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jeudi 10 mai 2012



In 2004, at a conference, I chose to call my presentation: Obesity as a Social Illness. It was not well received, since the oft repeated mantra of that time, and even now, is that Exercise More and Eat Better!
When a disease is so physiological, asked a participant, and we have scientists explaining the biomedical basis of both obesity and diabetes, how can you say it is caused by Society?
Soon after finishing my specialty training in Endocrinology, I became aware of the fact that Health Care cannot be improved ONLY by the participation of Disease Care Providers: Doctors, Nurses and other “providers” all of whom cater for Diseases. A strong social science input is necessary, I thought, and having had no exposure to it in the Medical Schools I had trained, I decided to study Medical Anthropology at the Brunel University of London programme, which to me has been the most useful part of my medical education. It made me analyse what we see not in terms of just the individual but also the culture and society that individual belongs to. I was also lucky to have been working continuously with American Indians and their input into my work has been great.
There were no shortages of people saying that it is a national problem and predicting more and more obesity in the future. (Why not do something about it to stop or admit failure of their efforts to stop?). Just two days ago, they published data to say 42 % of Americans would be obese by 2030, which is not really news but a reiteration of the failure that the Disease Care providers and the society have been barking up the wrong path.

"If you believe this is a massive national problem, you have to deal with it in a systems way," said Dan Glickman, chairman of the panel that wrote the report and a former secretary of the Department of Agriculture under President Bill Clinton. "This problem is incapable of being solved with a magic bullet."
(Part of the Institute of Medicine’s statement, quoted in Wall Street Journal 9th May 2012). Many would say society must change and the disease providers would then go on to blame the individual as if that alone would bring on last lasting benefit.
I have just spent one delightful week with the Lakota of Cheyenne River in South Dakota. And if you look at the recommendations by the Institute of Medicine, my Lakota friends are already well on their way to implement most of the recommendations, in fact they had begun it before all these came out.
Photo: Eating well in Eagle Butte, South Dakota in May 2012
"The country has begun to address obesity, but we are still doing far too little, given the tremendous burden it places on our health and health care costs," said Margo Wootan of the Center for Science in the Public Interest.
Two-thirds of U.S. adults and almost a third of children are either overweight or obese, and progress to stop this epidemic has been too slow, the Institute of Medicine concluded.
For schools, it recommended that students get at least 60 minutes of physical activity every day -- a combination of physical education, recess and other activities. Many schools have slashed P.E. and cut into recess in recent years in an effort to increase learning time amid tighter budgets. The report also says schools should serve healthier foods, backing national school nutrition standards, and teach nutrition.
Other recommendations include:
* Restaurants should ensure that at least half of children's meals comply with federal dietary guidelines, without charging more for the healthier options.
* Healthier foods should be routinely available everywhere, from shopping malls to sports arenas.
* More food companies should improve how they market to children -- and if they don't, the government should step in and mandate changes.
* To make physical activity routine, communities should be designed with safe places to walk and exercise.
* Public and private insurers should ensure better access to obesity screening, preventive services and treatments.
* Employers should expand workplace wellness programs.
* The president should appoint a task force to evaluate the effect of U.S. agriculture policies on obesity.
My own feelings are thus:
The US government should look into the subsidies they give to farmers to produce Corn and Soybean both of which eventually in their compounded chemical form end up in the American diet and is partially responsible for the obesity and diabetes in America.
Adopt programmes, which have been successful in poor countries with limited resources, such as MoPoTsyo in Cambodia, where educating Peers from the Community has had tremendous impact on the health. Those Peers are truly Health Care Providers since they don't just concentrate on Blood Sugar, Cholesterol, High Blood Pressure but have in their education and action, how to use the local lifestyle changes to impact on those measurements. It is one of the more successful programmes of Diabetes Treatment I have seen.
The American approach to Diabetes and Obesity has failed, so don't export it to the other countries but try to learn from others. America may lead the world in technological innovations but they have never been in the forefront of social innovations.
Social Innovation  is what we need now…not more medications..

I am thinking of my friends at the Lakota Cheyenne River in South Dakota and the staff of Asia Protein in Bogor Indonesia and with gratitude to my friends at Mo Po Tsyo Education Centre in Phnom Penh, Cambodia.
Peer Educators and the staff of Mo Po Tsyo in Phnom Penh, Cambodia.
Healthy Habits of the Staff of Asia Protein in Bogor, Indonesia