The Prescription Pad

Quick - Who is the Surgeon General of the United States? (His name is Richard Carmona, but who cares?) I had the opportunity to meet David Satcher, a Surgeon General you have probably heard of. Dr. Satcher had a habit of writing special Surgeon General's prescriptions for people, but they weren't for drugs. He'd write a prescription to eat vegetables, walk to the commuter train instead of driving, spend more time with your kids, that sort of thing.

I thought of Dr. Satcher's prescriptions when I read about a new study in the Annals of Internal Medicine -- reported here by Alex Dominguez for the AP -- that suggests a 90% lifetime risk for overweight among men and 70% lifetime risk for women. Many people who make it well into middle age without becoming overweight ultimately succumb. For weird and objectionable historical reasons this study, based on a cohort of children of the original Framingham Heart Study cohort, is limited to white gringos; the reality is probably even worse for the total population.

If you want to know why we're in such danger, just take a look at a picture of Henry VIII. That's what can happen to you when food is in unlimited supply, and His Royal Highness need not bestir himself to obtain what is needful. In Genesis we are told that Man is condemned to a life of toil but like many of the Bible stories, that turns out not to be true after all. It used to be that poor people did hard work and rich people didn't, but today's low-paying jobs at desks or behind retail counters don't include physical exertion. Rich people actually pay for the privilege of exercising, by joining "health clubs" in order to spend a few hours a week engaged in physical toil for its own sake, usually consisting of extremely boring activities like walking or jogging on a treadmill. Usually they don't manage to keep it up for more than a few months.

Since the Surgeon General isn't writing prescriptions any more, here's what David Satcher would have told you. We need to make physical activity a part of our lives, not something we take on as an extra burden. For urban apartment dwellers, in the 15 minutes you spend waiting for the bus, you could have walked to your destination. You can throw a frisbee in the park for free and there's no law that says you can't do it when you're sixty. If you're in the burbs you can ride a bike to the 7-11 for the quart of milk, you don't have to drive. Get into gardening, build a stone wall, learn how to do things. If you can work up to strenuous exercise so much the better, but even a half hour a day of moderate exercise makes a huge difference.

This kind of personal advice is worth listening to, but there are also important social issues here. Patterns of residential and retail development based on the assumption of the automobile have made it much more difficult. Urban neighborhoods where people don't feel safe to walk the streets or let their children play in the park are even worse. The seduction of the television is literally killing us. The epidemic of obesity is threatening to reverse the gains in health and longevity we made during the 20th Century. It really is that bad. We need to get moving.