How Did We Get In This Mess, Anyway?

Healthy Eating Tip: Health is in the big picture, not the details!

Part 2: How did we all get in this mess, anyway?

“If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.” Sun Tzu, The Art of War.

The Art of War has been required reading for those that wish to be the best at what they do for hundreds of years. Mid-19th century translations made The Art of War widely available in America. Bits of Sun Tzu philosophy has seeped into American culture, and we do not even know where they came from. “Keep your friends close, and your enemies closer” isn’t a quote from the Godfather, it is Sun Tzu. “He will win who knows when to fight and when not to fight.” (Only fight battles you know you can win) isn’t a Norman Schwarzkopf quote from the gulf wars, it is Sun Tzu. “A leader leads by example” isn’t a management philosophy that Jack Welch, the legendary CEO of General Electric created, it is Sun Tzu. “You have to believe in yourself” isn’t part of a Tony Robbins motivational talk, it is Sun Tzu. These are things that we hear motivational speakers, business people and leaders from many disciplines say all of the time, but they are all direct quotes from The Art of War!

I had heard the name Sun Tzu before but I touched my first copy of The Art of War at the Culinary Institute of America in 1984 I inhaled it. I adopted some Sun Tzu philosophy and added it to the professional tool kit that I still use every single day here at Smith County Memorial Hospital. When I bumped into heart disease in 2003, I used the same principles to build a lifestyle modification plan that worked for me.

This series of healthy eating tips–health is in the big picture, not the details–is based on the Sun Tsu idea of knowing yourself and your enemy. Two important aspects of knowing how to get out of the mess we find ourselves in are knowing how we got there in the first place, and knowing what we are fighting against. Today we discuss environmental or contextual conditions that place our nation in a battle against chronic lifestyle-related diseases, and next week we will discuss the specific physiological challenges we face that make lifestyle modification incredibly tricky.

Knowing yourself and knowing your enemy are two essential aspects of the lifestyle modification plan I adopted for myself and advocate for you. Last time, we discussed the importance of knowing yourself through self-empowerment, self-efficacy, self-awareness, and self-determination. Go back and read that post if you missed it. It is a crucial step in a lifestyle modification plan to know yourself and exactly what you are willing to and capable of changing. It is equally important to know what kind of challenge you are facing.

If money and time were not concerns, I would immediately pursue a Ph.D. in nutritional anthropology. In 2006, I transferred into The Ohio State University from Columbus State Community College, where I had completed all transferable courses, leaving me some serious elective credits to fill at OSU. Those elective courses I did not take in Medical Dietetics I took in anthropology. The study of how culture has affected human health over time is fascinating. It is also the key to understanding why we are facing the epidemic of lifestyle-related disease that is crippling our nation. Both ancient and very recent events have contributed to the health crisis we find ourselves in today.

We can easily view the entirety of human history up to and including today as a search, and indeed battle, for scarce resources. As hunter-gathers, our lives were consumed with the daily search for food. That one thing alone embodied our existence as humans for 200,000 years, even further back before we were classified as Homo sapiens.

Somewhere around 10,000 years ago, humans started to plant seeds and harvest food. This “agricultural revolution” transitioned us from hunter-gatherers to farmers, and we started living in one place in increasingly larger groups. For the first time, humans were able to specialize, and skilled workers provided excess agricultural products for the population. Animal husbandry soon followed, and population centers grew. Humans were able to concentrate on things other than finding food. Writing was invented, and our culture was born. Mathematics, philosophy, politics, the arts, and commerce were all things we had time to now pursue. These cultural changes were not without health consequences.

Many diseases were introduced to the human population through close contact with groups of animals and then spread quickly in densely populated cities. Bovine spongiform encephalopathy (mad cow disease), equine encephalitis, West Nile virus, Zika, and dengue fever were all transmitted from animals made more likely by humans living near large populations of animals. These diseases spread quickly because we were now living closely together in larger and larger communities. We are still experiencing this today. COVID-19 was transmitted from animals, and we see that it spreads faster in large cities where large numbers of humans live in close proximity and spreads slower in less densely populated areas like Smith Center.

The scientific revolution was a rather slow series of events in the 16th and 17th centuries that marked the emergence of modern scientific thought. Developments in mathematics, physics, astronomy, biology, human anatomy, and chemistry transformed the views of society about nature. The scientific revolution gave rise to abstract reasoning, quantitative thought, and the development of the experimental scientific method.

In 1712, Thomas Newcome tackled the problem of pumping water out of coal mines and invents the steam engine making a significant contribution to the industrial revolution, which was already underway in The United Kingdom. If Thomas Newcome is one bookend of the industrial revolution, then Henry Ford and his early 20th-century use of the assembly line might be considered the other. Since the agricultural revolution, the specialization of labor has continued and increased. However, the economy was still mostly based on human labor, with the odd beast of burden tossed in here and there. With the invention of the steam engine, everything changed, and from then on, the emphasis would be on machine-driven or mechanized labor. As everyone in Kansas knows well, the steam engine followed by the gasoline and diesel engines made a succession of energy-saving devices possible, enabling one person to work a large plot of land except where the harvest is concerned. There is a nice example of the evolution of mechanized farm equipment right across highway 36 from SCMH on the lawn in front of Wheels Unlimited used car sales.

At the end of World War II, America entered a time of great prosperity. Almost overnight, the availability of all types of products increased dramatically, and the American appetite for consumption with it. Food options also increased; a faster lifestyle in the 50s and 60s created a market for foods that could be fixed quickly in the kitchen, and the prepared food industry was born. The freezer and the microwave were invented to hold and prepare these items, and both became irreplaceable objects in the kitchen. The television became ubiquitous in American households in the 60s and 70s and fed by available dollars and desire; the great American consumer culture was born. The new advertising vehicle, the television, marketed the latest high-calorie snack foods directly to their target audience–children. In the mid-60s, fast food came into its own and was added to the American diet. I was reminded this week that my first memory of food was the mix of flavor profiles on a fast-food hamburger in Orlando, Fla., when I was in kindergarten; salt, fat and sugar, and the classic sweet and savory combination. I was hooked, and so were millions of other Americans. Television relentlessly marketed snacks, candies, high-calorie breakfast cereals, fast foods of every description, and an ever-increasing list of ready to eat prepared foods; almost all high-calorie and nutritionally deficient.

By 1980, we began to see an explosion of new snack foods, candies, gums, and tasty baked treats; Portions increased, amounts consumed increased, and the national average body mass index (BMI) increased right along with it. The number of products available in American supermarkets that can be categorized as “candy, gum and snacks” more than doubled between the years 1983 and 1993 says a 1999 article in the American Journal of Clinical Nutrition. The Centers for Disease Control and Prevention reported that the percentage of overweight Americans much more than doubled in that same time and the incidents of obesity nearly doubled.

In the early 1980s, three other events took place, all of which significantly increased the American inclination towards a sedentary lifestyle. The events represent an electronic and digital revolution. Cable television and the videotape machine-made 24-hour television viewing commonplace, the personal computer was invented, and the computer game first appeared. Also, in the 1980s, budgets for schools, but more importantly, physical education programs were decimated. We hit both sides of the weight-loss equation–calories in and calories out–and not in a good way!

The Year 2000; Media in the Home National Survey prepared by the Annenberg Public Policy Center of the University of Pennsylvania states that “children aged two to seventeen spend nearly two and a half hours (147 minutes) with television each day.” This number nearly doubles to 281 minutes when computer use, computer games, VCR-DVD, and internet usage are included, all of which can be categorized as electronic media. On average young Americans, 2-17 years of age spend just under 4 and 3/4 hours a day in front of various media screens heavily subjected to blatant advertisement, subliminal product placements and subtle lifestyle instruction designed to steer children and young adults towards lifetime use of specific products and styles of life that will maintain high usage of those products. Twenty-four hours a day, we are inundated with captivating advertisements wooing us towards high calorie and high-fat foods, and we’re watching so many hours that we can recite the ads verbatim. In Morgan Spurlock’s 2003 documentary, Super-Size Me, several people were interviewed on camera, none of whom could correctly recite the Pledge of Allegiance, but accurately reeled off the McDonalds Big Mac slogan from the 1970s without hesitation. There is now in America almost a cult of inactivity. The National Center for Health Statistics shows that “Less than one-third (31.8%) of U.S. adults get regular leisure-time physical activity.” Approximately 25% report no vigorous physical activity, and 14% report no recent vigorous or light to moderate physical activity; Physical Activity and Health: A Report of the Surgeon General 1999.

In 2020 the problem is even worse as we carry screens with us everywhere in the form of smartphones and tablets. I am no exception. I keep two cell phones very near me at all times for creating a mobile hotspot in case internet landlines go down or become slow, and if you see me walking the halls of SCMH near patient rooms, I will have a tablet strapped to my wrist.

In the spirit of looking at the big picture, not the details, it is easy to see that our original context as human beings was the earth. Our sustenance came from the earth; we had to gather food from trees, bushes and grass, killing the odd animal when the occasion arose. Life was a struggle to find food, shelter and security. We now live a life detached from our original earth context. We are living a life out of context; that is the issue.

Living in large urban environments, our connection with the earth has been rendered almost obsolete. We live in temperature-controlled dwellings well insulated from any inclement or even just uncomfortable weather; these dwellings are lifted up off the earth where freshwater is brought to us, and wastewater is taken away in real-time. And even before we build these dwellings, we manipulate the ground and pour a layer of cement down to insulate us from our earth context. We wash the smell of the earth off of us with daily showers, and life-aiding microorganisms that have assisted us for millions of years are exterminated in a frenzied antibacterial crusade. We pave roads to our dwellings so we can get our energy saving devices easily to and from, and don’t go anywhere that isn’t secured with a smooth, clean, insulating layer between us and the earth. Our food isn’t grown in soil; it’s purchased from a warehouse. It isn’t cooked or prepared by loving human hands; it’s processed in mega-batches by impersonal machines. There’s an entire generation now that won’t eat food unless it has been properly processed. We work with no regard for sunlight, feed off of all types of energy, and have created entire electronic environments up off and away from the earth that many of us consider more real than the ground we stand on. We consume natural resources at an alarming rate, none of which we view as imbued with intrinsic value until we find for it a useful function within our detached society.

If all of this is too much of a macro perspective for you and you think it is not applicable to you in North Central Kansas, consider this. A survey study published in the December 2019 issue of The New England Journal of Medicine using data compiled by the well-known and reliable National Health and Nutrition Examination Survey (NHANES) shows that the State of Kansas may join the 7th heaviest states in the union by the year 2030. This 2019 study extends accurate projections of body mass index (BMI) that were reported in 2012 in the American Journal of Preventive Medicine. “The National Health and Nutrition Examination Survey is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. The NHANES program began in the early 1960s and has been conducted as a series of surveys focusing on different population groups or health topics.”

The latest 2019 article identifies the following eight states as having a population over 50% with a body mass index greater than 30: Oklahoma 58.4%, Mississippi 58.2%, Alabama 58.2%, Arkansas 58.2%, West Virginia 57.5%, Louisiana 57.2%, Tennessee 55.8%, and Kansas with 55.6% of the population projected to have a BMI over 30 in 2030. BMI categories are normal weight (18.5 to 25), overweight (25 to 30), and obese (over 30).

We are not only close to the center of the United States, but we are also now the epicenter of the epidemic of lifestyle-related diseases that comprise the most significant health challenge we have ever faced.

As of July 9, 2020, people that have died in the US due to COVID-19 number 135,874. The CDC says that in 2019, 647,000 Americans died of heart disease. It is the largest single cause of death in the United States and has been for 80 years. If you include diabetes, hypertension and all other lifestyle diseases related to being severely overweight, that number dwarfs the deaths from COVID-19.

In 1983, William Castelli, the legendary director of the Framingham Heart Study, published a paper in Circulation (A Journal of the American Heart Association) naming excessive weight as an independent risk factor for cardiovascular disease. In 2006, another well done large prospective study of 17,643 men and women with a 32-year follow-up funded by the National Heart, Lung and Blood Institute and published in the British Medical Journal showed that “the risk of death among people with low cardiovascular risk but with diabetes and who were obese was 11 times that of the risk among people of normal weight.”

America is in a great dietetic experiment. No population on the planet has ever eaten the diet that we do and exercised so little. No population has ever been as overweight as we are in America right now. The agricultural, industrial, electronic, and digital revolutions changed our lifestyle by drastically reducing activity and increasing the availability of calorically dense and nutritionally deficient food. The scientific revolution changed the way we think about nature so much that we are not even sure what our environmental context is anymore. One thing is very certain. We are living a life out of context!

Living a life out of context has some serious health implications, and there are some physiological reasons why trying to change your lifestyle in a new 2020 context is difficult. We will discuss that next week.

Here are the references for today’s Healthy Eating Tip:

Sun Tzu. “The Art of War.” Translated by Lionel Giles. Bridgewater, MA : World Publications, 2007

Hubert, HB, Feinleib, M, McNamara, PM, Castelli, WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation (A Journal of the American Heart Association). 1983. 67:968-977.

McCrory, Megan A., Paul J Fuss, Joy E McCallum, Manjiang Yao, Angela G Vinken, Nicholas P Hays, Susan B Roberts. Dietary Variety Within Food Groups: association with energy intake and body fatness in men and women. American Journal of Clinical Nutrition. 69 (March 1999): 440 – 447.

Division of Adult and Community Health. National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Online Prevalence Data. 1984-2003.

Brown, Kelly D., Katherine Battle Horgen. “Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, and What We Can Do About it.” Chicago, New York: McGraw-Hill, 2004.

Critser, Greg. “Fat Land: How Americans Became the Fattest People in the World.” Boston, New York: Houghton Mifflin, 2003.

Nestle, Marion. “Food Politics: How the Food Industry Influences Nutrition and Health.” Berkeley: University of California Press, 2003.

Rappoport, Leon. “How We Eat: Appetite, Culture, and the Psychology of Food.” Toronto: ECW Press, 2003.

Schlosser, Eric. “Fast Food Nation.” Boston, New York: Houghton Mifflin, 2001.

Barnes, MA, CA. Schoenborn. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Health Statistics. “Physical Activity Among Adults: United States, 2000”. Advance Data. No. 333 (May 14 2003) DHHS Publication No. (PHS) 2003-125003-0234.

Woodard, Emory H. IV, Natalia Gridina. Media in the Home 2000; The Fifth Annual Survey of Parents and Children, The Annenberg Public Policy Center of the University of Pennsylvania, Survey Series No 7 (2000): 19-27.

U. S. Department of Health and Humans Services. Centers for Disease Control and Prevention. “Physical Activity and Health: A Report of the Surgeon General” 1996.

Finkelstein EA, et al. Obesity and Severe Obesity Forecasts Through 2030. American Journal of Preventive Medicine. 2012;42(6):563–570.

Ward ZJ, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. The New England Journal of Medicine. 2019;381;(25):2440-2450.

About the National Health and Nutrition Examination Survey. National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC).  (Accessed 1/29/2020).

Center for Disease Control and Prevention (CDC). Heart Disease Home. Heart Disease Statistics and Maps.  (Accessed 7/3/2020).

Greenlund KJ, Giles WH, Keenan NL, et al. Heart disease and stroke mortality in the 20th century. In: Ward J, Warren C, eds. Silent victories: the history and practice of public health in twentieth century America. Oxford, England: Oxford University Press; 2006. Center for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report (MMWR). February 16, 2007 / 56(06);113-118.  (Accessed 7/3/2020).

HB Hubert, M Feinleib, PM McNamara, and WP Castelli. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation (A Journal of the American Heart Association). 1983;67:968–977.

Mayor S. Obesity in middle age is an independent risk factor for cardiovascular disease. British Medical Journal (BMJ). 2006;332(7533):71.