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Body Parts and Skin in the Game

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FAMILY DINNER
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Family is the basic functional unit of our society. Family is where values are shared and culture begins.

Along with my customary harangue about the phenomenal and largely neglected power of lifestyle as medicine, that was my main message yesterday morning in Newport, Rhode Island, to a group of executives responsible for wellness programming for some of the world's largest and most powerful companies. We were convened, very aptly in terms of my message and mission, by ShapeUP, an organization facilitating health promotion by fortifying social connections.

Many barriers, most of our own devising and all surmountable, stand between most of us and the stunning potential benefits of living well, embracing the short list of lifestyle factors with the greatest potential to add years to life and life to years. Salient among them is the propensity to see parts but not the whole. We in modern culture are by no means unique in this vulnerability; its historical influence has established it in legend and in lore.

But it does us no favors. A fixation on parts of a healthy diet has us forever missing the forest for the trees. There are innumerable ways to revere or renounce some particular food and eat badly. There is, in decisive contrast, no way to adopt a healthful diet -- wholesome foods in sensible combinations -- and do so.

One of the liabilities of hyper-specialized medicine is that same tendency to overlook the proverbial elephant in the room. A highly visible consequence is the over-medicalization of our children for such conditions as rambunctiousness. Rambunctiousness is a normal attribute of childhood and should be addressed with something resembling recess and nothing resembling Ritalin. But that requires looking past the symptoms to the underlying causes in a society that has largely jettisoned active play and physical education from its children's typical day. Our eyes too often only skim the surface of such stories.

I routinely field interview requests from all the usual suspects for insights about silver bullets and body parts. What food is best for glowing skin? What nutrient is best for our brains? What supplements are most important for our bones?

The answer, of course, is that glowing skin, high-functioning brains, and a strong, resilient skeleton are in turn dependent on the effective toxin removal of the kidneys and liver; the efficient delivery of nutrient and oxygen rich blood by a strong heart through a clean vasculature; a salutary balance of hormones and inflammatory responses; and so on. The only way to take good care of our body parts is to take good care of our bodies, a whole far greater than the mere sum of parts.

A recent study shows that reasoning extends to our minds as well. Older adults with early cognitive impairment were randomized to purely mental exercises or actual exercises -- involving the body and requiring some focused concentration as well. The latter group had distinctly better results. The basic message here was that moving the body helps in preserving the mind.

Critically, though, this concept is not bounded by our skin. As John Donne famously told us, no man (or woman) is an island; we are, each, a part of the main. And that brings us back to family.

However good and effective some worksite wellness programs may be, most share a blind spot. They tend to overlook the critical role of family and the need to involve children. Children won over to the cause of health are powerful agents of change, and can as often lead as follow their parents; we have seen this innumerable times with our own programming (and I have see it in my own kids), Nutrition Detectives in particular. Children not involved in the cause of health can, as every parent knows, quite effectively sabotage any such effort. Junk food on hand ostensibly to satisfy your child will, at some point, inevitably, call your name.

On the one hand, we all -- parents, grandparents, aunts and uncles -- have a profound responsibility to our children. We are at a fork in the road, and they have been brought along. Along one tine is the bleak future in which one in three of them grows up to be diabetic. Along the other is a future in which we turn what we have long known about the big picture into what we routinely do, and fully 90 percent of the already extant diabetes prevalence is eliminated. It is an abdication of just such responsibility, an inattention to just such stark and portentous choices, to carry on with business as usual: to go on diets and leave our families behind (there are better options!); to hope for health but market the catalysts of disease; to propagate restlessness and suppress it with medication.

On the other hand, those of us hoping for health need our kids as much as they need us. In unity there is strength, after all. A family that eats well together has no junk food in the house in the first place. The easiest way to avoid falling off the wagon is to have a bigger wagon with higher rails. The family-sized wagon offers just such accommodations. A family that exercises together has another word for exercise: fun. Fun is not hard to sustain.

My message to the corporate titans in Newport yesterday extended to specific programming that can help advance this cause. In my lab, a program called BAWSS (Businesses Applying Wellness Strategies in Schools) is among our current priorities. We are working to show that by "adopting" schools as they currently adopt highways, and sponsoring state-of-the-art wellness programming there, businesses can do both well and good, fortifying the benefits of worksite wellness with the powerful effects of shifting families to a shared culture of wellness. Otherwise, what good happens at the worksite, may stay at the worksite when the kids at home say "no, thanks."

There is an important potential financial return on investment attached to BAWSS. But as I pointed out to the executives yesterday, the human return is apt to be more vivid still. I asked the audience members to raise their hand if a loved one -- only a loved one -- had been affected by heart disease, cancer, stroke or diabetes. Every hand in the room was up before I finished my list. Here's the thing: We know how to eliminate 80 percent of that collective burden. We can have a future, and bequeath the same to our children, in which fully eight times in 10, those conditions just don't happen.

To get there requires us to recognize that we all have skin in this game -- and not just our own. The skin of those we love is in the mix as well.

The best way to care for any parts of our body is to care for the whole. One of the best ways to do that is to look beyond our own skin to the body politic. Culture is the best spoon for delivering lifestyle as medicine. The basic building block of culture is the family. Let the game begin -- there.

-fin

Dr. David L. Katz is editor-in-chief of the peer-reviewed journal Childhood Obesity, the Childhood Obesity expert for About.com, and president of the American College of Lifestyle Medicine.

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