you are what you eat/you eat where you are

A couple days ago, CNN posted a link to an unusual weight loss story. Five months ago three morbidly obese Americans embarked on a trip to Tianjin, the third largest city in China, to get away from their unhealthy habits back home. They had won a contest by a Chinese medicine firm, and their entire stay at an in-patient weight loss facility was free until they reached their target weights. All three men are succeeding admirably, having collectively lost over 400 lbs.

This reminds me of a treatment facility here in Durham, at Duke no less. The Duke Rice Diet Clinic is located about three blocks from where I work. People come from near and far to pay as much as $2,300 per week (PLUS off-site lodging) to lose weight. Treatment takes up to 12 hours a day, and all meals are eaten on-site. For those who are trying to lose very large amounts of weight, or who can't resist the temptation to eat bad food without imprisonment, there are inpatient clinics. If you want an allergist at the Duke medical clinics you'll have to get on the waiting list for one of the handful they have, but if even your heart is fat there are seventy-one cardiologists to choose from, all apparently accepting new patients.

It's amazing that people literally need to leave their hometowns and lifestyles in order to lose weight. It is equally shocking to realize that we need stories like these in order to really understand the obesity epidemic, but it makes sense. Our society isn't geared toward goals like good health, happiness, or cooperation--it's structured instead around production and competition at every turn. For most Americans and domestic food companies, food is no longer about nutrition. Food has become little more than a commodity, an opportunity for profit, and a lifestyle "experience." In less grand terms, we've sold our food supply off to companies that don't have our interests at stake at all. If injecting needless fat, salt, sugar, and additives into food sells it, then the companies will never stop doing it so long as we live in a country where genuine business ethics verge on nonexistence. And through their partnerships with chain restaurants, gas stations, and grocery stores, these companies have managed to place themselves everywhere in your life. It's no wonder that we have trouble losing weight and keeping it off when Frito-Lay lives in your neighborhood. And is at the corner store. And at the restaurant near your work. And is all over the grocery store.

So what would it take to change the country, rather than a few individuals? Not every overweight person can ship themselves to Tianjin or scenic Durham, after all. What would have to happen would be that we'd have to change the whole culture, and we'd have to create incentives for companies to make healthier products. Or disincentives for creating bad products. New York is considering one such measure right now, a controversial one that I've only privately fantasized about until now. They're thinking about slapping an 18% tax on sugary soda, arguing that the 35 gallons of it we each drink a year might have some connection to our burgeoning waistlines.

Such measures are destined to meet strong resistance, but it's one of the only things we can do. It's not like public service announcements or advertising, which give people more "choice," are much better. The one or two government adverts people see a year related to health are invariably lost in the sea of advertisements telling us to eat, drink, be merry, be sexy, go shopping while you're at it, have you seen this new movie yet?, is that an iPod? yeah, you get the point. Fox was quick to brand the tax as an outright scam, linking it to the greedy government and PUBLIC HEALTH INDUSTRY. Wow, if ever I could think of a profit-driven, evil industry, it would surely be the public health industry. All of those graduate-educated people working for the public good, earning $35,000 a year, yeah, they are assholes out to get you. Fox would prefer to leave decisions about what drinks to make and consume in the hands of companies and consumers... because we're obviously doing such a great job regulating ourselves.

In China, on the other hand, being obese is shocking. All three men were in desperate physical condition in the United States, and one even had to have a tracheotomy since the fat on his body collapsed his windpipe, but we live in a culture where it has to go to that extreme before we care about physical health or will imply that people should change their behavior. China is often critiqued for public health decisions it has made, such as choosing to vaccinate tens of thousands rather than doing a single heart bypass surgery, but perhaps we have something to learn from them.

I've noticed similar things in my travels, as of late. In the last year I've been lucky enough to go to Montreal, Madison, Chicago, and San Francisco. With the exception of Chicago, all of these were places had significantly better food than an average American city, and the difference showed. San Francisco and Montreal are of course two of the best places in North America for food that is closer to the farm, and consequently healthier. Obesity seemed to be less of an issue, and from a personal perspective I have to say I felt fabulous eating the food in these places. Despite the fact that I eat what is a pretty "extreme" diet for where I live in the US (no dairy, no soy, due to food allergies; cut out most wheat, sugar, and additives to try to get over my allergies, asthma, and other problems), I still don't feel as healthy as when I go to California, where the food is much higher quality and more often locally grown.

So what do we do? If it takes traveling to or imprisoning oneself in a place that values natural food and health to feel better, it seems that incorporating those values into our own, somehow, would be the best bet. Now all we have to do is convince everyone else.

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