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Fighting Obesity With a Smoking Gun?

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"We blew it. They lived for 60 years skinny, then dropped dead of a heart attack or lung cancer. No social security, no long-term care, no diabetic old geezers eating up Medicare. We made our money and never had to pay it back." The pinstripe suited character blows cigar smoke at the camera. "Why did we ever get them to stop smoking!"

I'm certain that dialogue is in a screenplay somewhere, most likely the virtual one of a hard-hearted Republican. Skyrocketing health care costs from our obesity epidemic were an unforeseen evolution of our efforts to improve public health, first, by enhancing agricultural production and food supplies, and second, by actively discouraging cigarette smoking.

No, of course the simplistic solution is not to close down grocery stores and promote our re-addiction to nicotine as we head out to farm our vegetables. But activists appropriately fighting our obesity epidemic must acknowledge societal factors beyond "garbage in, fat out" as contributing to obesity among our species. with its caloric-conserving "thrifty gene."

Factors that promoted slimness in our history (bluntly identified) included:

• "The Thrifty Gene" that conserved calories in times of famine, pestilence, and war. Limited resources meant that those who used those resources most efficiently had the greatest chance of survival.

• Necessary physical activity. (A world without cars, household appliances, and supermarkets meant constant movement and exertion, simply to eat. Endorphins were a rewarding bonus.)

• Leisure physical activity. (A world without televisions, computers, video games, 15 hour work days, and child kidnappers on every street, meant outdoor and indoor active play, especially for children.)

• Smoking. (Yes, our very first "organic" antidepressant, nicotine, got our society through the transition from active agricultural to sedentary service industries, from open fields to Excel spreadsheets. Of course, smoking is harmful and lethal -- heart attacks and lung cancer are only the beginning. Emphysema sufferers can linger for decades in agony. But, nicotine does increase neurotransmitter levels such as dopamine in the brain and reward its users with euphoria and relaxation, and is an MAO inhibitor.)

We all know many of the factors promoting obesity: Easily available, high-fat and calorie "fast food"; processed/refined carbohydrates and sugars; a desk-bound lifestyle; sodas; TV and other screen media; lack of funds to purchase 'healthy' foods; lack of time to prepare 'healthier' dishes; lack of adequate sleep, etc. And, of course, stress.

Would that we could all have a personal chef like Oprah, or a cheerleader-trainer like Kirstie, as well as the time to devote to daily workouts. Many victims of obesity live in economically and/or safety-challenged environments, without fresh produce or healthy foods easily affordable or available. Outdoor activities may be limited by risks to life and limb rare a few decades ago.

Blaming victims of obesity for their "lack of self-control" cruelly ignores the realities faced by most working class, and even middle class individuals and families, whose relative incomes and personal and financial resources have been shrinking over the past 30 years as obesity rates have been rising. Encouraging Americans to adopt a more active lifestyle and healthy eating without addressing the economic and psychological realities of our depression is doomed to failure.

Of course we should all be eating a balanced diet as guided by the revised food pyramid, engaging in moderate exercise on a daily basis, and reducing stress through meditation, yoga, and other behavioral interventions. But, sleeping a refreshing eight to nine hours, getting up and enjoying a healthy breakfast, working out one to two hours, stimulating our minds in a rewarding and inspiring six hour a day/five day a week job, sushi for lunch, salmon for dinner, a quiet walk by the ocean before bed, is not in the cards for most of us.

Working two or three jobs; marshaling children and grandchildren at the crack of dawn to buses and safely to schools; racing to the low-control, low-pay retail store, factory, or office; grabbing a quick meal in the drive-thru line or the vending machine; keeping up the "numbers" as your computer activity is monitored; squeezing out the last month's rent; buying cheap food for the kids with Uncle Jim's disability check; and collapsing in front of the TV for Leno's monologue aren't conducive to supporting healthy choices in food, drink, or self-care. Survival, in this case, is of the non-fittest.

So, clearly we must praise interventions by Washington to improve nutrition for children and adults, in schools, in the food service industry, and in the home. We must promote education regarding health and wellness, and the enhancement of activity. But, we must target societal changes, and not just individual efforts, to truly succeed in halting the obesity epidemic. Some hopeful suggestions come to mind that we can ask Santa to bring us this year:

• Return the economy to stable footing and provide rewarding opportunities to those seeking employment and career advancement. Promote a work/life balance for all Americans instead of a karoshi treadmill.

• Expand public transportation networks coupled with "foot energy" to replace cars and oil.

• Declare a "War on War". Peace -- not just overseas, but in our own backyards, so children and adults can once again play safely in theirs. Our intervention efforts domestically should enrich our families, not drug profiteers.

• Reduce stress for all Americans -- focus our internal resources on supporting ourselves and our communities. Return taxpayer dollars to their proper roles--the support of society in need, including public option housing, health care, food, and quality education.

• Provide free or affordable counseling; nutritional, exercise, and psychological; for all Americans who need assistance with their lives. Expand non-medication approaches rather than pharmaceuticals as a first option for psychological conditions where appropriate.

• Declare discrimination towards those suffering from obesity illegal, whether on airlines or job interviews. Help support improved quality of life for those struggling with the emotional and medical complications of obesity, and recognize that lifelong cures are difficult to find and maintain, even with the best intentions. Don't enhance psychological stress for those already challenged.

Making our lives healthier will improve our bodies' health. And that would be a WIN for us all.

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