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A cultural public health approach worked for smoking and drowning. How about obesity, marriage and divorce?

"The Obesity Fix", by David L. Katz, MD, MPH, President of the American College of Lifestyle Medicine, is a very powerful, short, beautifully written article on its own terms. But as a longtime divorce lawyer, I find that everything in it speaks just as powerfully -- cries out just as desperately -- about marriage and divorce. We badly need a prevention-based public health approach, which is being pioneered by just a few small groups, such as Smart Marriages, The Doherty Relationship Institute, The Dibble Institute, the Coalition for Divorce Reform, and the new Marriage Opportunity Council. Katz writes:

If we simply committed to seeing, and treating, health more like wealth- it would go a long way toward fixing obesity, and the metabolic mayhem that follows in its wake. We respect wealth. We aspire to it. We hope to bequeath it to our children. We invest in it, and work for it. We care about it both for our own sake, and the sake of those we love. We recognize most get-rich-quick proposals as scams; we are sensible about money. We don’t spend everything we have today; we think about the future, and save for it. We get financial guidance from genuine experts, not just anybody who had a piggy bank once.

Obesity need not be a disease to be medically legitimate. Drowning is not a disease, and it suffers not at all for want of legitimacy. Drowning victims are reliably treated as the state-of-the-art allows when they show up in our emergency departments.

Nor does drowning invite fractious debate about personal responsibility. Rather, we tacitly acknowledge- by our actions- that personal and public responsibility are complementary, and both required. Parents need to watch their children at the pool’s edge or beach, and are well advised to teach them to swim. But there are lifeguards just the same. There are fences around pools.

And, of course, we don’t focus on the ex-post-facto treatment of drowning. We focus on prevention. Drowning is too common if it happens at all; but it is very much the exception. The rule is prevention, by application of the combined defenses born of personally and publicly responsible action.

If we treated drowning like obesity, we would have no lifeguards at the beach. We would not teach our children to swim. We would allow signage at a shore with notorious rip tides to read: “come on in, the water’s fine!”

If, instead, we treated obesity more like drowning, we would tell the truth about food. We would not market multicolored marshmallows to children as part of a complete breakfast. We would not willfully mislead about the perilous currents in the modern food supply. We would not look on passively as an entire population of non-swimmers started wading in over their heads.

Until or unless we choose to see things differently, McKinsey & Company is quite right: fixing obesity won’t be easy. That’s because the fix is in, and we are all OK with it. We apply the terms “junk” and “food” to the very same ingestibles, adopting a “nudge, nudge, wink, wink” coyness- even as formerly adult-onset diabetes engulfs our children. We line up for an endless succession of fad diets, while glibly asserting that our entire country runs, essentially, on donuts.

If we treated wealth like health, we would all be gullible, indigent, and likely homeless. If we treated drowning like obesity, our ERs couldn’t keep up with the demand for resuscitations.

But if, instead, we treated health like wealth, and obesity like drowning- we could fix what ails us. It might even be easy. For in our collective and righteous might, no force could oppose us. Collectively, we are culture.


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