Tuesday, December 18, 2018

Sonoma Medicine

The magazine of the Sonoma County Medical Association

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The Elusive Cookie Jar

Mark Sloan, MD

I was a chubby kid, or as my elderly Aunt Kit described me, “a tad fleshy.” A blunt-spoken woman, Aunt Kit’s view of humankind and its frailties was shaped by a poor Irish childhood and decades of hard domestic work in swanky high-rises on Chicago’s lakefront. Rail-thin herself, she viewed my fleshiness as a worrisome sign of underdeveloped willpower. “Keep the cookies farther than your arm can reach,” she sternly advised me, “and you’ll not be fleshy long.”


Sound advice, though I don’t recall ever acting on it. Like a lot of formerly overweight kids, it took me years--and Mr. Dannheiser, a pitiless ex-Marine football coach who ran the fleshiness right off me--to slim down. Willpower had very little to do with it.


Right about the time Mr. Dannheiser was running me ragged, the federal government began turning its attention to health promotion, focusing on improved nutrition, increased exercise, and smoking cessation. We’ve made significant inroads on smoking--when was the last time you saw someone light up on an airplane?--but those other goals have proven elusive, sometimes depressingly so. A scan of a modern U.S. “obesity map” is sobering: they’ve had to add new colors (dark red is the latest) as the obesity rate in several states spills over the once unheard-of 35% level.


With the ready availability of junk food, the near-disappearance of physical activity at our teach-to-the-test schools, and limitless electronic inducements to stay firmly planted on the couch, staying fit is even tougher than it was in my childhood. One-third of today’s school-aged children are overweight or obese. Given such an unhealthily stacked deck, it’s surprising that even more children aren’t facing a dismal future of heart disease, hypertension and diabetes.


Finding silver linings in such dark statistical clouds isn’t easy, but there are some optimistic trends on the obesity front, both nationwide and locally. Here are just a few:


• Through its iGrow and iWalk programs, Health Action, a county-wide collaboration supported by the Department of Health Services, has helped establish nearly 500 local gardens (a total of 22 acres) and has recruited 84 employers committed to workplace fitness. Another program, Safe Routes to School, promotes biking and walking to school.


• Since 2006, the Healthy Eating, Active Living Community Health Initiative, a project of the Community Activity and Nutrition Coalition of Sonoma County, and funded by Kaiser Permanente, has helped increase physical activity and improve nutrition in the Kawana and Roseland neighborhoods.


• The Redwood Empire Food Bank will provide more than 3,250 tons of fresh produce to the area’s needy citizens this year, and its Megan Furth Harvest Pantry delivers fruit and vegetables to 550 families weekly throughout Sonoma County. The REFB also has recently launched a healthy foods program for low-income adults with type 2 diabetes.


• Cotati may soon become the first jurisdiction in Sonoma County to add a Health and Wellness Element to its General Plan. Healthy by Design, a multidisciplinary group of local health, planning, human services and sustainability advocates, continues to promote the connection between land use planning and community health.


These and many other projects seek to address the larger structural issues that contribute to our ever-heavier society. But what can a physician do in his or her own practice, when faced with a daily schedule filled with overweight or obese patients? How can we best set individuals and their families on a path to better health?


This issue of Sonoma Medicine is dedicated to those questions. Drs. Cheryl Green and Lynn Mortensen write on the challenges--and rewards--of counseling the individual patient; Dr. Mariah Hansen considers the benefits of the family meal; Drs. Wendy Kohatsu, Rachel Friedman, and Alisha Prystowsky describe their innovative nutrition program for women at risk of gestational diabetes; Dr. Tara Scott challenges doctors to become advocates for healthy and sustainable food; and Dr. Jennifer Hubert discusses medical options for obesity treatment. As a postscript, Dr. Deb Donlon reviews Why We Get Fat, and What to Do About It, by Gary Taubes, a book that is sure to keep the healthy diet debate raging.


Aunt Kit’s advice about my arm and the cookie jar was right on the mark. Willpower will always play a role in staying healthy. But willpower alone, especially in the face of an unhealthy food supply and poorly designed communities, can only go so far.

Dr. Sloan, a Santa Rosa pediatrician, serves on the SCMA Editorial Board.


Email: mark.sloan@kp.org



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