Archive for Wednesday, November 19, 2003

View fat as the new alcohol

November 19, 2003

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America's waistband is expanding to a dangerous size XXL, so, naturally, the search for a cause of this proliferation of fat is moving as quickly as a hungry teenager toward a bag of potato chips.

Some think of dietary fat as the new tobacco: a public-health crisis that should be solved by sin taxes, sales regulations, warning labels and advertising restrictions.

The problem with this analogy is that smoking tobacco is never healthy and therefore never advisable. Eating a luscious slice of chocolate cake can, if you're careful, be part of a balanced diet. You "need" fat in your diet. Fat becomes a scourge only when consumed in excess, while smoking is bad news, period.

Instead of thinking of fat as the new tobacco, think of it as the new alcohol. If we changed our minds about obesity the way a former generation began to change its mind about alcohol, we might be able to move this debate beyond blame and treat it with the seriousness it deserves.

The analogy is timely and helpful because the rising number of obese and overweight Americans is prompting some scientists and federal officials to argue that obesity should be considered a distinct, identifiable disease -- much the way alcoholism was starting about 40 years ago. Doing so would make it easier for those who need treatment to get it and pay for it.

It would also enable us to distinguish between those who suffer from obesity, sometimes beyond their control, and those who are fat simply because they eat too much and move around way too little.

There's an obvious downside to the disease classification, of course. It could become the all-purpose excuse for indulgent, irresponsible behavior. And it could end up forcing government and insurance companies to pay for fad diets and miracle cures as phony as the promises in the before-and-after advertisements showing "Susan" losing 100 pounds in three weeks. After all, isn't gluttony one of the seven deadly sins?

Alcoholism, too, used to be considered a moral failure and a pernicious sin. Its status as a disease took centuries to evolve. Benjamin Rush was credited with first identifying it as a disease, but that was back in 1784. For a time in the mid-20th century, Alcoholics Anonymous described alcoholism as an "allergy to alcohol." It wasn't until 1957 that the American Medical Assn. endorsed the disease model and federal agencies subsequently agreed.

That same evolution is occurring now with obesity. Scientists are discovering that some people have a genetic predisposition to obesity, in the same way a predilection toward alcoholism runs in some families. Scientists also are finding that socioeconomic factors affect obesity, as they do alcoholism.

Personal behavior and responsibility still play a huge role (pun intended). The alcohol analogy works here, too. Think of how socially acceptable it was just decades ago to host the three-martini lunch, the drunken frat party, the drink before and after and in between.

Though alcohol abuse remains a serious issue, it's now socially acceptable to serve "lite" beer rather than straight scotch, appoint a designated driver and counsel college students against binge drinking. Thanks to Mothers Against Drunk Driving and a host of other groups, our consciousness is raised.

Imagine if we treated nutrition as seriously.

We'd serve a bowl of fruit alongside that iced carrot cake, insist that schools mandate phys ed in addition to yet another standardized test, and have vending machines that sell water instead of Coke.

We'd recognize that some people need help not to be fat, just as some people need help not to drink. And we'd feel responsible for offering that help.

We'd recognize denial for what it is: an impediment to recovery.

And we'd stop demonizing fat and start realizing that, like alcohol, it can play a marvelous role in a healthy lifestyle as long as it is consumed smartly, in moderation. Friends shouldn't let friends drive drunk. They shouldn't let them eat junk, either.




Jane R. Eisner is a columnist for the Philadelphia Inquirer. Her e-mail is jeisner@phillynews.com.

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