OBESITY AND DIABETES AS SOCIAL ILLNESSES
In 2004, at a conference, I chose to call
my presentation: Obesity as a Social Illness. It was not well received, since
the oft repeated mantra of that time, and even now, is that Exercise More and
Eat Better!
When a disease is so physiological, asked a
participant, and we have scientists explaining the biomedical basis of both
obesity and diabetes, how can you say it is caused by Society?
Soon after finishing my specialty training
in Endocrinology, I became aware of the fact that Health Care cannot be
improved ONLY by the participation of Disease Care Providers: Doctors, Nurses
and other “providers” all of whom cater for Diseases. A strong social science
input is necessary, I thought, and having had no exposure to it in the Medical
Schools I had trained, I decided to study Medical Anthropology at the Brunel
University of London programme, which to me has been the most useful part of my
medical education. It made me analyse what we see not in terms of just the
individual but also the culture and society that individual belongs to. I was
also lucky to have been working continuously with American Indians and their
input into my work has been great.
There were no shortages of people saying
that it is a national problem and
predicting more and more obesity in the future. (Why not do something about
it to stop or admit failure of their efforts to stop?). Just two days ago, they
published data to say 42 % of Americans would be obese by 2030, which is not
really news but a reiteration of the failure that the Disease Care providers
and the society have been barking up the wrong path.
"If you believe
this is a massive national problem, you have to deal with it in a systems
way," said Dan
Glickman, chairman of the panel that wrote the report and a former secretary of
the Department of Agriculture under President Bill Clinton. "This problem
is incapable of being solved with a magic bullet."
(Part of the Institute of Medicine’s
statement, quoted in Wall Street Journal 9th May 2012). Many would say society must change and the disease providers would then go on to blame the individual as if that alone would bring on last lasting benefit.
I have just spent one delightful week with
the Lakota of Cheyenne River in South Dakota. And if you look at the
recommendations by the Institute of Medicine, my Lakota friends are already well
on their way to implement most of the recommendations, in fact they had begun
it before all these came out.
Photo: Eating well in Eagle Butte, South Dakota in May 2012
"The
country has begun to address obesity, but we are still doing far too little,
given the tremendous burden it places on our health and health care
costs," said Margo Wootan of the Center for Science in the Public
Interest.
Two-thirds
of U.S. adults and almost a third of children are either overweight or obese,
and progress to stop this epidemic has been too slow, the Institute of Medicine
concluded.
For
schools, it recommended that students get at least 60 minutes of physical
activity every day -- a combination of physical education, recess and other
activities. Many schools have slashed P.E. and cut into recess in recent years
in an effort to increase learning time amid tighter budgets. The report also
says schools should serve healthier foods, backing national school nutrition
standards, and teach nutrition.
Other
recommendations include:
*
Restaurants should ensure that at least half of children's meals comply with
federal dietary guidelines, without charging more for the healthier options.
* Healthier
foods should be routinely available everywhere, from shopping malls to sports
arenas.
* More food
companies should improve how they market to children -- and if they don't, the
government should step in and mandate changes.
* To make
physical activity routine, communities should be designed with safe places to
walk and exercise.
* Public
and private insurers should ensure better access to obesity screening,
preventive services and treatments.
* Employers
should expand workplace wellness programs.
* The president should appoint a task force to evaluate the
effect of U.S. agriculture policies on obesity.
My own
feelings are thus:
The US government should look into the
subsidies they give to farmers to produce Corn and Soybean both of which
eventually in their compounded chemical form end up in the American diet and is
partially responsible for the obesity and diabetes in America.
Adopt programmes, which have been
successful in poor countries with limited resources, such as MoPoTsyo in
Cambodia, where educating Peers from the Community has had tremendous impact on
the health. Those Peers are truly Health Care Providers since they don't just
concentrate on Blood Sugar, Cholesterol, High Blood Pressure but have in their
education and action, how to use the local lifestyle changes to impact on those
measurements. It is one of the more successful programmes of Diabetes Treatment
I have seen.
The American approach to Diabetes and
Obesity has failed, so don't export it to the other countries but try to learn
from others. America may lead the world in technological innovations but they
have never been in the forefront of social innovations.
Social Innovation is what we need now…not more medications..
I am thinking of my friends at the Lakota
Cheyenne River in South Dakota and the staff of Asia Protein in Bogor Indonesia
and with gratitude to my friends at Mo Po Tsyo Education Centre in Phnom Penh,
Cambodia.
Peer Educators and the staff of Mo Po Tsyo in Phnom Penh, Cambodia.
Healthy Habits of the Staff of Asia Protein in Bogor, Indonesia
