As my newly published review article, “Can We Say What Diet is Best for Health?” makes the media rounds, some questions arise more commonly than others- and some are just more interesting than others. One that stands out in both categories is: what’s the problem? Why, if we really do (and yes, we really do!) have knowledge of the basic theme of eating that could do so much to promote health- adding years to life, and life to years– don’t we embrace it and put it to that excellent use for ourselves and those we love?

There are a number of answers, and different ones received particular emphasis in different interviews. But several of the most important start along distinct trajectories only to wind up at exactly the same place: money.

One such trajectory has to do with those entities – Big Food, Big Publishing, Big Pharma, Madison Avenue, Big Weight Loss industry- that profit enormously from the status quo. Many in this space would be well within the bounds of reason, if not propriety, to wish fervently for our dietary pseudo-confusion and related health travails to last forever. Maybe they do- but I won’t presume to say. I will say: it’s much about the money being made.

But it’s about our hard-earned, carefully tended money as well, and that’s the more interesting part of the story. Because if most of us in our culture treated our money and wealth in any manner vaguely comparable to how we treat our health we would be, in a word, morons. Or, at best, suckers. That’s the problem, right there. Fix this, and a world of opportunity would open up before us.

What’s the case?

Over nearly 25 years of patient care, I have seen — far too many times, painful to recall — people reach retirement age with nicely gilded nest eggs, and disastrously scrambled health. I have never met anyone seriously willing to trade their capacity to get out of bed for a large bundle of cash. I have known many people who would gladly give up large fortunes for the chance to get out of bed one more time, or get out of a wheelchair or be free of weekly dialysis.

But now we enter the Twilight Zone, where what’s real and important, and how we behave, part company. We value money (i.e., wealth) before we have it, while we have it and if ever we had it. We want it if we can’t get it. It’s a crime when someone takes it from us. We fight to keep it.

Health is more important, but most of us — and our society at large — value it only after it’s lost.

Consider that one of the more significant trends in health promotion is providing some financial incentive for people to get healthy. This strategy is populating more and more programs in both real space and cyberspace, and is incorporated into many worksite wellness initiatives.

I have no real problem with it — whatever gets us to the prize is okay with me. But it is… bizarre. We have to be paid to care about getting healthy.

Consider if it were the other way around. You could do a job, and you would get money for doing the job, but then you demanded an “incentive.” Money is not an incentive? No! We insist on being provided “health” to incentivize us to work for the sake of wealth. Unless you, my employer, can guarantee that working for you will help make me healthy, you can take this job and paycheck and…

Ludicrous, right? It doesn’t even sound rational to insist on getting paid in health to accept benefits in wealth. And yet, we all accept that it’s perfectly rational to require payment in wealth to accept benefits in health. We all accept it, that is, until health is gone, we realize what really mattered all along, and we say: What the %#^$ was I thinking? Too late.

I have a real problem with this, not because I want to be in charge of anyone else’s life, but because I know that people want to be in charge of their own lives. Once health is gone, so is control. Your life is governed by medications, procedures, doctor visits and emergencies. You are the very opposite of in charge.

Our society makes it quite clear that responsible adults take care of their money. They don’t spend it as they earn it — they put some into savings. They anticipate the needs of their children, and their own needs in retirement. Wealth — or at least solvency — is cultivated. If you neglect to take care of your budget and your savings, you are, in the judgment of our culture, irresponsible.

But our culture renders no such guidance for those who routinely neglect their health. Those who don’t have time today to eat well, but will have time tomorrow for cardiac bypass. Those who don’t have time today to exercise, but will have time tomorrow to visit the endocrinologist. Those who get, and apply, mutually exclusive recommendations dosed almost daily by daytime television. Prevailing neglect of health costs us dearly, individually and collectively, and it costs us both health and wealth. Being sick is very expensive — in every currency that matters: time, effort, opportunity cost, legacy and yes, dollars.

What if health were more like wealth?

• If health were like wealth, we would value it while gaining it — not just after we’d lost it.
• If health were like wealth, we would make getting to it a priority.
• If health were like wealth, we would invest in it to secure a better future.
• If health were like wealth, we would work hard to make sure we could pass it on to our children.
• If health were like wealth, we would accept that it may take extra time and effort today, but that’s worth it because of the return on that investment tomorrow.
• If health were like wealth, society would respect those who are experts at it- and not substitute the guidance from those who are not.
• If health were like wealth, young people would aspire to it.
• If health were like wealth, we would be serious about it.

But health is not like wealth. We venerate wealth, and all too often, denigrate health. People are routinely willing to lose weight fast on some cockamamie diet to look good for a special event. It’s not healthy, but what the heck? Well, it would be like cashing out your 401(k) to show up at the special event in a flashy car you can’t really afford. It would feel good for a day, and bad for the rest of your life. We know this, and responsible people don’t treat wealth this way. But we mortgage health to the point of foreclosure as a matter of routine.

Health is not like wealth. It is vastly MORE important. Just ask anyone who has one but not the other.

We are raised to aspire to wealth, while health is often left to languish in that space where stuff just happens. Wealth is its own prize; we need an incentive in another currency to recognize health as such. We watch sitcoms to laugh at get-rich-quick gullibility, then apply that very delusion ourselves to promises of get-thin-quick, get-healthy-quick, or stay-young-forever. We look to genuine experts for advice in almost any field, and certainly when it comes to managing our money- but if some Hollywood celebrity tells the world “I lost weight by eating only pencil erasers while being thrashed about the elbows with wilted artichoke leaves”- we get in line and reach for our credit cards.

To the extent we own wisdom or at least common sense, we are encouraged at every turn to apply them to our careers, and our bank accounts. But they lapse into a coma with every weight loss infomercial.

The result is an endless appetite for an unending parade of “my diet can beat your diet” contestants, rather than a sensible devotion to applying the fundamentals of healthful eating. It’s exactly analogous to frittering away all of our money on a comparable parade of get-rich-quick schemes, while ignoring the readily available, reliable information about sound investing. Or, if you prefer: it’s shopping for fiddles while Rome burns.

Wise is wonderful, but probably sets the bar too high. We could be both healthy and wealthy- or at least exercise comparable control over both- if we were just comparably sensible about both. We don’t even need to be wise to be healthy- we just need to be serious about it, rather than silly. What’s the problem? When it comes to eating well and being healthy, we are not serious people. Silly prevails.

-fin

Dr. David L. Katz has authored three editions of a nutrition textbook for health care professionals. He is editor-in-chief of the peer-reviewed journal, Childhood Obesity, and President of the American College of Lifestyle Medicine. He was commissioned by Annual Review in Public Health to write the review article, Can We Say What Diet is Best for Health? He is the author, most recently, of Disease Proof.

www.davidkatzmd.com
www.turnthetidefoundation.org

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