Sunday, August 5, 2012

Phat, yo.

Now that the new year of medical school has begun, I feel like I've been able to take in much of the information that is thrown at us (I'm referring not to curriculum content, but administrative and relatively non-consequential information provided during orientation and such) now that I have a much better idea of what to expect. Perhaps this was discussed last year, perhaps not -- I couldn't tell you, as the 1st year orientation was really nothing more than a blur of faces, introductions and free, University provided food. This time however, I did find myself intrigued by the emphasis that some of the researchers and head administrators were putting on the school's resolve to become a leader in research (in all facets -- from lab bench, community and policy) concerning the obesity epidemic.

Modern Day look at Mare Island, with the Napa River separating it from the mainland part of Vallejo.

The school at which I attend medical school is relatively small, it doesn't have a large academic hospital attached, it doesn't pull in hundreds of millions (UCSF was awarded $475.4 million for research and training grants, fellowships and other awards in 2010) in grant money and it's research facilities are comparatively small. That said, I think the school is poised to not only be a major player in figuring out how to help the medical community address the issue of obesity, but will be able to do this by helping the population surrounding the campus of the school to figure out how to best do this. Vallejo, CA recently came out of Bankruptcy, which at the time was the largest municipal bankruptcy in the United States. There are many articles available chronicling the bankruptcy of Vallejo, but this one is especially intriguing, as it provides for the people actually involved to speak about it. Many people will point to the closure of the Mare Island Naval Shipyard as the main reason for the eventual bankruptcy. Of course, Vallejo is somewhat unique in that it was a city based around an economic engine that was suddenly taken away. But, there are more, and significant municipal bankruptcies coming, which, in a strange sort of way sets Vallejo up to be a frontrunner in figuring out how to return to economic vitality after the shit storm (warning: hilarious graphic language!) of the past 4 years.

A not so modern look at Mare Island and Vallejo

Vallejo also has some of the worst "food deserts", which can easily be verified by the tremendous lack of decent food or coffee any where near the school's campus. Luckily for us, the students, almost all of us have transportation or the means to get to a decent grocery, or we can just eat our fill during the hours of the school's cafeteria operation. If I was an owner of a grocery story, and I was being robbed with arms on a regular basis, I'm fairly sure I would pack up and leave as well -- and, that is what has happened. Obviously, this is a part of (not the whole of) the obesity epidemic -- and an issue that, especially for families on a tight budget, with limited transportation options, looms large and sees them feeding children with fast food and other unhealthy options, stuff that can be had at convenience and liquor stores. 

The solution to this specific problem is not one that is obvious; it can't be solved with a simple legislative bill, or even with an increased police presence (although, this would be a step in the right direction.) At Touro, we have, if nothing else, the will and desire to effect change in this very community. Thankfully, we also have some resources, intellectual ability (depending on what day you speak to a COM student you may have varying degrees of confidence in this statement) and man-power to help people. And, this, in my opinion is the key. As an institution, and as a part of the larger medical community, we lobby the legislature for this or that -- hopefully the impetus is for lawmaking that allows physicians to better help the people that we are sworn to help and protect, and as such, this type of action, for the most part, is a good thing. But the other hand, so to speak, should be getting dirty with the hands on activity of helping those in our community. Last year (and I assume it will go on this year as well) a program that paired COM students with pregnant women from Vallejo, many of whom were very poor, and without a support system to receive help of all kinds -- having someone to share in the experience not be the least of the benefit. This type of one-on-one interaction is exactly what the school, in my opinion should be actively pursuing.

1 lb of muscle and 1 lb of fat
Of course, there are intriguing biochemical questions as to why the obesity epidemic has come into being. I would argue that many of the reasons are obvious, and don't need research involving micro-pipettes. Portion size in restaurants, declining levels of activity are easy to spot in every-day life, most likely in our own or in the lives of loved-ones. That said, there are questions concerning our food supply and the changes that have occurred with the mass industrialization of our food supply, especially here in the United States and what kind of impact it has on our health. Through out the years, I've heard a number of younger people say that they don't care what they eat, and the reason for this is that their grandparents ate whatever they wanted and they lived to a ripe old age. I would argue that much of what the grandparents ate is not available in the same form, and furthermore, much of what the younger person was definitely not available to eat in the days of the grandparents, especially in the prime of their life. Preservatives, chemicals used in the production of produce (from fertilizers to pesticides to genetic modifications), and high-fructose-corn-syrup in everything. HFCS is in so many food items that yes, the grandparents would probably consume, but they ate they goods prior to the HFCS addition.

Most people know about HFCS, as it has been publicized in it's potential implication with obesity and other health issues. Luckily, Touro is home to a world-renowned researcher who is tackling this very issue. Here is a BBC piece interviewing Dr. Schwarz. While the whole program is immensely interesting and informative, the portion with Dr. Schwarz begins at the 5:40 mark. The research wing at SFGH is the same I stayed in numerous times with various studies:

Here is a brief (and not surprisingly, dumbed-down version -- does America get the programming it deserves, or are we made "stupider" by the programming we get?) 60-minutes piece featuring Dr. Schwarz:

Now, all of this is very interesting and does works to add to the foundation of the idea that the introduction of HFCS -- which is not a new idea, but has been gaining steam as of late, played a part in the rapid fattening of humans. This graph shows the historical timeline (REMEMBER: Post hoc ergo propter hoc):

The HFCS is only a piece of the biochemical/food engineering puzzle. Around the same time that HFCS was being added, the American public was being sold the idea that dietary fat was the root of all of our health problems. Thank goodness we have so many "fat-free" foods -- imagine what kind of sordid state of public health we'd be in without them! This article, while short and sweet does a good job up summing up the relationship between the omittance and demonizing of dietary fat and why it plays a part in you and me getting fatter.

So, in summation, I'm off to eat some cheese and eggs with my bacon -- I don't wanna get any fatter, after all!

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