Into The Age of
Chronic Health
The most amazing thing about modern health care systems is
that they let most of us die from chronic diseases which we know how to
prevent. So why don't we?
As a public health scientist I have devoted the past 15
years of my life to answering this question. Many of my colleagues outdo each
other with doom and gloom predictions of aging societies buckling under the
economic burden of aging related diseases. I believe that the age of chronic
health and longevity is about to begin. With you. And with a radically new approach
to make the prevention of heart attacks, strokes diabetes and cancers finally
work.
Because, until now, it doesn't. But don't just take my word
for it, let's look at some of the facts first:
You have probably heard that obesity is the new smoking. In
fact for every American who stopped smoking in 2011 another one became obese.
Today, for the first time in human history there are more
overfed than malnourished people walking this planet. And their lifestyles of
too much food and too little exercise have become the number one risk factor for
the number one chronic disease and killer: cardiovascular disease with its most
well-known end points - heart attack, stroke and heart failure. With nasty
other diseases on the side: diabetes, kidney failure and certain cancers.
You probably also heard about major studies, like the U.S.
government funded Diabetes Prevention Program, and the Look AHEAD trial, which
proudly, and correctly, report weight loss and major reductions in
cardiovascular risk factors among participants in the lifestyle arms of these
trials. What you don't hear so often, is that within 3-4 years after
enrollment, most participants will have regained not only most of their weight but
also all their risk factors.
Ok then, lifestyle
change prevents disease. But what prevents lifestyle change?
Why is it that over the last 30 years of public health
efforts we have not seen a demonstration of any program that results in a
clinically meaningful weight loss that can be maintained for more than 2-3
years in the majority of participants and at low cost? That's the question which Dr. Richard
Khan threw at an assembly of public health advocates, who had gathered earlier
this year under the event's message "Prevention works!". Dr. Khan, who teaches medicine at the
University of North Carolina, was the chief scientific officer of the American
Diabetes Association for 25 years. The man certainly knows what he is talking
about.
Now think about the implication. If you chose a lifestyle of
which you know might increase risk of disease and premature death, then you
make that choice either willingly or it is not your free will which makes that
choice.
My money is on the latter. Because how else could we explain
that an obese child maintains her fattening habits despite experiencing the
same psychological agony as a child with cancer? How else could we explain that
obese adults maintain their bulk when it significantly reduces their chances of
getting an academic education, a job and a mate? How else could we explain that
over the past 20 years the obesity rate in the US went up by 60% when, during
the same period, Americans doubled their spending on weight loss products to
US$ 60 billion annually? They WANT to lose weight, but they don't. The
explanations are called addiction, hormones and hyperbole.
Food addiction
The neurohormonal architecture which drives an addict to
crave and consume his drug, despite knowing and hating the consequences, is
exactly the same architecture that keeps us going for the sweet, fatty and
salty stuff in restaurants, hawker centers and vending machines. Does that
explain, why the food industry adds sugars to so many foods in which you least
expect it? You bet. In fact we shouldn't be afraid of calling ourselves food
addicts, because this is what Mother Nature intended us to be all along. With
this addiction she drove our ancestors for millions of years to what is
naturally sweet in the natural human habitat: fruits. They deliver not only the
carbohydrates for which we have very little storage capacity in our bodies and without
which our brain can't function. Fruits also pack a punch of essential
micronutrients. Unlike the cokes and cakes and cookies which deliver more sugar
than we need and no other nutrients with it.
Hormones
Once you have changed your figure into the shape of a
beached whale, you will also have changed the way the hormones of your gut and
of your fat tissue work. It's a rather complicated picture unfolding in the
labs of biomedicine, but one emerging theme is a colossal malfunction of the
satiety and appetite signaling pathways. Instead of feeling full, you are now
ready to add a tiramisu to a lunch that would have satiated a family of four in
rural Bangladesh.
Hyperbole
Actually it's called hyperbolic discounting, and it's a
simple mathematical formula, which behavioral scientists have found to neatly describe
why we will still grab that tiramisu tomorrow even though we swear today that
we won't. It has to do with how we more steeply discount the relatively larger
but more distant reward of staying healthy against the relatively smaller but immediate
reward of enjoying the tiramisu. It doesn't operate only in humans. The
behaviors of rats, pigeons and apes, for example, follow the same formula.
Which means, Mother Nature must have found out early during evolution that this
principle is a recipe for survival in her species. We simply inherited this
survival tool.
With all these issues stacked in favor of an ever expanding
population of chronically ill people, why do I believe that we might be close
to the age of chronic health and longevity? For three reasons: Because Wall
Street is getting into the act, because we can outfox our brain, and because
biomedical science has got the tools ready.
How we will enter the age of chronic health is the subject of the next episode, so stay tuned!
In the meantime, visit my crowd funding campaign, watch the videos, recommend the campaign to your friends and, if you like what you see,
participate in our chronic health project: www.indiegogo.com/adiphea
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