PRESIDENT’S COLUMN How Local Is Our Food?

Obesity is epidemic in the United States and is a major cause of deaths attributable to heart disease, diabetes and cancer. The need for programs to address this epidemic is great, but creating these programs will be a huge challenge. Unfortunately, economics and politics influence what we eat far more than we realize.

The Obama administration recently announced changes to government-subsidized school meals affecting the daily diet of more than 32 million children. What surprised me was how many stakeholders tried to influence the debate and the subsequent final rules. The National Potato Council, for example, opposed attempts to limit the servings of potatoes (presumably in chips and fries). Lawmakers from potato-growing states opposed earlier versions of the lunch program because they would have cut the amount of potatoes served. The American Frozen Food Institute was concerned about guidelines restricting sodium levels. There was even a fight over how much tomato paste would have to be put on a piece of pizza for it to count as a vegetable.

Even as the obesity epidemic has increased during the past few decades, we have been told by nutrition experts and the American Heart Association to eat a low-fat diet. While I don’t doubt that diets high in saturated fat contribute to increased LDL cholesterol and subsequent coronary artery and other vascular diseases, I have often wondered if the replacement of fat calories in our diets by carbohydrate calories has influenced the obesity epidemic. As Gary Taubes argues in Good Calories, Bad Calories, the addition of high-fructose corn syrup to just about every processed food we consume exacerbates the obesity problem not only by increasing the caloric content of foods, but also by efficiently stimulating insulin production.

Why is high-fructose corn syrup so ubiquitous? Farm subsidies and commodity pricing policies keep corn prices artificially low, allowing food manufacturers to save a few pennies on each item by sweetening processed food with high-fructose corn syrup rather than table sugar.

Physicians and policy experts have attempted to combat the epidemic by encouraging regular exercise for both children and adults. Sonoma Health Action, for example, started the iWALK program in 2009 to address this critical issue. Participants are encouraged to walk at least 30 minutes per day, five days a week. Such programs are a crucial component of a healthy lifestyle.

While I agree wholeheartedly with initiatives to increase exercise, when it comes to weight loss and weight control, I believe that diet trumps exercise. I felt great after my 30-minute workout on the treadmill before work the other day. The computer on the treadmill, however, told me for all my efforts I had burned only 380 calories. Next stop, the coffee cart (I was kind of hungry). The muffin that I devoured in 90 seconds gave me back those 380 calories, and probably more.

The obesity epidemic is surely a Herculean problem. Many people do not have access to safe, nutritious and affordable food. Ironically, despite the pent-up demand for healthy food, many small independent farmers cannot make a living.

Our responsibility as physicians is to educate our patients about healthy food, but we also need the political will to curb subsidies that make fast food artificially cheap. Change will require sustained public policy initiatives that promote consumption of healthy whole foods through increased access, education, awareness and affordability. Change will also require the personal will of every one of us to make the right choices: consuming healthier foods, consuming smaller portions and increasing fitness through both aerobic exercise and resistance training.

Dr. Sugarman, a Santa Rosa dermatologist, is president of SCMA.

Email: pediderm@yahoo.com

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