Last week, I had the distinct opportunity to present my research and speak at a Mayo Clinic symposium on addictive health behaviors. I came armed with my theories, my thoughts and my life experience. A doctor who works at an American inner city hospital shared with me that as a family practitioner he has a very difficult time with dietary recommendations when it comes to weight loss. I can well imagine that telling patients to eat their 5-a-day is simply not practical when a bag of chips is far more inexpensive and available. After all, we are a consumer society based upon instant gratification and at the point-of-purchase no one thinks that a $1 candy bar may lead to the costs associated with treatment for diabetes.

What could I tell this doctor? Even as I drove the 45 minutes north from Jacksonville for the symposium, I noted how difficult it was for me to grab a healthy lunch on the go – a far cry from my home in Miami Beach! Despite my negligible salary and a life made more comfortable through student loans, a healthy diet and a gym membership are my priorities and my luxuries! As George Bernard Shaw observed that “youth is wasted on the young”, writer Jeremy Schlosberg’s examination of dieting 20 years ago concluded that “dieting is wasted on the thin” – the thin who can afford it! A 40-day supply of Alli – the only FDA approved, over-the-counter weight loss product comes with a $60 price tag and you may need some new underwear as well, since Alli can cause “treatment effects”… use your imagination!

The act of dieting is a luxury – paradoxical in terms, and if you go looking for the history of dieting in America, your search will be less than fruitful. It is as if modern society is in denial about its maladjustment to what has become of our bodies. 

Where a heavy body weight used to be synonymous with wealth, countries in which food is now in abundance are the main markets for diet aids. As food in the US became more and more accessible and inexpensive, weight was no longer a symptom of affluence. Instead, weight loss – or abstaining from food – became the vogue. Economics 101: supply and demand.

I often kid around and tell people that my goal in all of this is to cure obesity in Africa! I can assure you, however, that it would be mighty difficult to find a package of Tofuyan’s low-carb pita bread in Malawi! The paradox is such that growing economic wealth and changing values drive our affluent consumers to spend on anti-luxury. That’s right – nutritive, low calorie foods are my luxury and not only my source of sustenance. I pay $8.75 for a quart of Tasti-D-Lite, rather than $2 for my local grocery’s own fatty ice cream.

An enduring “big business”, weight loss commercials online, in print advertising and on broadcast television often convey an unrealistic image of transformation and re-invention. Much in the same vain as food intake itself, the weight loss methods revealed in print use instant gratification as their selling feature. “Fast”, “easy”, and even “miracle” are words of seemingly gross empowerment not foreign to weight loss advertisements. Obesity is a moneymaker – for medical, pharmaceutical and weight loss industries, as well as for manufacturers and distributors of prepared foods, chain restaurants, etc. It is – in essence – a gain / gain situation – the more weight gained - the greater the caloric intake needed to maintain it - the course of usual efforts to lose it - the resulting health implications from it.

I am pleased to hear about reform to health care in the US and I am hopeful that new leadership will continue to advocate for the health and welfare of our public – a ban on trans-fats and a move toward better nutrition in schools for our children are a good start. In the discourse of public health that has recently captured the headlines of the Democratic debates, it is important that we consider that we all pay per pound – so to speak. Who would endorse an obese Hillary Clinton, lobbying for universal health care? Winning the battle of the bulge in America will ultimately comprise a change of mind, a charge of government and a lot of cold, hard cash! Cash cow, anyone?

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