American College of Physicians: Internal Medicine — Doctors for Adults ®

Monday, July 11, 2016

Invincible food, vulnerable father and son

One of the regional supermarket chains in my part of the world, in fact the very one my family shops most often, routinely markets pizza in their TV commercials. The very point of TV commercials for a retail supermarket is to get people into the store, and this strategy must work for them, or the commercials would stop running. TV time is expensive, and businesses that spend their cash on things that don't earn back more than they cost don't tend to last very long.

So marketing this pizza must work, presumably both to sell the pizza itself, and to get people into the store, where they buy other things, too. Soda, for instance, to wash the pizza down.

This particular pizza, and the marketing campaign in which it figures, are both noteworthy in a variety of deeply disturbing ways for anyone who has heard the rumors about the state of either public health (i.e., epidemic obesity, epidemic diabetes, etc.), or the planet (i.e., climate change, water shortages, habitat destruction, etc.). You see, it is not just any pizza.

The pizza in question is called the In-Vince-Ible pizza, presumably both because it is just too “good” to be beaten by any other pizza, and because it is fronted by Vince Wilfork, a NFL defensive tackle currently with the Houston Texans, but known and loved here in Connecticut for his 11-year-run with the New England Patriots. This pizza is the younger sibling in the franchise, expanding the brand established with the In-Vince-Ible sandwich.

The sandwich features a pound of meat, comprising ham, pepperoni, hard salami, and capicola ham. The pedigree of the meats in question is not provided, but given the prevailing norms, one presumes that both cattle and pigs were harmed in the making of this meal. The on-line ad campaign acknowledges that customers might want to share this mega-meal, but more or less taunts them to eat it alone. I could not find the nutrition details for the sandwich anywhere, but since the meat represents some 700 calories, and then there's the whole loaf of Italian bread, the cheese, the mayo and the rest. It is clearly more than a full day's supply of food for many in the target audience.

The pizza has a similar profile, representing carnage in the service of carnivorous palates. It, too, features ham, pepperoni, hard salami, and capicola ham, and differs from the sandwich perhaps mostly in its geometry, and by placing a somewhat greater emphasis on cheese.

My concerns here are the obvious ones; let's start with epidemiology. We do, indeed, live in a world of rampant obesity and chronic disease, both fueled by dietary misdirects and excesses of just this sort. Despite the cottage industries in propagating doubt about the fundamentals of diet and health, or the links between a typical American diet and all manner of adverse outcomes, there is no legitimate doubt.

You remember the arguments that cigarettes couldn't really, reliably be implicated in lung cancer, don't you? Those arguments were made by the companies selling tobacco, and scientists they hired to prevaricate on their behalf. You've heard of the Merchants of Doubt, right? I trust you realize that no industry has an exclusive contract with the mercenaries of pseudo-science. They stand ready, apparently, to help obscure the truth about any given field.

Where the likes of this pizza and sandwich, and soda and donuts and French fries are introduced, health is devastated, and in short order. Where just this sort of fare is removed to make way for more vegetables, fruits, beans, lentils, whole grains, nuts, seeds, and water when thirsty, the improvements in health are stunning. Where this sort of dietary debauchery was avoided in the first place, if only by cultural happenstance rather than foresight, longevity and vitality tend to be rather enviable.

As disturbing as the epidemiologic implications of a pound of processed meat for lunch are, a more intimate view of this matter is in some ways even more so. According to his official “specs,” Vince is 6’2” tall, and 325 lbs. That gives him a BMI of almost 42. I have no doubt Vince is monstrously strong and has a lot more muscle than the rest of us, but it does not require a metabolic chamber to ascertain his severe obesity even now, as he continues to play the game. Studies show that the “eyeball test” differentiates fat from muscle nearly as well as fancy measures of body composition. Meaning no disrespect whatever to Vince, an especially perspicacious eyeball is not required to see that his health is in peril. There are plenty of images on-line; search them and see for yourself.

So, do we not care that Vince is severely obese even during his career as a professional athlete, to say nothing of what will become of him when he stops playing? The movie Concussion, and other high-profile attention to CTE has us all concerned, and rightly so, with the blows football players take to the head in service to their craft, and our entertainment. The obesity and metabolic mayhem to which they are subject in retirement may exact a greater toll, yet be too mundane in our culture to garner much concern, let alone figure in a feature film. Thankfully some insiders are attending to it, notably former NFL player Jamie Dukes.

I'll just go ahead and say it: I am worried about Vince. He seems like a nice guy. I very much suspect his health is a ticking bomb, and retirement will markedly trim the fuse.

As a father, preventive medicine specialist, and the founding editor-in-chief of the peer-reviewed journal, Childhood Obesity, I confess to even greater concern about Vince's young son, who also figures in the ad campaign. We look on as Vince encourages his son to eat like a man. Alas, this young boy is learning to eat in a manner that threatens to give his generation a shorter life expectancy than ours, and to situate him in a population where nearly one in two adults is diabetic, and he likely among them.

And yet, we are all, apparently, OK with this. Such is the influence of culture. If our culture tells us it's fine to market even to children the very products most certain to steal years from their lives and life from their years, a population of decent, loving parents and grandparents manages to look on and feel no outrage. The case for a collective trance is not far-fetched.

And all of this says nothing about the environmental costs of that pizza and sandwich. Although, inevitably, there is some pushback from scientists with direct ties to the industries affected, the consensus among experts the world over is that the implications of meat-centric diets for everything from climate change, to water consumption, to biodiversity is nothing less than calamitous. Even one of the founding fathers of our Paleo diet understanding asserts, and forcefully, that nearly8 billion Homo sapiens simply cannot be substantially carnivorous and expect to stick around.

James Cameron has aptly noted that a society subordinating public and planetary health alike to profits from the customary practices is sleepwalking off a cliff. But maybe we are awake after all, and passing the pizza under the pigskin's good-time halo, too bemused to notice the precipice, and our looming doom.

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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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, 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.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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