Stanley Feld M.D.,FACP,MACE

Ninety percent of the Medicare dollars are spent on the complications of chronic disease. Obesity is the cause of the onset of many chronic diseases such as Type 2 diabetes mellitus, and heart disease.
I have said there is a solution to the predicted $34 trillion dollar healthcare deficit. It is the prevention of the onset of chronic diseases. The government, corporate policies, patients, and physicians do little to prevent to onset of chronic disease or its complications.

In pursuit of the dollar Major League Baseball has outdone McDonald’s as an irresponsible corporate citizen. You will recall the relationship of McDonald’s super sized campaign and its relationship to elevating cholesterol and heart disease.

The public outcry caused McDonalds to retreat from its super sized campaign.

“Baseball and gluttony, two of America’s favorite pastimes, are merging in a controversial trend taking hold at Major League Baseball stadiums across the nation: all-you-can-eat seats.”

These cheap seats were difficult to sell. Now these seats are more expensive. They are advertised as party time with all you can eat food and drink. When people go to a ballgame they want to have fun. The message is fun equals baseball, hot dogs, nachos and soda pop. In a world where the” media is the message”

Major League Baseball is playing on the emotional message of fun while promoting the Obesity Epidemic.

“Fans in these diet-busting sections, for a fixed price usually ranging from $30 to $55, are able to gorge on as many hot dogs, nachos, peanuts and soft drinks as they can stomach. Some teams charge extra for beer, desserts and candy.”

I predict all thirty major league teams will have all-you- can–eat-seats in 2009. Where are the Presidential candidates on the issue of the obesity epidemic? Can the government do anything to protect us? Can people do anything to protect themselves? Can major league baseball do anything to stop this madness?

“At least 13 of the 30 major league teams are offering all-you-can-eat seats for all or part of the 2008 season, up from six last year. Some of the teams that offered them last season are expanding their all-you-can-eat sections this season.”

I have been saying for the past 2 years that citizens have to be responsible for themselves. The corporate interest is to make as much money as it can.

No one is going to step forward and protect us from ourselves unless public outrage occurs and we have a culture change toward overeating. “People Power’ expresses itself through public outcry.

“All-you-can-eat seats, usually in distant bleacher or upper-deck sections, are allowing teams to squeeze revenue out of parts of ballparks that used to sit empty game after game, team officials say.”

It is clearly all about money. All you can eat seats is an erroneous policy decision to increase revenue. The baseball executives always have lame excuses for bad policies.

“We’re getting rid of (tickets) and making the public happy” by offering them a way to save money, says Andrew Silverman, executive vice president of sales and marketing for the Texas Rangers. The Rangers saw sales of 616 seats in their stadium’s left-field corner take off last year after the seats were designated as all-you-can-eat areas.”

The public relations ploy is to put the blame on the fans and not their baseball franchise.

Mark Tilson, vice president of sales and marketing for the Kansas City Royals, says it’s up to fans to eat responsibly.
“We’re not making anybody purchase these seats, or eat seven hot dogs,” says Tilson.

Mark Tilson is correct. This is a strong reason for Americans to be responsible to themselves. If they owned their healthcare dollar they might not choose to abuse themselves especially if there was a financial incentive to take good care of their body. If they abuse their body they should be responsible financially as well as emotionally.

“What attracted me was eating as much as I could,” says Toney Fernandez, 20, of Harbor City, Calif., but “then I got hooked by the whole atmosphere:

The Dodgers began offering 3,300 right-field bleacher seats with unlimited Dodger Dogs, nachos, peanuts, popcorn, soft drinks and water. The section averaged 2,200 fans a game last season — and sold out for one-third of the team’s home games.

“Before the unlimited food and drink, such seats sold for $6 or $8, if they sold at all. Now, they go for $35 in advance and $40 for game-day tickets.”

The teams are doing it for money and not the health of their fans. The fans have eating contests.

” At the Braves’ Turner Field, some fans had hot dog eating contests, says Derek Schiller, executive vice president of sales and marketing.”

“The Royals tout their section with the slogan “Eat, drink and be merry!” At one game, a teenage boy scarfed down a dozen hot dogs, nachos and a couple of bags of peanuts.”

Ron Ranieri, general manager of concessionaire Aramark at Atlanta’s Turner Field, calculates that a typical all-you-can-eat customer downed: 3.35 hot dogs; one 20-ounce soda; one 7.9-ounce bag of peanuts; one 3-ounce order of nachos and 32 ounces of popcorn.

This translates to a caloric intake of about 4500 calories or about three times the recommended daily food intake. What is worse is that it also represents about 4 times the recommended saturated fat intake. This excessive intake increases the risk for heart disease, diabetes, stroke, and cancer and in turn the cost of healthcare. The question is who should be responsible for this excessive food intake. Should it be the government, society or the patient? In a free country it should be the patient’s responsibly for the excessive intake.

Should the government pay for care as a result of this abuse? Should the patient be responsible for the abuse? Should a system be created so that the patient acts responsibly and not abuse to his body? My answer is yes. The system be be able to accomplish this goal is not universal healthcare coverage with a single party payer.

Stanley Feld M.D.,FACP,MACE

As a nation we started to “eat out” more in restaurants in the last 30 years. Fast food restaurants have proliferated. We have invented “Power Breakfasts”, “Power Lunches” and “Power Dinners”. We meet friends for lunch. There is not a day that goes by that I do not have the opportunity to ingest 1500 calories for lunch, whether it is at hospital rounds, or a lunch meeting.

Restaurants have become meeting as well social gathering places for people. In the past we might meet on the baseball field, basketball court or gym. We might even go to a foodless educational meeting or social dance halls. Sunday bikers meet for a latte and a muffin at Starbucks before their bike ride.

As the number of restaurants have proliferated, restaurants somehow had to increase demand. Price and volume became the attraction for the fast food restaurants. Volume of food at the mid level restaurants enabled them to increase the price and the perceived “value”.

We find ourselves in the midst of Restaurant Wars. The war is about serving more food for less money. This concept is supposed to give one restaurant a competitive advantage over the next restaurant.

“Americans are eating about 12 percent more calories a day than they did in the mid-1980s, according to government statistics. The percentage of Americans who are overweight, meanwhile, increased to 66 percent in 2004 from 47 percent in the late 1970s. Hardly anyone believes it is a coincidence that Americans became fatter at the same time they began eating out more than ever and restaurants super sized their portions.”

In McDonald’s advertising “Campaign 55” in 1997 the price of a Big Mac was decreased to 55 cents. According to classic economic theory, the steep price cut will draw more customers, who will buy more Big Macs, which will fatten the company’s bottom line.

“But what of the fattening of American waistlines? What of the thickening of American arteries?”
Ray Kroc, the patron saint of franchisers, opened his first McDonald’s in 1955 with a 55 cent hamburger. In 1997 as business slowed, Campaign 55 was successful in increasing store traffic. The Big Mac is good only when a Big Mac (530 calories and 28 grams of fat) is purchased with french fries (450 calories and 22 grams of fat for a large order) and a soda (310 calories for 32 ounces). The total meal is three-quarters of the government’s recommended daily allowance of 66 grams of fat. “

The total calories are 1290. Our government’s theoretical 1500 calorie intake is the number of calories necessary to stay even with our caloric output. We would be allowed only 210 more calories to go to reach 1500 calories the rest of the day.

Morgan Spurlock in his 2004 documentary ”Super Size Me,” ate only the super sized McDonald meals for breakfast lunch and diner for one month. He had a physical and laboratory examination by a physician before the diet and at the end of the month. His weight increased 20 lbs. His blood pressure increased, as did his cholesterol and triglycerides. He also felt lousy. He was on his way to the complications of metabolic syndrome. The metabolic syndrome leads to type 2 diabetes mellitus. Morgan Spurlock documentary movie is brilliant. It makes obesity’s danger vivid. I think the movie should be shown to every child in every school in the country. I believe its showing would be a great public service. If we are serious about public health and preventative medicine we should do some serious things to prevent chronic diseases.

In the last 30 years restaurant portions have increased in size as prices have decreased or stayed the same. The bottom line dictates the policy of the CEOs of restaurant chains. You simply make more money with bigger portions. The increase in price for the larger meals far outstrips the cost of the food. The big costs are labor, rents, interior build out and appliances. They are the fixed costs that are present whether the portions are large or small.

The real problem is we, as a nation, have been programmed to believe that we get better value from bigger portions than smaller portions.

Let us suppose we could reprogrammed ourselves to understand that we get better value from smaller portions than larger portions. The expectation would be that we would not become obese and we would prevent debilitating diseases. We need a public service advertising campaign sponsored by the government to make this happen.

In our “short term instant gratification society”, the concept of decreasing food intake is a very hard sell. However, if a few restaurants exercised some social responsibility, the media publicized the value of small portions, and the government had a national campaign to fight obesity, it might work. The CEO of Carlson Restaurants Worldwide has chopped portion sizes at TGI Friday’s. Carlson’s chain is famous for calorie-rich items like deep-fried potato skins stuffed with cheddar cheese, bacon and sour cream.

Many restaurant chains that have tried to reduce portion sizes have had catastrophic results. The reduced portion sizes have failed because:

• People want volume
• Wall Street wants to see bigger profits
• Dilemma: How do you sell the idea of giving people less food? More important, how do you make money at it?
• Consumers say they want smaller portions or healthier choices.
• However, when confronted with a choice they order the larger portions

I suggest that each person reading this go to TGI Friday’s this week and eat one of their small portion meals and support the concept.* A point might be made. We should not patronize restaurants providing bigger portions, portions that help us become obese and unhealthy. We could also share a large portion with your companion and have more than enough food for half the price.

People Power can be extremely powerful. However we have to exercise our power for it to work.

* (Note: I do not own Carlson Restaurant stock)

Stanley Feld M.D.,FACP,MACE

Farm bill legislation is reenacted every five years. This is the year the 2007 farm bill comes up for passage. Most politicians do not pay much attention to the farm bill. The provisions of the bill are difficult to understand. Politician trade their farm bill vote for a vote on their agenda. Michael Pollan points out ”The fact that the bill is deeply encrusted with incomprehensible jargon and prehensile programs dating back to the 1930s makes it almost impossible for the average legislator to understand the bill should he or she try to, much less the average citizen. It’s doubtful this is an accident.”

The farm bill subsidies generate overproduction of food. “The farm bill helps determine what sort of food your children will have for lunch in school tomorrow. The school-lunch program began at a time when the public-health problem of America’s children was undernourishment, so feeding surplus agricultural commodities to kids seemed like a win-win strategy. Today the problem is over nutrition. but a school lunch lady trying to prepare healthful fresh food is apt to get dinged by U.S.D.A. inspectors for failing to serve enough calories. The farm bill essentially treats our children as a human disposal for all the unhealthful calories that the farm bill has encouraged American farmers to overproduce.”

This is one reason for the increased incidence of type 2 diabetes in children. The care of type 2 diabetes mellitus increases the costs of healthcare. As complications of type 2 diabetes mellitus occur they will increase the cost of healthcare even further.

The farm bill also has an important impact on the environment and in turn our health. “The smorgasbord of incentives and disincentives built into the farm bill helps decide what happens on nearly half of the private land in America. The health of the American soil, the purity of its water, the biodiversity and the very look of its landscape owe in no small part to impenetrable titles, programs and formulae buried deep in the farm bill.”

The medical community is now recognizing that you cannot solve the obesity problem or the type 2 diabetes problem without addressing the farm bill. Michael Pollan suggests the new bill be called the food bill. The environmental community recognizes that as long as the farm bill promotes chemical and a feedlot mentality we cannot master the fight for clean water. A grass roots social movement is developing around the quality and volume of food produced. Parents are protesting vending machines in the schools and quality of school lunches. As more and more people are getting information from the web as well as other sources, there is more and more agitation about our food supply. If we could reprogram ourselves, we could vote with our forks and change the thrust of the farm bill away from junk food. However, junk food is cheap. We have also learned to like it a lot. We must protest our agricultural policies and demand that society educate itself toward healthy eating. The process has begun.

Pollan says “there are many more who recognize the real cost of artificially cheap food — to their health, to the land, to the animals, to the public purse. At a minimum, these eaters want a bill that aligns agricultural policy with our public-health and environmental values, one with incentives to produce food cleanly, sustain ably and humanely. Eaters want a bill that makes the most healthful calories in the supermarket competitive with the least healthful ones. Eaters want a bill that feeds schoolchildren fresh food from local farms rather than processed surplus commodities from far away. “

Fixing the food supply chain will not be that easy. It is not simply eliminating subsidies. Somehow, the incentive to overproduce food for the food processing industry has to be replaced by incentives for producing fresh food in local markets. The emphasis has to be on vegetables of all kinds. Rather than having tomato factories all over South America which efficiently produce tasteless tomatoes and ship them thousands of miles prior to ripening, we must encourage local farmers to produce fresh, nutritious, and tasty tomatoes. The incentives should be aimed away from overproduction of raw materials for manufactured food toward changing the eating habits of our people. It has to be incentive driven for the local farmer and not for the benefit of the large farm conglomerates that produces oversized cows and overproduced corn, soy beans, rice and wheat. Corn production might not be a problem if we accelerate its use in gasoline and helps free us from foreign oil dependency. The same could be done for soy beans. Our policy makers have to be creative, innovative and tough minded for the good of the nation without destroying the small farmer.

Once we realize the dangers of the farm bill, we can demand that our food policy become aligned with our health so our food will be of a quality that can protect us from becoming obese and subsequently from the chronic diseases obesity precipitates. It will take awareness by the people and a demand for farm policy change. This is the year.

Stanley Feld M.D.,FACP,MACE

I said our population should not have to bear the exclusive blame for becoming more and more overweight by overeating. However, we have a choice and should bear the burden of blame for not saying “we are tired of this and are not going to take it anymore.” We must be responsible for our choice to overeat even though we realize we are being programmed to overeat daily.

The question is, why and how are we being programmed to overeat? Michael Pollan has written an excellent book “The Omnivore’s Dilemma”. The book describes the problem of obesity clearly. He is also a contributing writer to the New York Times and has written several articles in the past year outlining the causes of the obesity problem. His last article nails it.

He pointed out the research of an obesity researcher at the University of Washington Adam Drewnowski. Drewnowiski went to the supermarket to solve the mystery . “He wanted to figure out why it is that the most reliable predictor of obesity in America today is a person’s wealth. For most of history, after all, the poor have typically suffered from a shortage of calories, not a surfeit. So how is it that today the people with the least amount of money to spend on food are the ones most likely to be overweight?”

This is a powerful observation. However, the socioeconomic factor is fading rapidly as all socioeconomic groups are becoming obese today. He wanted to see how many calories a dollar could buy. “He discovered that he could buy the most calories per dollar in the middle aisles of the supermarket, among the towering canyons of processed food and soft drink. (In the typical American supermarket, the fresh foods — dairy, meat, fish and produce — line the perimeter walls, while the imperishable packaged goods dominate the center.)” He also found that “a dollar could buy 1,200 calories of cookies or potato chips but only 250 calories of carrots. Looking for something to wash down those chips, he discovered that his dollar bought 875 calories of soda but only 170 calories of orange juice.”

The supermarkets prime square footage and shelf space is devoted to processed foods that are considered junk food. What is junk food? Junk food typically contains high levels of fat, salt or sugar and numerous food additives such as monosodium glutamate and tartrazine; at the same time, it is lacking in proteins, vitamins and fiber, among others. It is popular with suppliers because it is relatively cheap to manufacture, has a long shelf life and may not require refrigeration. It is popular with consumers because it is easy to purchase, requires little or no preparation, is convenient to consume and has lots of flavor. Consumption of junk food is associated with obesity, heart disease, Type 2 diabetes and dental cavities. There is also concern about the targeting of marketing at children.

Pollan the states that “Drewnowski concluded that the rules of the food game in America are organized in such a way that if you are eating on a budget, the most rational economic strategy is to eat badly — and get fat”.

Pollan observes that “This perverse state of affairs is not, as you might think, the inevitable result of the free market. Compared with a bunch of carrots, a package of Twinkies, to take one iconic processed foodlike substance as an example, is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget.”

The Twinke is commonly regarded as the quintessential junk food. Each Twinkie contains about 145 Calories (607 kilojoules).A package of three Twinkies is one third of an average persons daily caloric intake. Five hundred million packages of Twinkies are produced each year.
Twinkie the Kid is the advertising mascot for Twinkies and can be found on packaging and related merchandise.

Are we being programmed and conditioned by the media? You bet we are.

“

So how can the supermarket possibly sell two or three of these synthetic cream-filled pseudocakes for less than a bunch of roots?” Michael Pollan points out the answer. It is in the farm bill. The farm bill subsidizes the Twinkie and not the carrot. “Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.”

The creative manufacture of increasing amounts of junk food has increased with each increasing farm subsidy.

The farm bill does nothing to support the farmers that grow fresh produce. Pollan points out that the real price of fruit and vegetables increased by 40% between 1985 and 2000 while soft drink (aka liquid corn) declined by 23 percent. The reason junk food is the cheapest food is the farm bill subsidizes these foods.

Shouldn’t we wonder why when faced with increasing obesity and the complications of chronic diseases precipitated by obesity leading to 90% of our healthcare costs, would our policy makers subsidizes businesses that promote obesity? Shouldn’t the government subsidize busnissess that promote wellness?

There are many perverse outcomes in our nation’s complex economic and political systems. The government permits energy companies to build “dirty coal plants” to generate electricity to solve our fossil fuel problem because we have an abundance of coal in America. The thinking is logical. However, the pollution from the particulate matter released by coal causes asthma, chronic obstructive lung disease and heart disease. Aside from the resulting morbidity to people affected by these diseases from the pollution, it costs the healthcare system $34 billion per year in avoidable recurring costs if the dirty coal plant pollution did not exist. It does not make sense when we are trying to solve healthcare costs if less harmful alternatives exist.

Another perverse example is osteoporosis. The complications of osteoporosis cost the healthcare system 20 billion dollars annually. You can decrease the fracture rate by at least 50% with current treatment. However, you have to discover this silent disease by measuring a patient’s bone mineral density. In order to save money Medicare is reducing reimbursement of bone density measurements by 70% in the next two years. The reimbursement will be below the cost of the test for most clinics. This is certainly not a way to promote early detection and treatment to prevent complications of this chronic disease. Faulty, perverse policy decisions occur frequently. I believe it is a result of an obsolete policy making process. We assume our elected representatives represent our interests but they seem to represent the vested interest of other powerful stakeholders. The result often is an expression of a lack of common sense.

The only way to stop it is if we the people express our opinions to our politicians and force our political system to respond and represent our needs and not the needs of other vested interests. Our well being is the only need they should be considering. With the internet, blogs, and instant communication we are capable of making our needs known. We must exercise our people power.

Stanley Feld M.D.,FACP,MACE

Obesity is an important contributor to our nation’s declining health and increasing healthcare costs. Obesity precipitates the onset of chronic diseases such as Type 2 diabetes mellitus. Five percent of our population has Type 2 diabetes mellitus. That 5% of the population with Type 2 diabetes mellitus consume 15% of our healthcare dollar.

Why are we as a nation becoming more obese annually? The answer is complex and has multiple interrelated reasons. These multiple factors must be understood and dealt with in order to solve the problem of obesity and decrease our healthcare costs. Solving the problem of obesity would be a major step in repairing the healthcare system.

As physicians we are quick to blame the patient for eating more than they are burning. Simply put this is the reason people gain weight. Why are we eating more than we are burning in 2007 rather than 50 years ago?

In order to answer this important question we must understand the relationship of calories to weight gain. We must also appreciate the ease of accumulating calories and the difficulty in losing calories. We as a nation have become obsessed with dieting and dieting schemes. The success of diets has been minimal. There is no quick fix to obesity. We must under go a lifestyle change. Effective durable lifestyle changes will only occur if there is a cultural change in our food preparation in America

The arithmetic of weight loss is discouraging. In order to lose 2.2 lbs we must lose kilogram (1000 grams) of fat. Fat is very dense in calories. Each gram of fat is 9 calories as opposed to each gram of carbohydrate or protein which is 4 calories. 2.2 lbs (1000 grams) equal 9000 calories. In order to lose 22 lbs you would have to burn 90,000 calories more than you eat or eat 90,000 calories less than you burn.

Let’s assume we burn 1500 to 2000 calories per day due to our basal metabolic rate (BMR) and normal daily activity. The BMR and the expenditure of calories with activity of daily living varies depending on age, height, and weight.

Let’s say you burn 2000 calories per day and eat 1500 calories per day. You would lose 500 calories that day. As soon as you go into negative caloric balance most people lose some body tissue water. The water weight loss is a meaningless measure of weight loss. In two days at 500 calories a day you would lose 1000 calories and in 18 days you would loss 2.2 lbs or 9000 calories. It would take 180 days to lose 22 lbs on a diet of 1500 calories a day if you burn 2000 calories a day. Most people burn fewer than 2000 calories a day. It is very difficult to stay on a diet for one half year and only lose 22 pounds when you might need to lose 40 pounds.

This is the reason that the approach to weight loss has to be a lifestyle change. A lifestyle change must be permanent. It should result in eating less and exercising (burning) more than you eat.

If we were predisposed to Type 2 diabetes mellitus and lost the weight we would avoid the ravages of the disease and decrease the cost to the healthcare system.

It is not our fault that the nation overeats. Overeating or eating calorie dense food has much to do with the economics, and politics of food production. The food industry’s economics and politics have resulted in social conditioning and mind manipulations that have resulted in overeating. We have to say this has got to change if we are serious about our health and controlling our healthcare costs.

Stanley Feld M.D.,FACP,MACE

The nation must declared War on Obesity to save its people from themselves. If you think, about it the problem is we get in our own way. It is time that we recognize that obesity is a disease and we must do everything we can to eliminate it.

I like to think of obesity as a disease with a genetic predisposition precipitated by environmental stimuli leading us to become a nation of overeaters. We as a nation must say we are tired of being manipulated. This will take national leadership and compromise by vested interests that are profiting from the obesity epidemic. The epidemic is decreasing the health of our nation. It will have a devastating effect on the costs of healthcare if not corrected now.

The benefited vested interest is the food industry. They have conditioned us so that as a nation we eat more and more and get fatter and fatter. Presently, our children are also being affected. Childhood Type 2 Diabetes Mellitus is becoming more and more prevalent because of the abuse by the large agribusinesses, the restaurant industry, the snack food industry and the supermarket industry. The abuse is driven by profit margins.

People power along with strong leadership has the ability to turn this around. We have started to create the hype for healthy eating. However, the food industries have countered the positive direction we were going in by engaging the advertising industry to undermine the effort. They have also gone on the offensive with subliminal advertising that encourage us to feel good eating junk food.

There was a recent article in the New York Times magazine section “You Are What You Eat: 2006 and the Politics of Food”. It is important that we spend some time on this article. It is up the nation to say enough is enough.

“The headlines about food this year read like a remarkable replay of Woody Allen’s “Sleeper,” in which the things Americans think they should eat more of — lettuce and spinach — were suddenly the ones that could make them sick, or even kill them.”

I do not think anyone has gotten killed by a potato chip or soda pop in the short term. I know there is excellent evidence that it will kill you slowly.

Marion Nestle a professor in the department of nutrition at NYU said. “This is the year everyone discovered that food is about politics and people can do something about it,” she said. “In a world in which people feel more and more distant from global forces that control their lives, they can do something by, as the British put it, ‘voting with your trolley,’ their word for shopping cart.”

We can certainly avoid unhealthy food if we were educated to recognize unhealthy food. We would then be able to mount a national protest, but only with the governments help. Eric Schlosser, author of “Fast Food Nation,” is equally upbeat about the spinach disaster. “Those negative events brought attention to the problems,” he said of the past year. “Even the growers think the system is broken and has to be fixed.”

I have observed some positive movement. There is a growing bipartisan consensus that obesity is bad. Soft drinks and junk food vending machines are being removed from schools by individual school districts as the expense of losing an income producing profit center for the school district. Governors nation wide are making nutrition a priority in schools. Some states have even reinstituted physical education.
Whole Foods has become a major food marketer in the United States. They have forced main stream food marketers to advertise “healthy food”. The organic food movement even becomes main stream with Wal-Mart and Target food markets. However, as more and more “organic food” has been demanded the food has become less “organic”.

“As Mr. Pollan wrote in The New York Times in 2001, about the dairy farms operated by the organic milk producer Horizon, “thousands of cows that never encounter a blade of grass spend their days confined to a fenced dry lot, eating (certified organic) grain and tethered to milking machines three times a day.”

The Department of Agriculture is now considering allowing salmon farmers to call their fish organic even if the fish are fed nonorganic fishmeal. The increasingly loose meaning of the word has led some consumers, who once bought anything labeled organic, to rely on new signifiers, like grass-fed, sustainable or local.”

“It is not only individual shoppers who are choosing to vote with their food dollars. Tired of waiting for the federal government to act, local governments have stepped in. New York City banned trans fats in restaurants and told restaurants with standardized recipes that they must provide easy access to calorie information. Other municipal and state governments are requiring public institutions to buy more nutritious, locally produced food.”

My question is “where is the evidence that “organic” is better for your health than non organic food?” The key questions in my view are food quality and food safety. As food has become a huge business whose profits making potential can be leveraged, we need to worry about the safety of growing the foodstuff, its processing and delivery. Organic assumes that chemical fertilizers are bad and pesticides are toxic to humans in the doses used. Therefore organic fertilizers are imperative and pesticides should be forbidden. I do not think there is any evidence for this assertion. I can visual abuse of pesticides but have not seen evidence. It could be that organic fertilizer could threaten food safety more than chemical fertilizers. The organic food movement is making us aware that something is wrong with the food industry.

I think the real issues are the safety, quality and quantity of the food we eat. The quality and quantity of the food we eat has a direct impact on the obesity epidemic.

I will discuss the quality and quantity of food we are exposed to next time.

Stanley Feld M.D.,FACP,MACE

I received a comment from Karen Madrono. You can read her complete comment in the “War on Obesity” post.

The point Karen makes below is critical to the understanding of how change must occur.

“Battling against obesity seems easy but I’m telling you, it takes courage and faith in yourself.
One must be conscious about every food that they put in their mouth. It could either make the person healthy or sick. It’s not the teacher’s obligation, though they should teach children the right food to eat but it is still up to person himself not to the doctor.

Our health is our most precious possession. We inherit our genetic predispositions. For example, twenty percent or more of us have a disposition for Type 2 Diabetes Mellitus. However, the Diabetes declares itself in only 5% of the Caucasian population. In America the percentage of Caucasians with Type 2 Diabetes Mellitus is rising. The incidence is much higher in Hispanics and Blacks. In fact, Clinical Type 2 Diabetes Mellitus is now appearing at a younger and younger age as the epidemic of obesity in America is spreading. Our Super-sized Fast Food portions are contributing to the epidemic.

The rising incidence of Type 2 Diabetes Mellitus is directly related to the increase in Obesity in this country. Obesity represents an environmental abuse to our genetically predisposition. Increasing weight results in insulin resistance. Insulin resistance leads to increasing blood sugars. Type 2 Diabetes Mellitus can be thought of as a disease that results from our inability to overcome the increasing insulin resistance resulting from increasing weight gain. The insulin resistance results in hypertension and a rising cholesterol. The end result is Coronary Artery Disease. The combination of diseases is currently called Metabolic Syndrome. Metabolic Syndrome is the major cause of heart disease in this country. It takes 8 years from the time of onset of Metabolic Syndrome to the time of discovery of Type 2 Diabetes Mellitus. Many times the diagnosis of Diabetes Mellitus is made at the time the patient has a heart attack.
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The entire Metabolic Syndrome can be reversed by weight loss. Weight loss can be achieved by decreasing food intake and increasing caloric output. Weight gain is the environmental abuse to our genetic predisposition. Weight loss is difficult to accomplish. It requires a consistent and long lasting change in life style activities. Many “tricks” have been tried. None of the “tricks” seem to work long term. Industries have been built around these “tricks” because we are a nation of instant gratification.

In the long term, it remains the patient’s responsibility to fix the problem by changing his lifestyle. Systems of Care can help the patient develop a lifestyle change. Government campaigns could provide educational tools. However, it is up to us to be responsible for ourselves.
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Karen has made the point abundantly clear. Thank you Karen.