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Upside Down and Inside Out

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden Lundgren
November 17, 2023

Environmental health was a required course in my MPH program. Despite the excitement of a field trip to a local sewage treatment plant, I didn’t much like the course. Environmental health seemed too circumscribed to be applicable to many diseases. In the years that have passed since then, I have come to the opposite opinion. Indeed, there seem to be almost no diseases without an environmental cause.

Those causes, however, are more diffuse and difficult to address than the traditional environmental disease classifications. We are living in a tsunami of chronic diseases. Cardiovascular disease and cancer are the leading causes of death almost everywhere. They are often referred to as lifestyle diseases meaning that individuals who practice good dietary and fitness habits can avoid the worst effects of these diagnoses.

But the environment in which we find ourselves makes it an uphill climb in the same way that being a coal miner makes it difficult to avoid black lung disease. For the purposes of this column, let us look at a single major driver of what makes us sick: obesity. Forty two percent of American adults and 20 percent of children are obese. Worldwide, 39 percent of all people are obese, up from 24 percent in 2008.

In a column written nearly 10 years ago, I listed 17 possible causes of obesity, and that was the short list. Let us consider something simpler. The obesity rate in mid-century America was 10 percent. Obese kids were hard to find. These figures stayed fairly constant until the 1970s when they began a sharp incline. What are the environmental conditions that have changed from then to now?

Obesity is not a simple matter of calories in and calories out, but clearly food intake and physical activity play a considerable role. In mid-century America, these look very different than today. To look at the latter first, people did not routinely seek out exercise. No running, jogging or gym visits (no gyms). Activity was built into the day. Children walked to school, sometimes miles away. Gym classes were almost daily. After school, children rode bikes, played tag and hide-and-seek and other games often until dark. Radio or later television viewing was what we call “appointment TV”—the family gathering to enjoy a single program together, then turning the set off (and no remotes).

Neighborhoods were built to meet the necessities of one-car families—the one car being used to transport workers to their jobs. Grocery stores, dry cleaners, hardware stores, etc. were within walking distance of most homes. With no car to carry a week’s worth of groceries home, trips were made almost daily. Laundry was hung out on a line to dry. Yard work was done with hand tools. Everything was more physically demanding. Writing a column like this required trips to the library, taking notes, handwriting drafts, then finally banging it all out on a typewriter. Now the process basically involves sitting.

The food was like something from a different planet.

Breakfast: Cereal with milk, a teaspoon of sugar (cereals were not pre-sweetened). Glass (4 oz) of juice.

Lunch: Sandwich (the filling no thicker than a slice of the bread). Glass of milk (8 oz). Piece of fruit.

Afternoon snack: One small cookie and maybe more milk—or fruit.

Dinner: Meat (maybe a single chop), potato, vegetable. Dessert: maybe cake, or more fruit. Milk for the kids, tea or coffee for the adults.

Immediately noticeable is the lack of constant snacking. Food was eaten at mealtimes, and mealtimes were family gathering times. Restaurant meals were a rare event. Fast food was unknown. Soda (8 oz bottle) or a single scoop of ice cream were occasional summer treats.        

It may be argued that a number of policy decisions led to our activity-deficient world, but as far as food is concerned, there was just one. As Lizzie Collingham recounts in The Taste of War: World War II and the Battle for Food, belligerent countries had to develop ways to feed their populations. Some enlisted nutritionists to calculate to the last nutrient that every person needed for robust health and developed ways to bring that food to where it was needed. In 1945, the first conference of the Food and Agriculture Organization was held. Strong presentations were made on managing the agriculture industry and food transport to guarantee that all peoples were well fed. There was widespread agreement to implement this plan—until it was torpedoed by the U.S. State Department in favor of commercial interests.

Those interests have brought us an abundance of cheap, available, highly processed, nutrient-deficient foods. They taste good enough to light up pleasure centers in the brain. We have a weight loss industry, a surgical industry and now a pharmaceutical boon for weight loss. We will be poorly nourished people in thinner bodies.

Can we re-create the mid-century environment? No. But we can bring back parts of it. Neighborhoods can be redesigned to promote walking. Farm subsidies can be aligned with nutritional needs. Ultra-processed and fast food can be heavily taxed with fruits and vegetables heavily subsidized. Or we can continue upside down and backward.          

Author: Burden S. Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care.  After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA.  She has served as a consultant to a number of non-profit groups.  Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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