Obesity – Is it a Choice or a Matter of Access?
We have an epidemic in this country. According to the CDC, obesity rates have almost tripled in the last 50 years. This puts a strain on our healthcare system because people who are obese are also at risk for other diseases like type 2 diabetes, heart disease, cancer, thyroid disorders, etc. The $147 billion price tag for the treatment of obesity and related diseases on Medicare and Medicaid should be a wakeup call. Despite the call to arms to reverse this trend, it just keeps getting worse.
There is also a glaring disparity in the trend for obesity rates. Low-income Americans, especially racial minorities, are more likely to be obese compared to middle-class white Americans. We have also seen a rise in childhood obesity rates from ~5% in the early 1970s to almost 20% in 2020.
Why are we seeing these trends?
I went to the CDC website to learn more about what the “experts” are saying. They list certain “causes of obesity” like eating and physical activity patterns, insufficient sleep, genetic factors, social determinants of health, illnesses, and medications. These things are true, but putting on my Functional Medicine lens, these do not get to the root cause of the issues. Why do our poor, minorities, and children have higher rates of obesity?
I have already discussed the school lunch program, which I find abysmal at best and is most likely contributing to the childhood obesity rates. So, I'll save any additional rants on that topic for another day.
I am reminded of a conversation I recently had with one of my patients. She is on Medicaid and her plan signed her up for some additional support from a pharmacist to help her manage her Type 2 Diabetes. In December, we had a lengthy conversation about food choices…eating more whole foods, fruits, and vegetables, getting good protein, and good fats. My conversation with her in January was quite different. She had just been released from the hospital after a diagnosis of pancreatitis brought on by her dietary choices.
I was a little frustrated but tried not to show it. We had just had a whole conversation about her diet. What happened? How could she turn around and (in her words) eat all that fried, greasy foods?
Access. That’s what happened. She does not have easy, affordable access to fruits and vegetables, good protein, and good fats. She has easy affordable access to processed and ultra-processed foods, fast foods, and lots of carbohydrates. She is poor. She lives in a food desert.
There is no easy access to the foods she knows she should be eating. She can’t afford regular vegetables, let alone organic. She can’t afford to buy meat, let alone grass-fed. She can't afford olive, coconut, or avocado oil. Access.
We have set our poor and minorities up for failure. We have not provided access to the right kinds of foods. We have not provided access to time. Time for exercise. Time for “selfcare”. Time for sleep.
Inadequate sleep was another “cause of obesity” according to the CDC. It is hard to get adequate sleep working 3 jobs to make ends meet. It is hard to get sleep as a single mother or father just trying to make it through the day. It’s hard to get enough sleep when you are worried if you will make rent this month, have enough food, or put gas in your car. “Get sleep” they say, like it’s that easy.
I have also seen a rise in prescriptions for injectable medications used for obesity. Wegovy, Ozempic, Mounjaro…running all these coupons, back-ordered due to increased demand, celebrity endorsements. Quick fix...if you can afford it. These medications slow the emptying of the stomach making you feel full longer, stop the liver from releasing glucagon (which is stored sugar) and increase insulin secretion which decreases blood sugar levels. People are using these injections as a quick fix to a poor diet. But, from my limited observations, the people buying this drug are middle- to upper-class, Caucasian women, like me. Soccer moms (not like me).
These are the people who have access and can afford organic produce, grass-fed meats, and quality fats, but they are choosing to inject themselves with a quick-fix medication. These are the people who have time. Time to exercise. Time to plan meals. Time to sleep.
We have an epidemic in this country. It’s an epidemic of apathy. We have an issue of access to care, food, time.
Matthew 25:35-40 (NIV)
For I was hungry, and you gave me something to eat, I was thirsty, and you gave me something to drink, I was a stranger and you invited me in, I needed clothes, and you clothed me, I was sick, and you looked after me, I was in prison, and you came to visit me.
Then the righteous will answer him, “Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?”
The King will reply, “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.”
Whatever you did for the least of these…
What are we doing to help provide access to care? What are we doing to provide access to food? Time? Sleep? Help?
I have a vision of a future that I would like to see. I would like to see insurance companies paying for food boxes of fresh, local produce from regenerative farms. I would like to see school lunch programs feeding our kids the same kind of foods to feed their brains. I would like to see fast-food places closing due to a lack of customers. I would like to see more farmer’s markets opening to provide local produce and reducing the carbon footprint of transporting produce from other countries. Eating seasonally. I would like to see access to free healthcare for all people. I would like to see access for all people. Enough of the apathy. Enough of the privileged few.
We have an epidemic in this country.
Are you ready to PIVOT to functional health and wellness (for everyone)?