There is a lot of excitement that deaths from opioid overdose decreased in 2018, dropping from 70K to 68K. Per the CDC:

From 1999 to 2017, more than 702,000 people died from a drug overdose. In 2017, more than 70,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Sixty-eight percent of those deaths involved a prescription or illicit opioid.

Slowing that epidemic was easy once since the cause was so clear. The marketing of Oxycontin (oxycodone) by Perdue Pharma initiated the crisis, and when we finally stopped giving out opioids like candy, the opioid problem stopped increasing. No doubt, we will continue to see a benefit in terms of fewer opioid overdoses (alas in a world of increasing meth and cocaine OD). I doubt we will see fewer substance use problems, since the folks that are addicted are still there for the most part. We just aren’t adding many new ones (except for youth and nicotine/THC via vaping of course).

In contrast, the ever-expanding obesity epidemic is a problem with no end in sight:

• Ward Zachary J, Bleich Sara N, Cradock Angie L, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. New England Journal of Medicine. December 19, 2019;381(25):2440-2450. doi:10.1056/NEJMsa1909301.

Investigators arrived at the following conclusions after using more than 20 years of data from 6.3 million adults to project into 2030.

• Nearly half of American adults will be obese within a decade and one-quarter will be severely so.
• Severe obesity – and the serious health problems and extra healthcare costs associated with it – will disproportionately affect women, low-income adults, non-Hispanic black adults, and states bordering the lower half of the Mississippi River.
• 29 states, mostly in the South and Midwest, will be hit the hardest, with more than 50% of their residents considered obese
• No part of the U.S. is spared – in all 50 states, at least 35% of the population will be obese.

According to Time, not the researchers: The data highlights the urgent need to find even more ways to address diet, exercise, and lifestyle factors that can contribute to weight gain, including nutrition education, access to safe places to walk or exercise, and support for avoiding sedentary behavior throughout the day.

Let’s take that apart. Like opioids, we have a problem where we are giving out something like candy. However, it is actually candy, meaning sugar or more broadly, sweetness, which includes fake sugar. It all started with low fat = high sugar, and it hasn’t stopped. Sure, soda sales are going down, but is sugar consumption decreasing? Is artificial sugar decreasing? And like opioids, if we ever stop new people from becoming obese, we will still be stuck with the cost of treating the obesity we have.

So what do we blame?

• Diet. Are we willing to tax sugar and processed food? Subsidize vegetables? Remove the concept of “generally recognized as safe” (GRAS) for chemicals? No, so these foods continue to thrive in the American diet.
• Exercise. We have handy maps that show how inactive we are from the CDC, as well. So, starting with the rise of Snackwell, as a society, we went from being so active that we burned a ton of calories to such high inactivity that we became obese? I am a big fan of exercise, but I don’t remember everyone joining in Jack Lalane back then. Golf was more popular, but does anyone really think that walking (or riding) around a golf course uses a lot of energy? I also see lots of people in active jobs, where they are on their feet, who are obese. And I see a ton of Fitbits and gyms now. So where is the data that inactivity is the cause of obesity (or activity is the solution)?
• Lifestyle Factors. Yes, there are a number of factors to be considered when addressing the reduction of obesity. However, each of these individualized situations can be considered, and methods of change applied if we have open and honest conversations about them.
• Nutrition Education. Really? So, after 50 years of guidelines in the form of plates and pyramids, people are confused and need more education? Honestly, the basics are pretty clear (to adults):
  • Candy/Soda – not healthy (but tasty).
  • Vegetables – healthy (but not tasty).
• I doubt more plates, pyramids, 5-a-days, or meal planners are the key to solving this problem.
• Access to Safe Places to Walk/Exercise. If the danger of society and urban environments limiting activity is the problem, why is obesity high in rural America? And if we could magically create running and jogging and walking trails throughout our neighborhoods (with lighting and safety monitors), would the obesity epidemic wither away? I believe the data is that our society is actually safer now.
• Support For Avoiding Sedentary Behavior. There are many opportunities to avoid sedentary behavior, such as taking a walk around the block or building during down-times, getting up and taking a break during long stretches of work or leisure, biking or walking to places rather than driving. However, our society revels in being sedentary because we can. We have access to endless hours of entertainment at the push of a button, so why not just stay on the couch?

Per the Wizard of Oz, pay no attention to the greedy industries stuffing empty calories and untested chemicals into your body.  Instead, let’s blame the non-existent “don’t move industry.” They have taken over, and, through their endless need for profit, convinced you to not move. And that’s the problem. We can build some walking trails and some education, so when you don’t use the trails or follow the education, we can blame you. Or, like the connection between tobacco and cancer, we need more studies.

Sadly, when you ignore the cause of a problem, it gets worse. The country (finally) recognized excess prescribing of opioids, and, in response to that realization (and doctors fear of getting sued or thrown in jail), the epidemic has peaked. We ignore the danger of food/drink/chemicals and blame other causes, and the problem is getting worse and worse.

---

Is sugar the whole problem? Larger portions are another element. The solution to the obesity epidemic will not come from the government or industry, but from individuals. I like intermittent fasting, because it also highlights the need for portion control (to counter portion supersizing by the industry):

• de Cabo Rafael, Mattson Mark P. Effects of Intermittent Fasting on Health, Aging, and Disease. New England Journal of Medicine. December 26, 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136.

But, I see little hope in changing the industry that profits by getting people to eat/drink more. And when foods with sugar added achieve higher sales. I’m not seeing a profitable business model for pushing portion control on people, and for the same reason, a sugar ban seems unlikely. That solution will come from outside, and that solution is us.