Americ-itis: The Real EpidemicJuly 1, 2019
As a bariatric medicine physician, I aim to help my patients lose weight, and maintain it.
Recently I saw a patient who was regaining weight, ten years after bariatric surgery. When her husband lost his job as a machinist, he stopped taking his bipolar medication and relapsed into drug abuse. She wanted to leave with their three children but felt trapped because she couldn't afford to support them alone. As a result, she started stress eating.
Unfortunately, stories like hers are common in my clinic. They illustrate how healthy efforts often get crushed by a diagnosis I have started calling ‘Americ-itis’.
Americ-itis: The Real Epidemic
Just as appendicitis describes a sick and inflamed appendix, Americ-itis describes our culture, inflamed by harmful policies that promote illness. Untreated for four decades, this condition has led to declining life-expectancy and an explosion of obesity, diabetes, and other chronic diseases.
The Americ-itis incubation period began with the passage of the Agriculture and Consumer Protection Act of 1973 which subsidized the cultivation of corn and wheat.1 This enabled the food industry to mass produce processed foods and beverages, from soda sweetened with high-fructose corn syrup to burgers stuffed with corn-fed beef.
In the late 70s, growing income inequality created conditions ripe for the rapid spread of Americ-itis, concentrating in poorer communities and radiating outward. Facing lower incomes and rising costs, Americans began commuting farther, working longer, and feeling more stress, resulting in less time for healthy behaviors like sleep, bonding with loved ones, exercise, and cooking fresh foods.
Wherever cheap processed food and income inequality overlapped, Americ-itis erupted, spreading obesity and chronic diseases in its wake.
Processed Foods and Income Inequality
The evidence supporting the Americ-itis origin story is hard to ignore. A 2015 study of 160,000 households showed that 61% of groceries consisted of processed food.2 A 2016 study of 10,000 adults demonstrated that 56% of their calories from the last 24 hours came from processed food.3 Those that consumed the highest amounts had significantly higher heart disease risk.
Among the 300 studies published over the last 40 years on income inequality and health outcomes, 96% show a consistent relationship between greater income inequality and worsening health. The US is a clear outlier among developed nations, with the highest income inequality and poorest health outcomes (Figure 1).4 Though life expectancy continues to rise in other developed countries, US life expectancy dropped for the first time in two decades in 2015, largely driven by rising rates of diabetes, obesity, alcohol poisoning, drug overdoses, and suicide.5
Fig. 1. Index of health and social problems in relation to income inequality in rich countries. Income inequality is measured by the ratio of incomes among the richest compared with the poorest 20% in each country. The index combines data on: life expectancy, mental illness, obesity, infant mortality, teenage births, homicides, imprisonment, educational attainment, distrust and social mobility. Raw scores for each variable were converted to z-scores and each country given its average z-score
As our life expectancy falls, our health care costs rise. Since 1983, our health care spending has outpaced all other developed nations. By 2035, the annual cost of heart disease is projected to exceed $1 trillion.6 In comparison, that is like spending more than the 2008 bank bailout on one health condition, every year.
Health Care Reform
Sadly, health care reform efforts are unlikely to reverse these trends as long as they neglect the rotting core of the Americ-itis epidemic: cheap, processed food and income inequality. Policy prescriptions aimed at these two could include shifting farm subsidies benefitting corn and wheat to incentives for fresh produce or tax reforms funding investments in education and vocational training.
Details of reforms like these could fill months of debate and volumes of discourse, but neither are likely without a dedicated "anti Americ-itis" campaign. The doomsday forecast of accelerating health care costs, rising chronic disease rates, and declining life expectancy, should motivate physicians and the health care system to wake up and start championing this cause. Hundreds of millions of Americans desperately need our help.
Realizing that neither of us had the tools to defeat the Americ-itis epidemic, my patient opted for her only remaining option: quarantine. She found an affordable rent 230 miles away, buried in the Mojave Desert. The closest grocery store with fresh fruits and vegetables was a 60-mile drive, and she hoped to homeschool her children during the day while working at a gas station at night. I immediately realized her plan spelled certain disaster for her health and weight. Americ-itis had already claimed her, and all I could do was watch.
1 Congress, U. S. "Agriculture and Consumer Protection Act of 1973." Public Law. 1973:93-86.
2 Poti JM, Mendez MA, Ng SW, Popkin BM. "Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?." Am J Clin Nutr. 2015:1251-1262
3 Siegel KR, et al. "Association of higher consumption of foods derived from subsidized commodities with adverse cardiometabolic risk among US adults." JAMA Int Med. 2016:1124-1132.
4 Pickett KE, Wilkinson RG. Income inequality and health: a casual review. Soc Sci & Med. 2015:316-26.
5 Centers for Disease Control and Prevention. Mortality in the United States 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db267.htm. Published December 2016. Updated December 2016. Accessed April 2017.
6 American Heart Association. Cardiovascular Disease Costs Will Exceed $1 Trillion by 2035, Warns the American Heart Association. American Heart Association. http://newsroom.heart.org/news/cardiovascular-disease-costs-will-exceed-1-trillion-by-2035-warns-the-american-heart-association. Published February 2017. Accessed April 2017
ABOUT THE AUTHORDr. Sameer Murali is a bariatric medicine physician providing weight management services for approximately 120,000 obese adult Kaiser Permanente members in San Bernardino County. He is the Kaiser Permanente physician lead for Bariatric Surgical Services for the Southern California region. He completed medical school and internal medicine residency at UT Southwestern in Dallas, and completed a masters in health services research at UCLA.
Read more articles from Dr. Murali.