Obesity: Prevention is the cure

The Emperor of All Maladies by oncologist Siddhartha Mukherjee is a biography of cancer, told as the story of the patients battling the dreaded disease, the doctors who care for them and the researchers laboring in search of a cure. It's also the fascinating story of cancer itself - a mysterious, ancient, devious, tentacled villain, whose nature we've been trying to unravel for centuries. The chronicles of this effort are a window into the thrill and tediousness of medical and scientific research. It is the best book I've read in a while and I'd like to share just one thought I had while reading it.

The "war on cancer" was declared 40 years ago. Twenty something years into this war, the incredible effort and funds invested in finding new drug therapies and new treatments yielded a few significant "wins" - childhood leukemia, Hodgkin's lymphoma and testicular cancer became, quite often, curable diseases. But despite some progress, a snapshot of cancer in the 1980's showed that more Americans were dying of cancer than ever before.

An 1985 article in Scientific American by Harvard biologist John Cairns quantified the lives saved by cancer treatment at the time and found the number to be quite modest. Cairns wasn't at all surprised by the humble gains, and suggested no one who knows anything about the history of medicine should be. Treatment alone had never eradicated any disease. Tuberculosis, which was one of the leading causes of death in 19th century America, declined well before the arrival of effective antibiotics against its causative bacteria thanks to better nutrition, sanitation and living conditions. Polio was eradicated in the US through vaccination, which prevented disease. Mukherjee quotes Cairns:"The death rates from malaria, cholera, typhus, tuberculosis, scurvy, pellagra and other scourges of the past have dwindled in the US because humankind has learned how to prevent these diseases…To put most of the effort into treatment is to deny all precedent."

Obesity treatment doesn't work

Which brings me to our fight with obesity. The weight-loss industry is a multi-billion business. Books, meal plans, support groups, supplements, specialty foods, drugs to suppress appetite, exercise plans and weight loss surgery are just a partial list of possible treatments. They all have their place, and testimonials of success stories can easily be attached to each treatment modality.

But while treating people for obesity is possible, we are facing an epidemic -- two thirds of our population are overweight or obese -- can we delude ourselves into thinking we can treat the majority of our population?

No human ailment has been defeated by treatment, and obesity is no exception. Thousands of weight loss products and plans, and the numbers won't budge: We're getting no thinner.

Prevention is the cure, and most of our effort should be focused on prevention. The problem is that prevention isn't heroic, sexy or profitable. Saving someone from the abyss garners attention, while avoiding a problem goes unnoticed - there is no story to tell.

But prevention is what we have to do, and in order to do that we need toeducate our kids on what, how and how much to eat, improve our food landscape, create living conditions that promote physical activity, and remove the oh-so-many messages and cues that make overeating of all the wrong things the default.

Obesity and cancer

Obesity prevention brings us right back to the war on cancer.
Tobacco is a very potent and widespread carcinogen, responsible for an impressive one-third of cancers. Cancer prevention efforts have to start with fighting tobacco use, yet despite major efforts one in five Americans still smokes.

Obesity is a known risk factor for many major chronic diseases, including heart disease, diabetes and stroke. Obesity is also the most prevalent risk factor for many cancers -- breast, endometrial (the lining of the womb), colon, kidney, and esophageal cancer are all associated with excess weight.

Prevention is the only way to cure an entire society. It's the economical way to do it, too. Obesity treatment has proven to be one of the toughest problems to solve, even at the individual level (so very few dieters manage to maintain their new thinner weight). In the case of obesity, the diet wars have been a distraction from the fact that most diets fail. Prevention, starting at a very young age, is our only chance to reduce our levels of obesity and disease as a society.

Dr. Ayala

"If people are constantly falling off a cliff, you could place ambulances under the cliff or build a fence on the top of the cliff. We are placing all too many ambulances under the cliff." - Denis Burkitt

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