A return to moderation

Modern medicine has produced its share of miracles. Antibiotics, vaccines, and public hygiene have drastically reduced our risk of dying from infectious diseases. Angioplasty and coronary artery bypass grafts have extended lives of people who would otherwise be dead from ischemic heart disease. Such successes, however, have come at a price. We treat all illnesses as if they were deterministic processes that we can treat with medical intervention, whether it be the latest pill or the newest, state-of-the-art surgical procedure. The responsibility and action of the patient may not enter into the equation, other than being required to take another prescription.

This dehumanization of medicine has turned doctors and patients into automatons. Doctors follow detailed rubrics of symptoms and signs in order to make airtight diagnoses, and then prescribe treatment. Such treatment is often designed to solve the patient’s problems with exploring his motivations. This works just fine for what I call diseases of randomness, like cancer, infectious disease, and metabolic syndromes like Type I diabetes and hypothyroidism. But when illness is caused by lifestyle, depersonalizing medicine results in treatments that paper over the problem, rather than hitting at its root cause.

A prime example of this unfortunate tendency is treatment for obesity. All over the world, people are becoming fatter, faster than ever before. Diet is a large factor in this, as is a general lack of exercise. As Western-style fast food and supermarkets have spread into Latin America and Asia, so has the obesity epidemic. So how do we deal with this? One option is medical treatment for obese people, like bariatric surgery, or as I read this week, new treatments designed to kill appetite by inhibiting the sense of smell. This is a direct analogue to classic modern medical treatment of infectious disease and problems like hypertension and hypercholesterolemia. It’s easy, requires minimal active changes in lifestyle, and I suppose it would reduce the level of obesity.

The only problem is that medical intervention doesn’t solve the obesity issue; it only treats the symptoms. People are becoming obese because our culture has both made cheap, calorie-dense food readily available and reduced the necessity of manual labor to burn off those calories. It’s a vicious cycle: we sit around more, and eat more because it requires less effort to procure our food. No wonder we’re fat. We can either treat obesity by artificial means, by reducing our appetites or our stomach sizes, or by taking responsibility for it. It is possible to eat less, choose different foods, turn off the TV, unplug the computer, and get more exercise. Any or all of those would eliminate much of our excess fat (with the exception of those very few who really do have innate, uncontrollable metabolic problems). But, in this age of convenience, all those things require deliberate and inconvenient choices.

Choice is the issue here; never before in human history has overeating been a plague of the poor. Girth and wealth have been directly correlated since civilization began, until now. The reason is that for essentially all of us in the developed world, and increasingly outside of it, calories are no longer limiting; we are now able to choose what we eat. (And to make matters worse, increased mechanization means that fewer of us have to manually labor to make a living.) Empty calories are usually both cheaper and tastier than the alternatives, so choice, in this case as in so many others, is not an unqualified good.

In order to reverse the trend toward morbid obesity, some very unpopular ideas are going to need to be revisited. Some might even call them virtues: responsibility, moderation, and above all, self-control. We need to recover a system by which to make proper choices. But you say, what about the growing trend toward “preventive medicine”? Don’t doctors constantly harp on exercise and moderation in eating? Absolutely. But, all this nagging isn’t working; if it were, the obesity problem would be abating, not escalating. This advice is being couched in the standard therapeutic model I mentioned above—treating health as a deterministic system where input from the doctor, implemented dutifully by the patient, solves the problem. In the case of obesity, for the most part, this utterly fails. Medical interventions like surgery or the aforementioned nasal spray might reduce body weight, so I can see the allure. But, wouldn’t it be better if we could do so without artificial means?

What we need is a return to virtue. I’m not saying this will be easy, or a panacea, but it might work for some. Why do we make bad choices? Why are we, as a modern society, so bereft of self-control? For one, our culture promotes consumption and self-indulgence, not conservation and moderation. The doctor’s message of diet and exercise falls flat in the face of carefully crafted advertisements and peer pressure. If we don’t reverse this spiritual sickness, diseases rooted in how we live will continue to plague us.

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