and expect that they will grow into healthy adults. This gross lack of insight is a reflection of a society devoid of competent leaders.
The good news is that the upcoming generation will in fact have better insight because of the wasteland of a planet that our generation will leave them. I see the seeds already. They will not be burdened with the excess earns that leads to purchasing for purchasing sake. They will make better use of their resources and in doing so will rescue our sick planet from the brink of our self-imposed destruction.
I hope to live long enough to see concrete evidence, but I have seem enough to be hopeful.
One day the greedy self-centered industries that feed the obesity beast will be found out and regulated into oblivion. That day cannot come soon enough, but I will be patient because the patient shall inherit the earth.
Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care. As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.
Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.
As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.
No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.
Our lives are short and then we die. How are you going to make the best of your experience? Are you going to be conservative and play it safe?
We often worry more about others and are less concerned about how we are using our limited time. Ignore them, because in the long arc of time they do not matter. I say wake up and dream. Dream of your adventures, but make sure you wake up and experience them. Do it now because only you will live the regret. Do it now because there is no better time. Do it now because we hold the keys to our happiness.
Take hold, escape and live it.
Because life is what happens when we are making plans, plan less. Life is in the moment. Make your list and check it off, because time will not wait for you. We have come too far to give up now. We have survived for a reason. We have survived so we can enjoy. We are here because evolution has chosen us. She is a strict master and only those who take hold and grow will succeed.
We have gotten lucky, we have come too far to give up.
We need to raise the bar. We need to go out and take our rightful place. Do not get pushed, go do the pushing. Brush off the dust. Go dancing in the rain because you are a champion and the world is your play ground. We are like butterflies. We have survived a long birth, it is time to explore. The world will hear us. The world will respect us. The world does not matter. It is our world. Hold on, but not too tightly. Enjoy it, do not stifle it. Take hold and make it count. Be a little breathless, but mostly keep your smile on and remember that it is your world.