Privilege is ultimately front and center here. Mr. Cisna could have stopped his fast-food diet at any point. Many Americans, however, are beholden to unhealthy eating out of necessity. We owe it to them to help build a healthier food system, rather than hold up fast-food chains as beacons of health while simultaneously chastising individuals for making "bad choices."
Whether we're talking about broad public health prescriptions or individual prescriptions, it's all a matter of benefit versus risk, and that requires a careful look at the evidence. Doctors and patients alike may find themselves understandably confused by changing guidelines and the uncertainty inherent in predicting the future.