In my column for FindLaw this week, I discuss a recent case in which the South Carolina Department of Social Services accused a mother, Jerri Gray, of child neglect and arrested her because her 14-year-old son, Alexander Draper, weighed 555 pounds. The column is critical of the government's decision to treat Gray as a criminal, in the light of what we in the United States generally eat and feed our children at home and what the government feeds them in the public schools. One could say that with school lunches as a model, it is not surprising that we have shockingly high and increasing rates of obesity (among adults and children) and the typical illnesses of affluence, including cardiovascular disease, cancer, and diabetes.
In this post, I want to focus on a related set of questions that a pediatrician raised in a Science Times article (entitled "When Weight Is the Issue, Doctors Struggle Too") this week: "How on earth ... am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don't follow it very well myself? .... And ... how am I supposed to help stem the so-called epidemic of childhood obesity when not a week goes by that I don't break my own resolutions?"
This pediatrician, Perri Klass, M.D., discusses the pros and the cons of having an overweight doctor advising overweight patients. On the one hand, the doctor understands her patients' challenges better than a person who has never had to struggle with her weight (like an AA sponsor, perhaps). On the other, "you could argue that when the doctor gives advice she obviously finds difficult to follow, there's an underlying -- and undermining -- complicit wink: Now that I've told you about healthy eating, let's have a cookie together -- we'll change our habits tomorrow!"
In some ways, the overweight pediatrician is a little like the government condemning a mother for her son's obesity while filling school cafeterias with spaghetti and meatballs, macaroni and cheese, and gallons of milk. Actions speak louder than words.
Am I proposing that only thin people practice medicine? No. But I do think it would be helpful if medical schools educated doctors about good nutrition -- their own and their patients' -- given how much illness is directly linked to diet. Instead, we see hospitals serving patients -- even cardiac patients -- the sorts of food that contribute to their odds of remaining ill. The most healthy diet -- one that consists primarily or exclusively of whole, plant-based, food -- is virtually impossible to obtain in the hospital. If it were not so sad, it would be funny to recount the stories of vegan hospital patients who have tried repeatedly but in vain to avoid being served a breakfast of eggs, sausage, and French Toast.
The writer of the Science Times article recounts another, sometimes-overweight doctor's statement that "'[t]he advice we're supposed to give in pediatric clinic, it boils down to "Eat less, exercise more."'" Though the part about exercising more is good advice, the part about eating "less" is inadequate, at best. Telling a child or her parents that the child should eat "less" does nothing to address the hunger pangs that anyone will feel when she reduces the amount that she eats. If one has to feel hunger to lose weight, moreover, then the odds of remaining svelte diminish substantially. A campaign recommending that children "abstain" from eating is, in other words, no more likely to be successful than the campaign to get teens to abstain from sex has been.
Rather than telling people to starve themselves to become thin (and then hospitalizing the adolescents who take the message to heart and become anorexic), doctors could achieve much greater success by telling parents and their children to eat "differently" rather than "less." Numerous studies have found that obesity rates are much lower in vegans than in people who eat animal products. One of the apparent reasons for this difference is that plant foods (at least whole plant foods) contain fiber, which produces feelings of fullness without adding calories. Fiber also plays a role in mediating the speed of digestion, which can reduce the craving to binge. Animal flesh and products contain no fiber.
By following and recommending a healthful, vegan diet, then, a doctor will not need to direct children to refrain from eating when they feel hungry. Perhaps the doctors struggling to control their own and their patients' respective weights might consider the possibility that ignorance about nutrition -- rather than a lack of willpower -- is the real culprit.
Posted by Sherry F. Colb