Friday, April 6, 2012
Dads, dudes, diabetes and duty
I am, and have long been, on the masthead at Men's Health magazine as an editorial advisor, with contributions focused principally on weight control. Proud of it, too.
I do note, in passing, that I don't always agree with my good friends there. They seem to feel that a hefty dose of bacon can cure just about anything that may ail you, and I beg to differ. I submit as evidence in defense of my position a 50-year-old body (Well, 49; but who's counting?) with an elusive "six-pack" built and maintained on "mostly plants." But I digress.
More relevant is that I am a father of five kids, and editor-in-chief of the peer-reviewed journal Childhood Obesity.
I am here to talk to my fellow fathers about kids. Paternity, posterity, peril, and promise if you will.
Dads, dudes, countrymen (and city men, for that matter) lend me your ears! Manly middles, portly posteriors, and notoriously thick skulls can come along for the ride. I am talking to you, mano a mano. Ladies, please do listen in. If nothing else, you may want to print this out, roll it up, and smack some guy in the head with it when we're done here.
We know that women are the guardians of the family health. We know that women, wives, mothers tend to do the heavy lifting when it comes to medical care, preventive services and diet. We know, consequently, by process of elimination if nothing else, that men tend to stand idly by and watch the women in their lives do this heavy lifting mostly on their own. Not very chivalrous, but it is what it is. Men often turn up at their own medical appointments only because a wife or girlfriend "made them" do it. Pitiful!
This is even true regarding the health of kids we helped make. And it's not acceptable.
I trust you've heard the familiar litany of bad news about the health of our kids. Childhood obesity is more prevalent in the U.S. than in virtually any other place on the globe, and more prevalent now than ever in history. The fattening of our children propels them to an ever greater burden of ever more dire chronic disease at ever younger ages.
The spread of Type 2 diabetes among children is already yesterday's news. But yesterday, when I went to medical school, this disease was called "adult onset" diabetes to distinguish it from "juvenile onset." On my watch and yours we have witnessed the transformation of a chronic disease of overweight, middle-aged, sedentary adults into a pediatric scourge.
Yesterday's news is bad--a tragedy, in fact. And a travesty. A disease that should never occur in children has become routine among them, and our collective societal response was to change the name to make it ok.
Still, today's news is even worse.
Today's news is the proliferation of cardiac risk factors among children, and their growing need for treatments that until very recently were limited to adults, such as statin drugs and bariatric surgery. And even coronary bypass. Today's news is a 35% increase in the rate of stroke among 5- to 14-year-olds, with no smoking gun on the scene except epidemic childhood obesity to account for it.
What, I wonder, will tomorrow's news be? I think, guys, that it's partly up to us.
In a culture where real men don't eat quiche, where salad is "the girl food," and where a man's man is tough and beefy, it may seem that eating well and being active to protect our health requires us to get in touch with our feminine sides. If so, it would likely do most of us some good, but it's not required. There is another way entirely of looking at this scenario.
The wolves are at your door, fellas, and if you are like most guys, you aren't doing a damn thing about it. You are NOT defending hearth and home. Very "un-guy" like.
The wolves are obesity, insulin resistance, metabolic syndrome, Type 2 diabetes and behavioral disorders--with heart disease, stroke and cancer to follow--stalking our children.
So, grab your (proverbial) muskets, and defend hearth and home! That is what guys do. That is time honored "guy stuff." In all too many cases, these wolves have already sunk their teeth into the tender flesh of our kids.
To cultivate the health of your children, you must cultivate your own. Even if you are too tough and manly to care about the minor inconveniences of open heart surgery or the occasional amputation, no guy gets "toughness" credit for failing to care about, or look out for, his kids.
If your kids love and respect you, they will do as you do. If eating well is too big a bother for you, it will be too big a bother for them. If worrying about health and nutrition is limited to "nutrition nannies" (like me, I suppose), then your children, like you, will roll their eyes at the very choices that could immunize them against a future of foreshortened joy and forestalled opportunity.
If you are too busy, too unconcerned, too manly to exercise, what will motivate your son to be otherwise? If physical activity is not instilled by you as a family value, what will inspire your daughter to seek and gain its incomparable benefits?
I have been taking care of patients for 20 years, so I have met a lot of you guys. If I hadn't--if I were younger, more naive, or simply more hopeful--I might ask you to pursue health for your own sakes. But I have learned the hard way how thick the average guy's skull is. (Ladies, don't worry. If you do roll this up and hit a guy in the head with it, chances are he won't feel a thing.) Most of my male patients get religion about their own health when staring up at the harsh ER ceiling lights from a gurney. Sometimes they get to come down from that gurney and try a new way forward. Sometimes, alas, that chance never comes. But either way, the timing leaves a lot to be desired.
For me, it's a personal loss every time something bad happens to someone good who just couldn't be bothered. Who only ever really cared about preventing a heart attack--or stroke or cancer--after the diagnosis. The unnecessary loss of years from life and life from years is the recurrent tragedy against which I channel my every effort. But you know what they say: You can lead a horse to water. So I fail all too often; the teachable moment comes after the calamity and the cycle of preventable loss and lamentation goes on.
So I pin little faith on talking you into taking better care of yourselves for your own sakes, but I think I can count on the sacred and inalienable bonds of fatherhood to call on you to do it for your children's sake. Is avoidable loss and preventable lamentation something you can countenance paying forward to your daughter or son? No father worthy of the title could say "yes."
Gentlemen: You are role models for your children. Like it or not, you are playing follow the leader, and you are the leader (or one of them). Lead toward health, your children will follow you there. Lead elsewhere, they will follow you elsewhere. They will do as you do. So do the right thing for their sake. Eat well and be active for their sake. Be part of their solution or you will be part of their problem.
The mission need not be complicated. Simply acknowledge health as a worthy goal and a priority. Let your kids know that you want them to eat well because you love them, because you want them to be healthy, and healthy people have more fun. Then, make a conscious effort to eat well, too. No need to make perfect the enemy of good, just some movement. I'm sure you know the basics of the route, but if not, you can always ask for directions, right?
Just by letting your kids know that you don't want the growing body of a son or daughter that you love constructed out of junk, the mission will be advanced.
Physical activity is even easier. Just walk the literal walk. Be active with your kids. The older and more capable they become, the greater the options, but you can start when they're still in the cradle.
Every aspect of stepping up and being a healthy role model for your children is part of a virtuous circle. By setting the example your kids need for the greatest likelihood of their own healthy future, you'll be laying the groundwork for yours. Just as well, because when those kids grow up and have kids of their own, you may want to be around for it. You don't want to be that guy seeing revelations among the overhead lights in the ER. By making health a shared pursuit, you'll have things to talk to your kids about and things to do together.
As fathers, we are charged with no responsibility more sacred than protecting our children. So I am asking you, mano a mano, to protect yours. Their future vitality--their future joy or misery--will be determined in part by the choices you make.
For all the guys out there too tough to care about their own health until it's too late, how about setting a healthy example to defend your kids? It's classic, time-honored guy stuff. It's got "Dad," and "dude,'" written all over it.
It is, in a word, our duty. So let's man up and do it!
David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.
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