The Other Epidemic

 

We’re late for soccer. It’s always the elusive shin guards, hunkered away in some shadowy corner. I suppose I, too, might sequester at the prospect of the flailing cleats and errant kicks of 10-year old girls.

Lolli sanctifies punctuality, an odd proclivity for a girl her age. Any remote intimation of tardiness plugs the chatterbox, that normally lives inside her head, into a speaker and an endless stream of anxious inner dialogue is amplified out into the world. I wonder where she gets this loquacity.

I am channeling all my parental empathy to pull back from DEFCON 5. Lolli is fiddling with the AYSO app, checking the game schedule for the tenth time, when she discovers that I am the parent responsible for bringing this week’s snack. F*cking snack. Obviously, I have not procured the cursed snack.

This post-game pastime is often more sacred than the game itself. Somehow, when a parent provides a superlative snack, there is a mystical halo effect that gilds the child a profound sense of belonging and confidence.

The beleaguered designated parent, saddled with bulging satchels of mystery grub, are eyed with the scrutiny of a military aid carrying the nuclear football. Hushed whispers weave their web, “What’s the snack going to be today?”

Any consternation about potential lateness is now usurped by the absence of snack. Lolli’s countenance matches the color of her crimson jersey. She’s apoplectic.

The moment has arrived for me to activate my rarely invoked Zen master super powers. I drop Lolli at the pitch and assess the situation. Can I acquire a satisfactory snack and return in time for my part of the sporting ritual, the nervous pacing of the sidelines punctuated by the occasional bark of encouragement?

Lolli’s games are at Johnnie Cochran Middle School just off Crenshaw Boulevard in Mid City, Los Angeles. The non-descript appellation, Mid City, is appropriate in exactly the way you might imagine; an endless straggle of asphalt in every direction, pocked by bi-level mini-malls and fast-food fare from Arby’s to El Pollo Loco. Google Maps tells me there are no less than a dozen 7-Elevens within the throw of a stone. In the hopes of finding something with a semblance of nutritional value, I am looking, in vain, for a grocery story. I just start driving.

Finally, nestled between a 99-cent store and a laundromat, I spot a pile-up of grocery carts in front of a concrete fortress, the contents of which is only drearily revealed by a lime-green neon sign spelling ARKET, the “M” having met an untimely death. I park, hustle in and survey the savannah for options. There is an aisle completely dedicated to soda and sport drink of every fluorescent hue. Another reserved for savory chips of all geometries. And yet another preserved almost exclusively for variations of Oreos. There is also ketchups and sauces, spreads and breads.

If you were to pick up any single one of these items and read the label, they would share one common ingredient: refined sugar. In fact, added sugar is in over 80% of the foods on the grocery store shelf. And, in food deserts like this one, the percentage is even higher. 

This missive is not a dissertation on sugar, the food industry or obesity. I couldn’t possibly address the depth of this scourge on society within the parameters of this article. If you want thorough, researched information about the public health and socio-political implications of processed food and refined sugar then read or listen to Dr. Robert Lustig or Dr. Mark Hyman. Still, here are some broad points.

 

The consumption of sugar and sugary sweeteners, mostly in the form of high-fructose corn syrup (HFCS), has skyrocketed over the past 100 years. In 1915, the average annual sugar consumption per person was 17.5 pounds. As of 2011, the number rose to 150 pounds of sugar per person annually. 

The average American now consumes 30 teaspoons (or 120 grams) of sugar per day. That is approximately double the US government recommendation. A significant portion of this supplemental sugar is delivered in beverage form. Perhaps unsurprisingly, a 12 oz. can of Mountain Dew contains 46.5 grams of sugar. More startling though is the prevalence of sugar in beverages that are marketed as part of a healthy lifestyle like sport “hydration” drinks. Or consider a 20 oz. bottle of Sobe Energize Green Tea, an innocuous, even purportedly “enlightened,” thirst quencher, which packs a whopping 61 grams.

Table sugar (sucrose) is a disaccharide compromised of glucose and fructose which, in digestion, are separated and metabolized very differently. Glucose provides calories for cells. The liver turns excess fructose into fat. Fructose is known to induce leptin resistance and greatly increase the risk of developing obesity. As leptin plays an important role in regulating hunger, suppressing leptin release can produce an insatiable appetite and lead to over-consumption.

Why is high-fructose corn syrup so omnipresent? It’s cheap, about half the price of cane sugar, largely because the Big Food industry and corn refiners having successfully lobbied for subsidies that are guaranteed through the Farm Bill. The production of high-fructose corn syrup (and other sweeteners) under their true cost of production is a citizen-funded, government-enabled grant to companies like Coca-Cola who pack their drinks with sodium to make your thirstier and mask it with cheap HFCS. This allows Big beverage to market its product in increasingly larger portion size. We have all witnessed, and perhaps experienced, the 44 oz. Big Gulp, the daily consumption of which will yield fifty-seven pounds of fat by year’s end. 

What is the by-product of ubiquitous high fructose corn syrup (and processed food in general)? From 2000 through 2018, the prevalence of obesity in the United States increased from 30.5% to 42.4%. What is obese? Obesity in adults is defined as a body mass index (BMI) of greater than or equal to 30. BMI is calculated as weight in kilograms divided by height in meters squared, rounded to one decimal place. To save you some math, a BMI of 30 for someone 6 feet tall is 222 pounds. A BMI of 40 (severely obese) is 295 pounds. And the prevalence of severe obesity has increased in the last 20 years from 4.7% to 9.2%. For comparison, obesity rates in China hovers around 6%. Little doubt remains that there is a correlation between sugar consumption and obesity rates.

Sugar is also known to suppress the immune system. Just by consuming 100 grams of sugar can suppress white blood cell function by 40% for at least 5 hours. 

Why interrupt your Sunday brunch with this disquisition on the evils of sugar at this very moment? Because while COVID-19 is a nasty, highly transmissible and potentially fatal virus, lurking behind the pandemic, is a more pervasive and insidious epidemic. We consume too much sugar. We are increasingly obese and living with chronic disease and inflammation. In our immune compromised state, we increase our susceptibility to viruses.

Escalating obesity prevalence is directly tied to sky-rocketing rates of chronic disease, most notably diabetes. There are 35 million American adults (10.5% of the population) with Type 2 diabetes and nearly 100 million additional people that are pre-diabetic. The estimated domestic total economic cost of diagnosed diabetes in 2017 was $327 billion.

There is a distinct socio-economic component to these data that often correspond with racial inequities. Black men are 7% more likely to be obese than white men. And Black women are the most disproportionally impacted group with obesity rates at 57% (17 points higher than white women). Comorbidities, the simultaneous presence of two chronic diseases or conditions in a patient, such as obesity and diabetes have contributed to a COVID-19 age-adjusted fatality rate among Black Americans that is 3.7 times White Americans. 

I cast no aspersions on people carrying extra weight. My childhood chubbiness and its accompanying self-esteem issues have been thoroughly documented in my prior screeds. And, in full candor, I am currently in a knife fight with a pair of muffin tops that are cresting over my belt loops as I approach 50. To be clear, being healthy should not be confused with the commodification of wellness which projects unattainable images of perfection in attempt to create a feeling of deficiency and then markets products and services to address that perceived lack. Being well is not about appearance. It’s about health and, thus, should not be judged.

The media floods us with daily stratagem to address the riddle of snowballing COVID diagnoses. Indeed, there was a point when America could have followed the lead of other nations and quashed the spread through well-documented policies that include a combination of personal responsibility and governmental leadership. These tactics include mask-wearing, social distancing and personal hygiene in combination with mass testing, contact tracing and the curbing of superspreading events. (By most estimates, just 10 to 20 percent of coronavirus infections account for 80 percent of transmissions.) Incompetent leadership may have ironically informed a new strategy for international terrorism. “Leave the United States alone. They’ll do themselves in.”

While there is a glut of newscasters, scientists and CDC officials hammering home important, if conventional, policies, there is a deafening silence from the media and the mainstream medical community around personal health, the pre-COVID ground conditions in America that have led to such widespread transmissions and fatalities (5.2MM cases and 166,000 deaths at publishing).

There is data emerging suggesting a correlation between excess weight and COVID-19 severity.

A recent OpenSAFELY study reports the risk of dying from COVID-19 increased by 27% among obese individuals and was doubled in patients with a body mass index greater than 40.

In a prospective cohort study of patients with COVID-19 from New York City, the prevalence of diabetes and obesity was higher in individuals admitted to hospitals than those not admitted to hospitals (34.7% vs 9.7% for diabetes and 39.5% vs 30.8% for obesity, respectively).

Instead of celebrating the elixir of binges, from Chubby Hubby to Netflix, that has conspired to coin the term “the COVID fifteen” (referring to weight gain from inactivity during quarantine), we could be seizing this moment to have an initiative for public health:

• To promote exercise, mindfulness practices and proper nutrition as a means to build healthy immunity.
• To take on Big Food and hold them accountable by, at the very least, internalizing their true costs.
• To educate widely on nutrition, promote cooking and community gardens.
• To provide incentives for grocery to enter underserved neighborhoods and stock fruits and vegetable.
• To make SNAP benefits redeemable online such that these services can deliver to underserved communities.
• To consider taxes on egregious products (similar to cigarette tax).
• To enlarge the FVRx program (fruit and vegetable prescription program for children).
• Pass a new Farm Bill.

There is very little public discourse focused on what we need to do to improve the underlying well-being of society. And while robust immune systems are not going to protect us from more lethal viruses (like Ebola), there is plenty of good reason to address the underlying roots causes of our societal dis-ease. We can leverage this moment to invest in our communal health or continue lining the pockets of Big Pharma to incessantly treat the mal-effects.

Further, well-being must cease to be a class privilege. Running, walking, practicing yoga, core exercise and meditating require time but virtually no financial resources. If you could benefit from a free yoga or meditation course to jumpstart your wellness routine, please email me.

The access both logistically and financially to high quality food, however, must be addressed.

Enough confabulating, I am late for kick-off. I return to the game sheepishly with my bags of treats. Fifteen individually packaged bags of chips, a case of juice boxes, a pack of Chips Ahoy and a watermelon that I manage to carve up with an old library card.

The Red Devils are crushed 8-1, mostly due to the opposition’s pair of dazzling Brazilian twins. The mourning quickly dissipates though as snack is unveiled. Lolli, who knows my sugar rant too well, is relieved by my selections. She gives me a nod as if to acknowledge and assuage the wave of hypocritical guilt she knows I am surfing. The team drowns their sorrows in corn syrup. Finally, out of pure sympathy, a compassionate mom reaches for a jagged slice of watermelon. We look at each other, then together at the kids and simultaneously shrug in resignation.