THE BLOG
06/18/2014 06:30 pm ET Updated Aug 18, 2014

We Have the 'Cure' for Obesity, But Is the Pill Too Difficult to Swallow?

Many years ago, I mentioned to a doctor friend that a woman I knew -- a Seventh Day Adventist who never drinks alcohol -- had been told she was at risk for cirrhosis of the liver due to her poor diet and excess weight.  My doctor friend looked at me skeptically and said I must have misunderstood the diagnosis -- one could not develop cirrhosis that way, she said -- and since I'm no medical expert, I assumed I'd been misinformed.

But while "nonalcoholic fatty liver" was so rare 30 years ago there was no medical name for it, the New York Times reports it now affects one in 10 American children, with the rate among children and teens more than doubling in the last two decades.  Of those afflicted, 10 to 20 percent will eventually develop the liver scarring that can lead to cirrhosis, liver cancer and liver failure, requiring a transplant for survival.  The condition is also a risk factor for developing heart disease and Type 2 diabetes.

The cure for nonalcoholic fatty liver is quite straightforward: improving one's diet by cutting out fast and processed foods and sugary beverages.  But despite incredibly powerful motivators  --  "crippling" abdominal pain (one patient referred to it as "being stabbed in your stomach with a knife") and the possibility of needing a liver transplant (or, far worse, needing a transplant and and being unable obtain one, as demand outstrips the number of organs available) -- many patients still find this "treatment" just too difficult:

Yubelkis Matias, 19 ... was told she has NASH several years ago. She is reminded of the trouble brewing in her liver by the sharp abdominal pains that come and go ... [S]he has been told by her doctors that diet and exercise may be her only shot at reversing the disease. But at 5-foot-5 and 200 pounds, she finds every day a struggle

"I'm on a roller coaster," she said. "I eat healthy, then not healthy -- pizza, McDonalds, the usual. My doctor told me I have to quit all of that. But it's cheap, and it's always there."

[...] "A lot of times when I see a patient with fatty liver," [Dr. Shahid M. Malik of the Center for Liver Diseases at the University of Pittsburgh Medical Center] said, "the first thing out of their mouth is, 'Well, is there a pill for this?' And there's not. There just isn't. You have to make lifestyle changes, and that's a much more difficult pill for people to swallow."

One could attribute these patients' inability to improve their diets to a lack of individual willpower, but this conclusion ignores a whole host of societal factors that make eating healthfully on a regular basis extremely difficult for many people.  As Dr. Thomas Friedan, director of the Centers for Disease Control and Prevention, once memorably said:

... if you go with the flow in America today, you will end up overweight or obese.  That is not a reflection of individual personal failing.  It's a reflection of the structure of our society ... [T]he popularity of weight loss programs is a reflection of both the intense desire of many people to lose weight as well as the great difficulty of doing so.  [Emphasis mine]

Meanwhile, when you have a condition like fatty liver disease that's growing ever more prevalent, and patients clamoring for "a pill" instead of weaning themselves off their unhealthful diets, it's predictable that drug companies would see the potential for huge profits.  The Times reports that at least two companies are now scrambling to develop drugs which will help treat the disease, and one of those companies saw its stock price "soar" when its first clinical trial showed promise.

Too bitter a pill for our elected leaders to swallow?

There's nothing new about any of this, of course.  Food companies profit from our dependence on their products while drug companies reap the profits on the other side of the equation.  But somehow the prospect of kids doubled over with liver pain and facing potential liver failure, entirely due to Big Food's grip on our palates and our lifestyles, got to me on a visceral level.

I'm reminded of this quote in the film Fed Up from Dr. David Ludwig, a professor at the Harvard Medical school and a pediatric obesity expert:

What does it say about our society if we would rather send children to such mutilating procedures but yet lack the political will to properly fund school nutrition and ban junk food advertising to children? It reflects a systematic political failure. We're the richest society in the world. We've failed because we've placed private profit and special interests ahead of public health.

Dr. Ludwig was referring to a morbidly-obese teen undergoing gastric bypass surgery, but he could just as well have been referring to an overweight child needing a liver transplant.  And, indeed, we are clearly in the midst of a "systematic political failure," because just as we already know the "cure" for fatty liver disease, we also already know the the "societal cures" for all obesity-related illnesses:

  • Restructuring the agricultural subsidies that make fast food and processed food unnaturally cheap, while inadequately supporting farmers growing fruits and vegetables;
  • Banning the advertising of junk food to children;
  • Taxing and/or placing health warning labels on non-nutritive, sugar-sweetened beverages;
  • Investing more money in federal school meal reimbursement, so schools can afford to buy healthier food and pay for the increased labor needed to prepare it;
  • Investing in school infrastructure, both to build school kitchens in which scratch-cooked meals can be prepared, as well as home economics classrooms where children can acquire basic cooking literacy and skills; and
  • Requiring and funding meaningful nutrition education curricula, including home economics, throughout the K-12 school years.

And yet, like a fatty liver patient addicted to fast food, our elected leaders are currently too addicted to Big Food's and Big Soda's lobbying dollars, and/or too afraid of "nanny state" rhetoric from the right, to muster the political courage to fulfill that Rx.

For four years now, I've been saying on my blog that some day the costs of obesity, both financial and personal, will be just too high for our legislators to continue to ignore.  But when you read about one in 10 kids facing the possibility of a liver transplant due solely to the unhealthful American diet, you really do have to wonder: Where on earth is the tipping point?