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09Dec

We live in an obesogenic society filled with mental, emotional, and physical cues that make us the most overweight population in history. This is not sustainable, and our fragile healthcare system will soon collapse under the stress of this immense disease burden. 42.4% of Americans are obese, this number is expected to increase to 50% by 2030. There is good evidence that 87.8% of adults are metabolically unhealthy, a term that identifies how excess fat mass exacts a heavy toll on health. Metabolic dysregulation, typically due to obesity, is causing an explosion of chronic disease – type 2 diabetes, cognitive decline, heart disease, autoimmunity, and cancer. Obesity has surpassed smoking as the number one preventable cause of death. There are a staggering 900,000 lifestyle related deaths a year just in the USA. Our obesogenic environment is a despicable hate crime being perpetrated on our fellow citizens. It is exacting a horrific toll of unnecessary mental, emotional, and physical suffering. Understanding and ending the obesity crisis must become a national priority.

“The obesity crisis is a tragedy we seem powerless to slow down, much less stop.”

It is Not Our Fault

If you struggle with weight it is not your fault. Confusion, rage, discouragement, and hopefully a bit of enlightenment will ensue upon reading this. Obesity is a difficult and personal topic that must be dealt with straightforwardly, immediately, and comprehensively.

In 1950, 10% of the American population was obese. We did not suddenly become ignorant and slovenly. Our genes did not mutate in 70 years. Rather, modernity has created an onslaught of environmental/evolutionary mismatches. These discordances are destroying our mental, emotional, and physical health.

The amazing scientific and technological progress of the last 75 years has brought with it an overwhelming number of modern-day challenges. Poor sleep, sedentary lifestyle, lack of sunlight, and high-calorie, low nutrition, addictive foods are the most common physical mismatches. These challenges are exponentially compounded by unprecedented levels of mental and emotional stress.

Mental Stress

We are living during the greatest moment of change in human history. Society is accelerating so quickly it is impossible for anyone to keep up. It is difficult to quantify the devastating impact these increasing levels of stress are having on our health – we know it is bad.

Emotional/Relationship Stress

Relationship disruption is perhaps the most devastating impact of our evolutionarily mismatched modern society.  The power to dominate the planet comes from our ability to cooperate on a massive scale. Extended parental investment and the need for community are hard-wired into our neurology. The intersubjective stories, some good – many awful – bind us across generations and cultures.

These stories are rooted in our need for relationships. Every fiber of your being yearns for social connection. Not the delusion of relationship propagated by the “anti”- social media rage machine. Suicide, fast and slow, is the horrific symptom of this modern culture of addiction, depression, isolation, and desperation.

Never before have we been able to survive while isolated. This, in my opinion, is the most devastating effect of our modern-day “progress.” Food has become many people’s relationship of last resort. As modern society makes it possible to disconnect and isolate, there is one mandatory relationship that remains. In this context we must consider; Will the perfect diet transform our relationship with food (life)? The obvious answer is no. This does no minimize the importance of the study of nutrition. We must approach this crisis holistically to end the mental, emotional, and physical suffering caused by the obesity epidemic.

The End of Fat Shaming

We look in the mirror and hate what we see. We gained excess weight by eating for emotional reasons and then want to lose weight for emotional reasons, beginning a descent into perpetual conflict. There is nothing intrinsically wrong with drinking a six-pack of beer and eating a pizza nightly. There is only one question: Is this behavior consistent or inconsistent with my vision for life? The day you earnestly ask and answer that question is the day your new journey begins.

If you are able to create a body that carries 50 pounds more than you desire, you can also consciously and deliberately create something new. There is no shame, no right and no wrong, just a decision followed by a change in thoughts, feelings, and actions. On this new journey, we must identify and confront the mental, emotional, and physical challenges for predictable results.

“We must institute mental, emotional, and metabolic flexibility in our lives for permanent weight loss – there is no other solution.”

Metabolic Flexibility – Good Science

Diet: A small word for such a big topic. The search for what is proper nutrition is an information quagmire. The challenges in nutritional epidemiology are well known (look up healthy user bias). The diversity of diets proposed by competent caring scientists is overwhelming. The diversity is astounding; vegan-carnivore, low fat-high fat, high carb-low carb, saturated fat-polyunsaturated fat, it is a minefield of confusion. The following offers some actionable insights based in good science. In your pursuit of good health look for the environmental mismatch and correct it. Sleep eight hours a night, collapse your eating window to 12 hours or less, move more, get sun, turn off your devices well before you go to bed, love more, argue less, help others – easier said than done, but harder if you don’t.

Regarding diet, experts from all ends of the spectrum agree on one thing; eliminate processed foods. We are inundated with high-calorie, low-nutrition, inexpensive, convenient, addictive food. This is our most seductive and debilitating environmental mismatch. Food is survival and we are drawn to these types of hyper-palatable foods. This survival instinct has become a bug in our modern society. There is good evidence that processed food is a major cause of the obesity epidemic. You know the culprits, refined sugar, processed flour, processed vegetable oils, unnatural fats, and Hot Pockets!

Metabolic flexibility is the key to healthy longevity. It is important to be able to cycle between using food for energy and metabolizing stored food, better known as fat. A never-ending abundance of excess food has shut down this natural cycle and is the underlying cause of all chronic diseases. The constant abundance of food is pro-growth, pro-disease, pro-cancer, and pro-aging. Flexibility is the key to long-term health; physically, mentally, and emotionally.

Mental Flexibility – Structural Conflicts

Structural conflicts are the main offender here (there are many more). When we eat for emotional reasons (stress) it causes weight gain. We then catch awkward glimpse in the mirror or hear an impolite comment and we want to lose weight for emotional reasons. This pattern creates a common structural conflict that consumes all your creative energy. You cannot eat and not eat at the same time. After a lifetime of yo-yo dieting and/or failed willpower, we ultimately live in a very narrow range of tolerable conflict.

I will not depress you with the permanent weight loss statistics – the numbers are abysmal. Health, the most important area of your life, is embroiled in conflict, stress, anxiety, and eventually dis-ease. Ultimately, we live in a narrow range of tolerable conflict, with a diminished quality of life, and long-term suffering.

Emotional Flexibility – Food is Our Only Mandatory Relationship

Perhaps the most devastating environmental mismatch is social isolation. Modernity allows us to disconnect from everyone and everything except food. We then try to make food do things for us it was not designed to do. The following is the short list:

  1. Void – Food is great at filling a physical void. It was not  designed to fill mental or emotional voids – emptiness, boredom, or loneliness.
  2. Stress – creates a chronic sympathetic response, there is no quicker way to evoke a parasympathetic response and temporarily relieve stress than eating.
  3. Opposing Needs – We have the need for consistency and variety. Food is perfectly designed to meet both needs simultaneously – always there, infinite variety.
  4. Love – Food means love, family, and relationship in many households.
  5. Addiction – Food clearly has addictive properties, especially processed food; it is myopic to look at it solely as an “addiction.” Drugs, cigarettes, and alcohol are not mandatory.
  6. Social Isolation – We need connection,  someone or something we can count on. The modern world allows us to disconnect from everyone and everything except food.
  7. Environment – We live in an obesogenic environment. Inexpensive, high calorie, low nutrition, addictive food in abundant supply.
  8. Immediate Gratification – Eating is an enjoyable, relaxing, necessary survival activity.
  9. Perverse Incentives – The food and medical industries maximize for profits while optimizing for obesity and disease.
Ending the Obesity Crisis

Obesity is our greatest mental, emotional, and physical challenge. Obesity is the crisis behind the crisis. The nutrition and diet industries are confusing. World-class scientists completely disagree. Mental stress is growing exponentially. Social isolation is our most disturbing and devastating environmental mismatch. Obesity is the symptom of a much deeper societal problem.

It is no one’s fault. This crisis is not about right or wrong and certainly not about shame. The question should be: Is excess weight a conscious and deliberate creation or are you letting a society filled with perverse incentives dictate your health? We must transform the perverse incentives and eliminate environmental mismatches. Weight loss programs must focus on mental, emotional, and metabolic flexibility. They must be based in good science and create an environment where people can transform their relationship with food permanently. Now is the time to take responsibility for our health and create the environment, society, and life we deserve. This is a national health emergency. Ending the obesity crisis with the hundreds-of-thousands of premature, painful, and unnecessary deaths must become our top priority.

Dr. Steven Cangiano began his college career with aspirations to become a high school teacher. These aspirations took a turn when he decided to follow in his father’s footsteps and go into the field of podiatric surgery. He completed his medical school training at Temple University and his surgical residency at the NY College of Podiatric Medicine where he was chief resident. He continued his academic career and fulfilled his early teaching aspirations by becoming an assistant professor of surgery at the age of 27. He was board certified in foot and ankle surgery at the age of 28. As residency director of the Franciscan Health System of NJ, Dr. Cangiano grew the program into the largest in NJ. Dr. Cangiano published multiple articles in medical journals and spent a total of thirteen years in academic medicine before venturing off into the world of complementary medicine.

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