Home Cooking and the Obesity Epidemic

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Every week I enjoy reading the New York Times WellBlog section, which has great articles highlighting the latest research on a health related topic such as how exercise, sleep, and diet impact our health. One article is titled “Can Home Cooking Reverse the Obesity Epidemic?”, and highlights a new book in which three sociologists who study food, family and inequalities studied 168 poor and middle class families in North Carolina argued that for families with limited time and money, avoiding processed food is not a realistic option. While the authors’ research found valid challenges and obstacles to “healthy eating”, I am disappointed their viewpoint did not include solutions and respectfully offer that there is SO MUCH that can be done to help families across all socioeconomic levels develop healthier eating habits and access to healthier foods, no matter their socioeconomic class.
The authors found barriers to healthier eating due to factors such as lacking a reliable oven and kitchen tools, food pantries full of processed foods high in salt, sugar, and fat, and working class families not having time to cook when already under tremendous stress from being overworked and feeling tired. The last thing they want is to spend little precious time cooking when family time is needed.
As a physician who has spent the past 17 years having conversations with families about their eating habits, for themselves and their children who come because they are “sick”, I humbly offer what I have learned.
  1. Data and research does support the fact that we can reclaim our health and reverse obesity if we decreased processed foods and cook meals. This is of course based on the ability to control calories and use ingredients we actually know and can pronounce. Most of us do not know the 9 out of 10 ingredients we can’t pronounce in most items listed in a nutrition fact label in processed foods that sit on a shelf for months at your local grocery store. 
  2. Data and research also supports that when we eat out, we consume way more calories than if we were at home. Mentally, somehow we tell ourselves “rules” don’t apply, we are spending money eating out so we are entitled to “enjoy” and splurge, and frankly eating out usually includes non-water beverages, alcohol, appetizers, entrees, and yes, dessert. 
  3. If families are spending “too much time” in the kitchen, when attempting to cook or prepare meals, which certainly competes for time to do other things, like laundry, paying bills, or making your children lunch, perhaps this is because we no longer teach nutrition, basic meal preparation, cooking, and how to grocery shop and meal plan, in any part of our children’s education or young adult education. How can anyone even choose the cooking option when we no longer emphasize or offer this skill?
  4. While food deserts are real, lacking money is real, and yes in the US, $1 can purchase 1000 calories in a box of Mac n’Cheese, or 100 calories in fresh fruit, families and adults can always make better choices, despite the limited choices they may have, but only if given the awareness and understanding of how food impacts their health. These are the same families and children that likely have very limited access to healthcare. I would know as the chief of a subspecialty in a children’s health system that serves 74% Medicaid. Just because someone is in a low income class or has less means, does not mean they have to be resigned, or they don’t want to know how to ensure health for their children and families if given the tools and knowledge.
  5. Policy change is a must! I am disheartened that families have told me WIC offers apple juice to them for infants as young as 4-6 months, completely against national AAP guidelines. One mother showed me the WIC app on her phone, and as I scrolled down, it was clear that most items were heavy on dairy  and calories, perhaps intent is good, and while there were great items like eggs and milk, significant yogurt, juice, cheese, cow milk, were all over the app. Maybe WIC should revamp to offer non-dairy options like almond and soy, simply dry pasta, butter, and a cookbook with their offerings.
  6. The policy for school lunches can be changed to ensure that industry does not incentivize schools and pay them to put soda machines on the campus, to allow Pizza Hut and Taco Bell or other fast food restaurants to come on campus, to make sure that school lunches are not offering french fries because the policy defines that as a “vegetable”, and canned fruits soaked in high fructose corn syrup fulfills the national guidelines. Parents can pack healthier lunch options any day, but rely on our tax dollars to feed their children while they work hard to make ends meet. 
  7. If families are in the kitchen together, prepping meals together, that is quality family time. Not easy—my own family does not often do that, and they are used to my cooking everything and calling them when meals are ready. But lately as my daughter Claire started making smoothies herself, at age 13, and hulls strawberries, I know there is hope in my modeling for her through the hours cooking on Sundays to help Monday and Tuesday dinners go much faster as I work a 12 hour day as a surgeon. Making a caesar salad with romaine lettuce, croutons, and a store bought rotisserie chicken, and good caesar salad dressing, takes about 5 minutes and is much better than eating out. There are so many options for meal prepping but most of us are too “busy” to prioritize what goes in the mouth. Only when our beliefs change and we embrace the “WHY” and the benefits of home cooking, are we likely to change any behaviors or commitment to time and energy spent in the kitchen.
  8. Thousands and millions of children and families are suffering from “health” issues, much of it due to what we eat or don’t eat (fresh fruit, more vegetables, drink more water). We all have a choice to make, unless health, being of healthy weight, believing that our eating and lifestyle habits matter, and raising our children in a way that teaches them good habits, matter more than anything else, then we can always identify more barriers but no one will be less reliant on our broken health care system which continues to not emphasize prevention but instead prescribe medications and a high volume of elective surgeries to address issues created by the obesity epidemic: bypass, hip and knee replacements, coronary stents, back surgeries, etc. 
I know and believe there is always something that can be done, for every family, to improve their health and eating habits. Thousands of families have shown me that change is possible, and they have opened my eyes to understanding that if given the information, support, and guidance, they will embrace and create change. This group of authors have inspired me to write my own book of stories on the families that have proven that.
Diet Obesity

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