I came across this tweet today.
The elderly, those with a metabolic disorder, and a few other small demographics, are the most vulnerable to poor COVID outcomes. That is clear. That is not to say that younger, healthier people can’t also be affected by the disease, but those cases appear to be the exception thus far.
I have seen many tweets like this in the past month or so. Standard replies to the question of ‘why not diet advice’ are as follows:
Because ‘big food’ runs the government
Because there’s no money in keeping people healthy
Because physicians are in the back pocket of pharmaceutical companies
Before I get into my take on this question, I want to give responses like these their due.
Food companies no doubt influence government food policy. Everything from dairy to corn, to fruit loops, has a hand in the nutritional pot. Pharma companies are scrambling to turn this pandemic into dollars. I am not arguing against that reality. I intend to point out that these are not the main reasons we don’t hear more about lifestyle-driven virus prevention.
The Elephant in the Room
What people are not talking about is the fact that Americans have not been historically receptive to diet and exercise advice. One hundred million Americans are spending twenty-billion dollars every year inside the weight loss industry. We can argue the intent of the weight loss market and the effectiveness of what it delivers, but we can’t argue with the fact that the obesity rate in the US is at almost 50% of all adults. The obesity rate has grown by around 25% in the last 15 years.
The obesity epidemic has been steadily rising during a time of unprecedented access to diet and exercise information. Five million diet books get sold each year. There are more gyms and gym memberships than ever before. Yet, as a nation and continent, we are all heavier and sicker than we’ve ever been.
Before the dogmatists start talking about how ‘if everyone followed their diet, they wouldn’t be overweight,’ let me clarify a few things. I don’t care if you follow a Vegan Diet, Paleo Diet, Keto Diet, Carnivore Diet, or the MetFlex-Rx Diet. If you are eating whole foods, avoiding processed foods, and being frequently active, your health will dramatically improve. There are many success stories attached to these various ways of eating, but we must realize that while transformation is undoubtedly possible, these cases are the exception. The vast majority of people who try to change what they eat or how much they exercise cannot keep it up.
You may think that with this current climate and fear of disease contraction, it’s an excellent opportunity to motivate the average person to improve his or her lifestyle. But cancer, heart disease, diabetes, neurodegenerative disease, and all other big disease killers have already been shown to be at least partially influenced by diet and state of health. If those aren’t already motivating the average person to clean up his or her diet, what makes you think COVID will?
If you are in medicine or in government, you must consider issues of expedience and compliance. Lifestyle changes are highly involved and challenging to apply. Those who manage to turn their health around are rare breeds. But everyone is capable of taking a medication or vaccine. This is unfortunate, but it is the current reality. Imagine if you took one million Americans and gave them these options. You can:
A- take this pill
B- you can start exercising every day, quit drinking, quit eating junk food, and abandon all of the other habits you’ve formed over the last 40 years
Which do you estimate will be the more common choice? Which route do you think will have the higher compliance?
I don’t mean to sound pessimistic. The health and fitness industry is the world in which I work. I have hope for all people. I believe all people (given the right circumstance, tools, and timing) can take control of their health. But that is my role and my reality. People in government and those who are responsible for containing the spread of a poorly understood pandemic cannot focus on the advice that is least likely to be followed. As lovely as lifestyle interventions for a pandemic may sound, if we know, statistically, that it has a low likelihood of ‘sticking,’ it is irresponsible to make it the focus of a solution. This is especially true when the goal is still to prevent the spread from overwhelming medical systems.
When the dust settles, and we have greater control and understanding of what happened over the past 6-months, we can start talking about long-term prevention. Even then, only a handful of people (hopefully you) will take that advice seriously for more than a few weeks or months. It’s not that the average person doesn’t want to be healthy. It’s because taking control of your health is far more complicated than being told what to eat and what to avoid.
Taking care of yourself matters, but it has always mattered. In this face of terrible diseases, rising obesity, and a host of other negative consequences, people are not getting fitter. We are getting fatter. I encourage those in the fitness industry to continue doing their part in aiding those who are seeking to change. Still, I would also ask that you attempt to understand why policymakers would be hesitant to put lifestyle interventions ahead of medical interventions. One has a high rate of compliance. The other is quite low. And we all know that compliance is the key to all outcomes.