The Obesity Fix

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By David Katz, M.D.

McKinsey & Company recently issued a report on effective means of fighting hyper-endemic obesity in the modern world. Among other things, they concluded that “implementing an obesity-abatement program on the required scale will not be easy.” I presume that is intended to be somber, but the magnitude of understatement makes it almost funny. And sad.

No, it will not be easy — not in the world as it is. In the world as it is, forget about fixing obesity, because the fix is in.

We live in a world where adults look on and shrug as multicolored marshmallows are marketed to children as part of a complete breakfast. (“What part?” one might constructively wonder.) We live in a world where knowledge that food companies literally engineer food to be as nearly addictive as possible produces no outrage. Perhaps we are all too busy eating to protest.

In the world as it is, fixing obesity will not be easy.

But the world could change. As daunting as that may sound, all that is really required is to see things differently.

The power of that — seeing things differently — was famously eulogized by Aristotle in his Poetics. In his philosophizing about literature in general, and poetry in particular, Aristotle characterized the writer’s “eye for resemblances,” by which he meant the use of simile and metaphor, and the underlying capacity to see similarity in dissimilars — as genius. At the pinnacle of expression, it is surely that — and beautiful genius into the bargain.

But back to obesity. We could, potentially, fix it — and perhaps even rather easily — if we simply saw things a bit differently. I am staking no claim to genius in these suggestions; just pragmatism.

1) See health like wealth.

We respect wealth. We aspire to it. We hope to bequeath it to our children. We invest in it, and work for it. We care about it both for our own sake, and the sake of those we love. We recognize most get-rich-quick proposals as scams; we are sensible about money. We don’t spend everything we have today; we think about the future, and save for it. We get financial guidance from genuine experts, not just anybody who had a piggy bank once.

If we simply committed to seeing, and treating, health more like wealth — it would go a long way toward fixing obesity, and the metabolic mayhem that follows in its wake.

2) See obesity like drowning.

Obesity need not be a disease to be medically legitimate. Drowning is not a disease, and it suffers not at all for want of legitimacy. Drowning victims are reliably treated as the state-of-the-art allows when they show up in our emergency departments.

Nor does drowning invite fractious debate about personal responsibility. Rather, we tacitly acknowledge — by our actions — that personal and public responsibility are complementary, and both required. Parents need to watch their children at the pool’s edge or beach, and are well advised to teach them to swim. But there are lifeguards just the same. There are fences around pools.

And, of course, we don’t focus on the ex-post-facto treatment of drowning. We focus on prevention. Drowning is too common if it happens at all; but it is very much the exception. The rule is prevention, by application of the combined defenses born of personally and publicly responsible action.

We are drowning in calories engineered to be irresistible. We are drowning in labor-saving technologies that may be saving labor, but costing us years from life, and life from years. As with drowning of the more literal variety, the fix is a combination of personal empowerment — the anti-obesity skill set analogous to swimming — and public accountability at the water’s edge.

If we treated drowning like obesity, we would have no lifeguards at the beach. We would not teach our children to swim. We would allow signage at a shore with notorious rip tides to read: “Come on in, the water’s fine!”

If instead, we treated obesity more like drowning, we would tell the truth about food. We would not market multicolored marshmallows to children as part of a complete breakfast. We would not willfully mislead about the perilous currents in the modern food supply. We would not look on passively as an entire population of non-swimmers started wading in over their heads.

Until or unless we choose to see things differently, McKinsey & Company is quite right: fixing obesity won’t be easy. That’s because the fix is in, and we are all OK with it. We apply the terms “junk” and “food” to the very same ingestibles, adopting a “nudge, nudge, wink, wink” coyness — even as formerly adult-onset diabetes engulfs our children. We line up for an endless succession of fad diets, while glibly asserting that our entire country runs, essentially, on donuts.

If we treated wealth like health, we would all be gullible, indigent, and likely homeless. If we treated drowning like obesity, our ERs couldn’t keep up with the demand for resuscitations.

But if, instead, we treated health like wealth, and obesity like drowning — we could fix what ails us. It might even be easy. For in our collective and righteous might, no force could oppose us. Collectively, we are culture.

Such is the genius, or at least pragmatic potential, of seeing things differently — and acting accordingly.


David L. Katz, MD, MPH, FACPM, FACP tends to see things differently. And write poetry, for whatever it’s worth.

Director, Yale University Prevention Research Center; Griffin Hospital

President, American College of Lifestyle Medicine

Editor-in-Chief, Childhood Obesity

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