Imagine a family — or for that matter, any number of families — in which everyone is hungry, thin as a rail, struggling to get enough to eat, and prone to starvation. Imagine the familial skin tautly stretched over protuberant ribs.
Now imagine that Mom — it could just as well be Dad, but we have data to suggest it is, indeed, more likely to be Mom — gazes dolefully at that too-thin reflection in the mirror, and commits to doing something about it. Imagine she watches the morning shows, catches some daytime television, reads the weekly and monthly magazines, and assuming she has recourse to it, searches the Web. She goes on a hunt for a remedy.
And her search is richly rewarded with a veritable treasure trove of lotions, potions, pills and programs promising to fix what ails her. Some few of the promises are believable, or nearly so. Most of the promises – presumably having something to do with filling out her flesh and smoothing over those ribs without the cost or inconvenience of actually getting more decent food — are entirely unbelievable. But she believes them anyway, because she chooses to do so. She believes them because she’s desperate, and needs to believe.
And so she signs up for something in the trove. But there’s a catch. These offerings are all just for her. She’s on her own. So whether or not any of the promises are fulfilled, whether or not her flesh does actually fill out and smooth over — that of her kids certainly won’t. Because her kids were never invited to this party in the first place. Mom’s approach to gaining needed weight in this instance leaves her kids to starve.
We may now pause to reflect on my hypothetical construct. Such a mother (or father) would be a cultural pariah, clearly. In fact, the more credible and effective her approach to needed weight gain, the more unconscionable it would be to leave her kids out. But more than that — she (or he) would be a criminal. Parents cannot fill their own bellies while allowing their children to starve. Such neglect of a child rises distinctly above the threshold of cultural condemnation, and systematic prosecution.
But, of course, we don’t live among families with protuberant ribs for the most part. There is, alas, still such extreme hunger among the poorest of our sisters and brothers around the globe. But more of us are too heavy than too thin. And here in the U.S., even poverty invites obesity and its consequences, not overt starvation. True, food insecurity is part of the formula, but the peril is still calorie overload, albeit complicated by nutrient deficiencies. The poor here, just like everyone else only more so, are prone to the sequelae of obesity not starvation.
Those sequelae are well established, and quite dire — particularly where kids are concerned. I trust they are familiar, and we need not belabor them here. Our kids succumb ever more commonly to what used to be adult onset diabetes. Our kids are prone to a rising rate of stroke. Our kids may inherit a shorter life expectancy.
And yet, in this world of epidemic childhood obesity and diabetes, moms — and to a slightly lesser extent dads — routinely sign up for go-it-alone diets, and leave the kids behind. We know the demographics of our nation. We know the approximate rate of dieting. We know the percentage of households with kids living at home. We know the prevailing character of dieting. The math here is rudimentary, and leads inexorably to the conclusion that in millions upon millions of households, parents go on diets by themselves and leave spouse, and more importantly children, to fend for themselves.
I presume you are ahead of me and can see where this is going. It’s criminal to feed yourself and let your child starve not because of any unique moral attribute of starvation, but simply because starvation imperils children. What matters here is more about ends than means. Starvation leads to harms, including the possibility of premature death — and so it is bad, because it does bad. Starving children are endangered children.
If you doubt that children are endangered by obesity and its metabolic complications, you simply haven’t been paying attention. That case is indisputable.
And so my simple assertion is that the neglect is the same in both cases: feeding yourself as your children starve, or dieting while your children get fat.
But let’s not be hasty. There are ways in which my outrageous hypothetical scenario of a parent finding means to fill an empty belly while neglecting the empty belly of their child potentially differs from the routine reality of parents prone to obesity going on diets and leaving their kids behind.
One, obviously, is directional: The problem in one case is too few calories, and in the other, too many. But this is entirely inconsequential — since what matters is not calories, but their effects. If in both cases there is a threat to the health of all members of a household, then the imperatives of basic parental responsibility to protect our children along with ourselves apply equally well to both scenarios. This distinction proves to be a thin and wispy veneer, concealing the reality that the two situations are the same in the ways that truly matter.
Another distinction is time. Starvation can, in principle, kill a child quickly; diabetes and other chronic diseases come on more slowly to rob years from life, and life from years.
But, in fact, starvation only kills quickly in extreme cases; usually, it, too, exacts a toll measured in years and decades. It stunts growth, and stalls intellectual development. Subjecting children to malnutrition is illegal just the same whether it threatens imminent death, or long term harm.
Meanwhile, the ills of obesity seem to be manifesting over ever more compressed timelines, with ever more consequences chronicled among ever younger kids. So perhaps starvation is generally a slightly faster menace, but not much. Besides, are we truly inclined to neglect forces robbing our children of decades of health, just because they come on gradually? If that were the case, it’s hard to understand why we aren’t willing to let our 4-year-olds start smoking. After all, it wouldn’t kill them… right away.
Such simple logic leads us, ineluctably, to this: Parents going on diets and leaving their kids out of it in an age of epidemic childhood obesity and diabetes are, in every way that matters, exactly analogous to parents seeking means to fill their empty bellies and leaving their kids behind in a world of widespread childhood starvation.
We are actually left with only one true distinction. Starvation is a time-honored nemesis; obesity, a relatively new one. We have had many generations to align our cultural imperatives with the former; we have not yet done so for the latter. The go-it-alone diet, in other words, is a cultural anachronism. It is senseless and obsolete. We are just waiting to notice.
So let’s notice now. If not now, when? If not us, who?
The multi-billion dollar weight loss industry — the attendant lotions, potions, pills, programs, and books — are overwhelmingly devoted to go-it-alone approaches adopted by parents who are thus invited to neglect the health of their children. Of course it doesn’t have to be this way. Of course we can get past false promises. Of course we can devise programs that are as much about finding health as losing weight. Of course we can devise programs that are suitable for all members of a household. It has been done — it just does not yet prevail, because we have not yet renounced the dysfunctional status quo that does.
We can, of course, continue to diet alone — but look around to see what it’s gotten us. We can only really live it together. Family is the basic unit of culture. Family is our unity, and in our unity is our strength. To say nothing of our responsibility — to one another, and above all, to our children.
Only together can we make sustainable, health-promoting lifestyle change. Only together can we share the strength borne of unity.
It is time for our culture to wake up and smell the Slimfast; time to condemn the prevailing abdication of parental responsibility on which a “diet” industry fattens itself with profits. It’s time for our culture to embrace the power that comes with responsible approaches to losing weight and finding health. It’s time for us to live the benefits of lasting health shared with those we love, and for whom we share responsibility.
Dieting, in all the misguided, go-it-alone, quick fix, false promise ways we have tended to do it for far too long already — stands in the way. Dieting, as we have done it, endangers our children. And so it is that dieting — must die.
DAVID L. KATZ MD, MPH, FACPM, FACP, is the founding (1998) director of Yale University’s Prevention Research Center. He received his BA from Dartmouth College in three years (1984; Magna Cum Laude); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He is a two-time diplomate of the American Board of Internal Medicine, a board-certified specialist in Preventive Medicine/Public Health, and a clinical instructor in medicine at the Yale School of Medicine.
Dr. Katz is the Editor-in-Chief of the journal Childhood Obesity, President-Elect of the American College of Lifestyle Medicine, founder and President of the non-profit Turn the Tide Foundation, and medical director for the Integrative Medicine Center at Griffin Hospital in Derby, CT. He is the principal inventor of the NuVal nutritional guidance system, currently in roughly 1700 US supermarkets in more than 30 states, coast to coast. He holds 5 U.S. patents on other inventions, with several patents currently pending.
Dr. Katz has been extensively involved in medical education. He was a founding director of one of the nation’s first combined residency training programs in Internal Medicine and Preventive Medicine (Griffin Hospital, Derby, CT); and served as Director of Medical Studies in Public Health at the Yale University School of Medicine for a span of 8 years. He has led classes and given lectures for Yale students in medicine, public health, nursing, the physician assistants program, and undergraduates, as well as medical residents and faculty.
Dr. Katz speaks routinely at conferences and meetings throughout the United States, and around the world, and has delivered addresses in at least 7 countries. He is a recognized thought leader in nutrition, chronic disease prevention/health promotion, weight management, and integrative medicine. In 2013, he received an honorary Doctoral Degree from the University of Bridgeport, division of Health Sciences, for his contributions to the fields of health and medicine. Widely recognized as a gifted public speaker, Katz has been acclaimed by peers as the “poet laureate of health promotion.” Dr. Katz and his wife Catherine live in CT; they have 5 children.