David Katz, MD, MPH, FACPM, FACP

David is the founding director of Yale University’s Prevention Research Center. He is a board certified specialist in both Internal Medicine and Preventive Medicine/Public Health. He is the director and founder of the Integrative Medicine Center at Griffin Hospital in Derby, CT.

Under Our Skin
As a clinician for the past 25 years, I have gone through the distinctive choreography of clinical care thousands of times: meet a stranger; exchange greetings; enter an exam room; close the door; dive into every intimacy. On innumerable occasions, I have encountered composed, well dressed, apparently accomplished, emotionally stable adults. And then behind the closed door of an exam room, that person would come undone and tell tales of personal catastrophe such as sexual assault in childhood, drug use by a child, beatings by a spouse, struggles with addiction, the list goes on.
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Processing Messages About Processed Food
The American Society of Nutrition (ASN) recently issued a controversial position paper on processed foods. It examined the food sources of key nutrients in the prevailing American diet. The authors noted that a significant percentage of many important nutrients, including fiber, folate, calcium, and potassium, were obtained from processed foods. The basic take-away message, if there was one, was that processed foods are not all bad.
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Faith, Facts, Lives, and Livers
One of the many myths about health issues today stands out for its sheer audacity, and that is the myth that the obesity epidemic itself is a myth. The argument is propagated in particular by University of Colorado law professor Paul Campos, whose book, entitled “The Obesity Myth,” garnered considerable attention when first published and has a following to this day. I’ve never considered it my vocation, but I do find that, as a defender of epidemiological fact, I am obligated to confront a lot of nonsense, folklore, and myth. Epidemic obesity, alas, is no myth, and here is why.
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Weight Is Not a Choice
Weight is powerfully influenced, but not directly determined, by our behavioral choices. Some people, making all the right choices, will be heavier than others making the same or even worse choices. And people making good lifestyle choices, including routine exercise, are apt to be fit even if they remain somewhat fat, and will be far better off than those who are either fat or thin, but unfit.
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Junk Food Warning Labels
At the 67th World Health Assembly that just concluded in Geneva, the case was made that junk food is even more damaging to public health than tobacco, and that warning labels should be posted accordingly. The argument is far more defensible than it may at first seem. Instead of thinking that warning labels might go too far, I wound up realizing they wouldn’t go nearly far enough. Junk should never have been glorified as a food group in the first place.
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Can People Be Fat and Fit at the Same Time
A recent study has generated widespread media attention because it challenges the notion that it is possible to be fat and fit at the same time. As ever, there is some potential devilry in the details. In the real world, fit and not-so-fat tend to go together, for the most obvious of reasons. But true fitness also means good metabolic health, and that is highly dependent on diet.
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The Salt Fix
We have long had abundant reason to believe that most of us living in the modern world eat too much sodium and would benefit from consuming less. Of two recent studies on salt intake and health outcomes, predictably the one that challenged the prevailing view garnered more media attention. The authors concluded that mortality and heart disease rates were higher among those with both low and high sodium intake, but the lowest for those with intake in the middle range.
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What Really Kills Us
Heart disease is not the leading cause of death among men and women in the United States. Cancer, stroke, pulmonary disease, diabetes, and dementia are not the other leading causes of early mortality and/or chronic malady either. They are effects. If these account for 80 percent of premature deaths, it stands to reason that their opposite could eliminate up to 80 percent of all premature mortality and chronic illness. This proves to be exactly true.
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Kindergarten and Karma
Dieting is an infamously lonely endeavor. People may eat with their families, but they diet alone. As a society we sanction a multi-billion dollar weight loss industry for adults. We line up, sign up, go on and fall off – all the while leaving our kids out of it. Every time we neglect a family-based approach to health and weight control, we increase the likelihood that our children will grow up to need those weight loss services even more desperately than we do.
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Drowning in Calories
Obesity is much like drowning. Our food supply is willfully manipulated to maximize our food consumption and, of course, the money we are willing to spend along the way. But how much sense does it make to acknowledge the calamitous effects of childhood obesity, yet continue to peddle multi-colored marshmallows to 6-year-olds as “part of a complete breakfast”? That’s analogous to holding people accountable for their own swimming, yet actively encouraging them to try out riptides. It is, in a word, hypocritical. With regards to weight and health, America runs on constant hypocrisy.
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Doctors and Patients, Ounces and Pounds
Historically, doctors have either neglected the topic of weight management or wagged an admonishing finger. That admonishing finger is useless at best. At worst, it is overtly harmful. Studies have shown that especially among younger women exposure to anti-obesity bias actually fosters unhealthy eating habits in the short term.
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Wishing You Healthy Holidays
In the pursuit of optimal health, there is the risk of sometimes forgetting what health is for. Health is for living, and while good health certainly makes life better, something is seriously wrong if concerns over health and weight issues ruin the good times. So don’t let those ruin yours. If something needs fixing, I don’t think it should be the holidays. Rather, I think it ought to be the rest of the year. Eat well and be active all year, and when the holidays come around – well, let the good times roll.
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Fixing Food Stamps Could Be a SNAP
The Supplemental Nutrition Assistance Program (SNAP), traditionally known as food stamps, has of late been much in the news. Competing views of SNAP figure prominently in the current Farm Bill quagmire. The harsh economy over recent years has landed one in seven American families on its rolls. In addition, the so-called Sequester keeps bumping people off, with many worrisome implications, and the rising poverty rate that makes such assistance ever more urgent is far more prevalent than most of us realize.
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Sleep on It
We have long known that sleep is of profound importance for good health. In fact, sleep is essential. We must turn off once in a while if we are to go on. Unlike many other factors that affect our health profoundly, the impact of sleep is both immediate and intimate. But most Americans sleep poorly or not enough. Research consistently associates chronic sleep deprivation with obesity and many other potential health risks.
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How Nurturing Your Health Can Change Your Genetic Nature
I have argued that the power of lifestyle – physical activity, dietary pattern, abstinence from smoking, etc. – constitutes the master levers of medical destiny. In response, I have received some pushback on behalf of genes. The counterarguments to mine are that what we do will not reliably determine what happens to us because of the potent influence of our genetic inheritance. There is of course some truth to this rebuttal. But it’s a bit like dismissing the value of master-level seamanship because of the risk of stormy seas. We will never control the wind and waves, but we still want a well-captained ship. In the poem “Invictus,” the ship of which we each are captain is our soul. In my purview, it is health.
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Disease-Proof
When you board a plane, you implicitly count on the skill of the pilot. You know, of course, that the pilot can’t control everything, e.g. atmospheric conditions. But controlling the cockpit is good enough for most of us. We know we can’t get a flight that is “guaranteed” to be safe, but we also know that with a skillful captain at the helm of a properly assembled plane, the odds are overwhelmingly in our favor. Well folks, I am here to tell you exactly the same is true when it comes to your health. The differences are only these: your body is the plane, and you are the captain.
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Debunking Vaccination Myths
This year, as every year, I will roll up my sleeve and get vaccinated against the flu. This year, as every year, I recommend you do the same. And this year, as every year, I know some of you will decline this recommendation, and some will even denigrate it. Anti-vaccine sentiments are seemingly pervasive in our culture and, at a minimum, ardent and vocal. The strongest argument against immunization is that it represents science interfering with nature. The notion is that our immune systems can handle the job without outside interference. The trouble with that is that the nature in question – the one to which our immune system is adapted – is long, long gone. It does not exist today, and it has not existed for millennia.
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How Your Medicine Can Kill You
I take no medications. I don’t need any because I practice what I preach, and use lifestyle as my medicine. Anyone can do the same with the right skill set, and if more people did, the pharmaceutical business would be a whole lot smaller and less profitable. But I am also pragmatic. I look around and see a world awash in chronic disease, stealing life from years and years from life. And while lifestyle is best to prevent all that misery, modern medicines are often best for effective treatment.
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Bunk About Junk Food
A recent article in the Atlantic, titled “How Junk Food Can End Obesity,” has attracted a lot of attention. In it, the author, David Friedman, makes the case that processed food is here to stay, so we are better off by making it a part of the solution than maligning it. The problem with this assessment is that junk food, by its very definition, is not good for anyone. If it was good for us, what basis would there be to call it junk? Junk food cannot help solve our health problems because if it did, it would no longer be junk food. For this reason alone, junk food should never have been a food group in the first place.
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Obesity as Disease
As obesity is now officially acknowledged as a disease, it will warrant greater attention by health professionals, including doctors. This, in turn, may produce more constructive and compassionate care. But overall, I see more liabilities than benefits in designating obesity a disease. For starters, there is the simple fact that obesity per se is not a disease. Some people are healthy at almost any given BMI. There are better ways of looking at the issues.
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Opinion Stew
When it comes to nutrition, not only does everyone have an opinion, but also seems to think theirs is an expert opinion. Almost everyone who has ever gotten fat and then lost weight is embraced as an expert, authorized to dispense advice and sell books. Don’t get me wrong, I am delighted for every individual who figures out how to lose weight, and more importantly, find health. But the notion that this automatically registers as expertise is simply absurd. As a result, we already have far too many silly diets than anyone could try in a lifetime, and we just keep getting fatter and sicker all the while.
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Fixing Obesity
We are poorly equipped to perceive calamitous causes and effects when they play out in slow motion. That is especially true when it comes to the obesity crisis we are currently facing in this country and around the world. We could fix obesity. It’s hard because profit and cultural inertia oppose change. But it’s not complicated. Consider how differently we would feel about junk food if it caused obesity or diabetes immediately, rather than slowly. Imagine if you drank a soda and your waist circumference instantly increased by two inches. It likely will anyway, it’s just a matter of time. But its not immediately obvious. And that’s part of the problem.
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Processed Food, Processed People
Anyone living and eating in the modern world, and paying even a little attention, knows that we are a very long way from Michael Pollan’s advice to eat real food, not too much, mostly plants. Not only does our food come mostly in bags, boxes, bottles, jars and cans, but mostly it isn’t really food. It’s food stuff. It doesn’t come from an animal or plant, it’s made in a plant. It rolls off an assembly line. And more than food is being processed. We are being processed by food industry marketing distortions.
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Addictive by Design
When Michael Moss, the Pulitzer Prize-winning New York Times journalist, wrote an exposé on his work on addictive junk food that recently graced the cover of the paper’s magazine, it revealed that academic debate whether or not food is addictive is at best a side show and at worst a boondoggle. Food companies know full well that food can be addictive and they engage scientists to make it so. Only by choosing natural foods that aren’t processed and adulterated, consumers can preclude food industry mischief.
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A Better Recipe
What we know about diet and nutritional health reminds me of the famous parable, “The Blind Men and the Elephant,” in which each of six blind men seeking knowledge of the beast take hold of a different part of its body, from tail to ear, and reach a different conclusion. Each one of them was partly right but wrong about the whole thing. Likewise, no one thing is wrong with the prevailing American diet, and no one remedy will right it any more than a single part represents the whole elephant in the room.
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The Missing Link in Health Promotion
There was a time when the irreducible unit of human culture was larger than the family. It was the clan or tribe or village. Family used to be what is now called the “extended” family, and traversed several generations. But the “nuclear” family does persevere, and it is the smallest unit of social cohesion at which culture is achievable. And culture will determine the road we take to the future of our health. It is culture that will make all the difference.
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The Hollow Leg and the Hypothalamus
There is a particular ‘Thanksgiving moment’ that occurs as the meal winds down. I set down my fork, groan, and say something like: “My goodness, I couldn’t eat another bite!” This, of course, is promptly followed by: “What’s for dessert?” How can that be? Is that just me? I don’t think so. The answer resides well above the stomach, namely in a part of the brain called hypothalamus.
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Chewing on the Future of Food
For Food Day on 10/24/2012, I was privileged to take part in a panel discussion on the future of food at the U.S. Capitol in Washington, DC. My panel, asked to consider what our diets will be like in 2050, devoted particular attention to issues of culture, cost, convenience and competing priorities. I raised the issue of culture, because it is both the cause of our current crises and the potential cure.
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A Matter of Minutes
A recent study in the Journal of the American Medical Association (JAMA) shows that just 20 minutes of daily physical activity is enough to make the difference between the onset of diabetes or dodging that bullet in at-risk children. The researchers randomly assigned over 200 overweight or obese grade school students to 20 or 40 minutes of supervised aerobic activity five days a week, or to a control group in which habitual activity (or lack thereof) was maintained for a period of 13 weeks.
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Taste Bud Rehab
A new study published online in the journal Archives of Disease in Childhood indicates that obese children and adolescents, as compared to lean counterparts, have less sensitive taste buds. The researchers suggest that this difference in taste sensitivity may be an explanation for the development of obesity.
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Having It All
Famously, you “can’t have it all.” Just as famously, the anklebone is connected to the shinbone. Things get interesting when these two tidbits of time-honored truth are juxtaposed and applied to health. I do one or more interviews for newspapers and/or magazines on health topics almost every day. Across the diverse audiences, one of the reliably frequent topics is what foods to eat or activities to do to promote the health (or beauty) of some body part.
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Can We Share a Taste for Change?
If people didn’t want ever-bigger sodas, Mayor Bloomberg would not be inclined to address soda size as a matter of policy in NYC. But is bigger truly better? The notion that more – measured in calories – is better used to make sense. It made sense throughout the long sweep of human history during which calories were a rate-limiting commodity in the struggle to survive. It made sense, even more recently, when calories were still relatively scarce and hard to get, and physical activity was unavoidable.
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Minding Our Business
I believe we should diligently regulate food marketing to children. You may believe I should mind my own business. I agree. There doesn’t seem to be much we can agree on these days across the spectrum of ideologies and politics. But if there is something, it’s that decent adults look out for the well-being of their children. Loving Parents and Grandparents, Inc. could be the most powerful special interest group of all time.
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Spoons Full of Sugar Helping (Too Much) Medicine Go Down
Kids these days – and adults, for that matter – are consuming far too many spoons full of sugar. This sugar excess contributes importantly to the epidemic of obesity, and all of its consequences, diabetes in particular. There has also been considerable attention to the contributions soda (termed by some of my public health colleagues “liquid candy”) makes to the American diet. Soda contributes lots of calories and sugar, and since excesses of calories and sugar are implicated in obesity and ill health, soda is certainly part of the problem.
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Health, Wealth and Conventional Wisdom
Healthy, wealthy, and wise is one heck of a trifecta. But what if you had to choose among them? Conventional wisdom is not always reliable, but “if you don’t have your health, you don’t have anything” is one of those times it’s spot on.
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Brown Fat, Smoke and Fire
Brown fat is hot. It is the focus of two recent research papers, one in mice and one in men, and the marquee item in a recent New York Times Article. Brown fat is hot because it may help keep us warm, burn calories and help keep us thin. But how hot is it? Proverbs tell us that where there’s smoke, there’s fire. But sometimes where there’s smoke, there’s just smoke – and a whole lot of hot air.
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Minding Our Brains
There has been enormous attention of late to the grim and genuinely frightening problem of Alzheimer’s disease. The problem is grim by its very nature. There is little we contemplate with greater dread than the loss of our minds. The problem is frightening at the personal level because we feel vulnerable to this increasingly common condition we don’t know how to cure, and at the collective level, where estimates suggest it could cost the nation a trillion dollars annually by 2050.
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Thanks, But No Thanks
It is at best ironic that America duped its families about food just as Americans gathered for the quintessential celebration of family and food – Thanksgiving. Congress gave us all permission to serve our children pizza as a vegetable. Good health is perennially on the list of reasons any family has to be thankful, and food is among the most potent of influences on health – for good or for ill. The differential effects of pizza and a mixed green salad on health don’t change just because politicians play around with the lexicon.
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Calories Are Personal
Weight loss drugs have historically fared quite badly, and in my view are likely to do so for the foreseeable future. Weight gain is normal when calories in exceed calories out on a daily basis. You cannot medicate away normal human physiology – any more than you give a fish a pill to let it breathe out of water. But there is more to the story of human weight gain than calories in versus calories out. When it comes to weight control, we are all a lot alike, but also quite a bit different.
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The Super Six
I recently saw a patient in clinic who had experienced a potentially life-threatening cancer a year or so ago, is now living in the aftermath of a surgical “cure,” and came to me looking for ways to reduce the likelihood of that cancer ever recurring, or any other ever occurring in the first place. Such collisions with our mortality tend to sharpen the focus of patient and clinician alike. As you might expect, discussion with this patient was far-ranging. He wanted to know about everything he could do to bend fate and probability in his favor.
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A Biological Basis for Our Obesity Bias?
You likely know that obesity is epidemic among children and adults alike and counts among the most urgent of public health threats in the modern world. You may also be aware that among the many consequences of obesity that collectively threaten not only years of life but the life in those years, is prejudice. Bias against obesity runs both wide and deep. However short the list of socially acceptable prejudice has become in an increasingly “PC” world, obesity seems still to be on it.
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The Cost and Value of Food
The conventional wisdom is that more nutritious foods cost more. In the modern food world, government subsidies are largely tied up with mass-production of crops used for purposes other than feeding people. Corn, for instance, is subsidized both for use in fattening feed animals, which are in turn consumed by people, and for production of such derivatives as high-fructose corn syrup. Soybeans are subsidized, and put to an astonishing variety of uses – many having nothing to do with the nourishment of man, or beast.
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“Eggsonerating” the Egg
The United States Department of Agriculture (U.S.D.A.) announced last week that eggs are 14% lower in cholesterol than previously thought. And they are also 64% higher in vitamin D. By itself, the announcement is potentially important news, with wide implications for the American diet. My view, though, is that news about less cholesterol is just one reason among several for … “eggsonerating” the egg.
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Satiety
There is a range of opinions regarding almost everything about weight loss. People differ on what diet is best, what supplements are best, how important exercise is, which lotions, potions, pills or programs work and which don’t. Even the relevance of calories has been challenged. There is, though, one area of universal agreement. If you want to lose weight, you need to eat less. Many diet plans just call for eating less food. Others demand less ofcertain foods. Inevitably, something about dietary intake has got to give.
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Food Dyes: Why People Want Them Despite Potential Health Risks
Studies have shown the powerful role of familiarity in food preferences. Babies prefer the taste of foods to which they are first exposed to through their mother’s milk. Most of us grow up with fond memories of the foods we tasted during early childhood. Cultural variations may also play a role. Inuit babies eat whale, Mexican babies eat habanero peppers. Much the same is true for food colors added through dyes. Our likes and dislikes of colors are largely based on familiarity.
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The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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