Obesity and Malnutrition

One of the most pressing health issues in developed countries is obesity. It is central to our fitness failure. This is the second post in my series on Global Issues: Human Health that is part of a survey of the issues designed to help seekers find their own way to make a difference. The video above is rather shocking. It may convince you about the dangerous relationship between our love affair with corporate profits and the ill-health that is making our health care costs skyrocket.

For a more academic view, you will want to view the videos from The Skinny on Obesity, produced by the University of California. Robert Lustig presents the first video in the series, An Epidemic for Every Body. You will discover the problems caused by eating too much sugar and why the high fructose corn syrup found in almost all processed and “fast” foods is a leading cause of the current epidemic of obesity and disease. Together, these videos might be enough to prompt you to make a change in your own life!

What can you do? Here are just a few suggestions for how to reduce sugar in your diet:

  • Get rid of sugar-containing drinks (especially soda) and minimize fruit juices
  • Increase fiber in your diet with natural foods (many boxed cereals are laced with sugar and corn syrup)
  • Wait 20 minutes for second portions (satiety signals are at the end of your intestine)
  • Buy screen time for your kids with physical activity

Eating natural whole foods such as meat, fruit and vegetables will support your health and contribute to eliminating sugar and refined carbohydrates at the same time.

Fructose may be the culprit, but the evidence supporting this hypothesis is controversial. A more holistic view is that we live in a “toxic environment” (see Food Fight by Kelly Brownell). High fructose corn syrup likely contributes to our problems, but we are better off examining a constellation of issues, including increased portion size. I remember going in the late sixties to a very special place near my father’s office in Detroit that served huge one-quarter pound hamburgers. Once or twice a year we might splurge and buy one on a Saturday, for lunch. Now, you can buy a hamburger with three such patties.

Lest you think obesity is a problem only for wealthy countries, consider this story from the United Nations Poverty and obesity: a new epidemic and this recent journal article: The emerging epidemic of obesity in developing countries. How is obesity related to malnutrition? This blog post from the UN, Overweight and malnourished, has some answers. It is possible to be obese and hungry at the same time; see The Obesity-Hunger Paradox and The Obesity Paradox.

Obesity and malnutrition are the most obvious signs of poor fitness. Personal fitness encompasses the health of our bodies, minds, and spirits. It includes all those practices we engage in during our everyday lives and those we choose to do to remain healthy, outside the realm of doctors, drugs, and hospitals. Being fit makes our own lives better and reduces the costs of health care. Poor fitness has become an epidemic problem for children, and Michelle Obama is leading a program to do something about it by getting kids outside and moving.

Hints for Further Research

The peptide hormone ghrelin helps make our hunger pangs go away, but we do not feel full until food reaches the end of our intestines, which release peptide YY. These hormonal signals are critical to ensuring that we do not get too fat. If we attempt to circumvent these natural signals with unnatural foods and eating patterns, we will contribute to our overweight problem.

Similarly, exercise itself can have beneficial effects on weight control. Part of this is the result of the increased basal metabolic rate of the physically fit and part is due to hormonal influences of exercise. High stress shifts our behavior to overeating. Mental stress makes us hungry. Exercise reduces stress. The relationships are an interesting area for further research.

Episode 5 of Skinny on Obesity brings us back to maternal health by emphasizing the importance of good nutrition for women of child-bearing years and during pregnancy and lactation. Especially important in the global perspective is the lack of critical nutrients. Lack of iodine and protein-calorie deficiency can cause serious mental impairment. A lack of iron causes anemia in mothers, a leading cause of maternal death during childbirth. An article from the Journal of the American Dietary Association, Poverty, Obesity, and Malnutrition: An International Perspective Recognizing the Paradox outlines the issues.

An interesting twist on the call for natural foods are special supplements designed in the laboratory to restore the malnourished. The United Nations World Food Conference of 1974 declared Spirulina “the best food for the future.” Is supplementation with micronutrients better than providing healthy, natural foods? You can answer that question for yourself, but my current thinking is that special supplements are good for emergency relief while we work to develop long-term nutrition supplies based on local, natural foods.

High fructose corn syrup has caused a great deal of controversy. Why is fructose bad? Is high fructose corn syrup worse than sucrose? Glucose stimulates insulin release from the beta islet cells of the pancreas, but fructose does not. Fructose is metabolized primarily in the liver. Once inside the liver cell, fructose can enter the pathways that provide glycerol, the backbone for triacylglycerol. So, even though the glycemic index of fructose is low, it may contribute to obesity.

Milk, meats and most vegetables have no fructose; only 5–10% fructose by weight is found in fruits such as grapes, apples and blueberries. Honey and molasses and common dried fruits have a content of less than 10% fructose sugar. One argument that our problems stem from the high levels of fructose found in corn syrups is the correlation between increasing numbers of overweight individuals and the increase in high fructose corn syrup since its introduction in 1974. The confounding variable is the increase in sugar consumption over the same time. Even so, an alarming issue is the extent of subsidies for food sources that are less than health and the high cost of health foods. See, for example Apples to Twinkies 2012 from US PIRG. We need to pay attention to these trends.

A research group at Princeton tells us fructose is bad. Even so, the American Medical Association and their experts at the American Journal of Clinical Nutrition disagree, although you can find articles in the same journal that take a different stance. Is the group at Princeton right? They propose that it may be the imabalance of higher fructose in corn syrup that is the culprit.

A very recent article from the Annals of Internal Medicine repeats the mantra that calories are the culprit and not fructose. The problem is that both fructose use and calorie counts have increased dramatically over the past fifty years. At the same time, consider the source. WebMD is adamantly opposed to the fructose hypothesis and the health system profits from our ill health, just as the military-industrial complex profits from our fear of terrorism. Fears in both camps are in their self-interest to preserve. Consider as one example Food without Thought: How U.S. Farm Policy Contributes to Obesity.

The Lancet recently published a series of their articles on obesity. Especially interesting is the metabolic syndrome, a group of health problems that include diabetes and heart diseas. “Obesity travels with those diseases” which account for some 75% of health care expenditures. The United Nations see this as a challenge of epidemic proportions even in developing world, even more so than infectious diseases.

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Maternal and Newborn Health

Maternal health is Goal 5 of the United Nations Millenium Development Goals. This is the first Global Issue we will study. It begins and grounds our discussion of the issues that face us as a civilization, because of the central importance of caring for the next generation. After a brief introduction to the issue, I will provide some hints for further study and reflection that will be of special interest to students who are keeping blogs about these issues.

According to the World Health Organization (WHO), “maternal health refers to the health of women during pregnancy, childbirth and the postpartum period.” In our discussion, we will broaden that to include the health needs of newborns. The two are closely linked, according to the UNICEF site, “Babies whose mothers have died during childbirth have a much greater chance of dying in their first year than those whose mothers remain alive.”

“The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour” (WHO). We want to look behind these direct causes to the root causes, which include inadequate nutrition and limited access to effective medical care. We do not want to restrict our investigation to the developing world; we want also to consider pockets of poverty in the developed world and the possibility that even the wealthy have issues of maternal health that are worth our while to investigate. In all areas, education is an important component of the solution.

Hints for Study and Reflection

A great resource for issues that affect developed countries is the Maternal and Infant Health site from the Centers for Disease Control and Prevention (CDC). Among issues that speak to me, I find Tobacco Use and Pregnancy and Postpartum Depression. Resource Guides are available through The Maternal & Child Health Library at Georgetown University. For example, you can study the Guide and links for Postpartum Health by clicking on the link.

Another list of health risks can be found at the Healthy People site, Maternal, Infant, and Child Health. “Healthy People provides science-based, 10-year national objectives for improving the health of all Americans.” What factors make it difficult to improve maternal health in the United States? The CDC site and their MICH objectives is a good place to start.

The World Health Organization (WHO) site provides a rich vein in which to probe global issues of maternal and newborn health. WHO provides snapshot statistics of Maternal and Newborn Health by Country. You might want to discuss the situation in a particular country of interest to you.

The UNICEF site and WHO lay out some solutions worth considering. Which of these solutions is practical? How might they be implemented? What is keeping us from implementing them?

According to a joint report, “Trends in maternal mortality,” jointly funded by World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank, maternal deaths dropped by 34% from 1990 to 2010. You can read the news announcement and find a link to the report at The Partnership for Maternal, Newborn, and Child Health website. Consider how increasing wealth leads to more positive maternal outcomes.

Family planning that includes abortion counseling is a sensitive topic for many of us, but one that cannot be ignored. Some religious groups also object to contraceptive use. Contraceptive approaches include Engender Health’s Advanced Family Planning and the work of Marie Stopes International. Natural Family Planning does not use contraceptives and is supported by The United States Conference of Catholic Bishops. Students will want to review and discuss those programs compatible with their own views on life and ethics.

WHO has links to Maternal Health News and maternal health topics from the Bulletin of the World Health Organization and from other scholarly journals. The United Nations Population Fund also has News on Reproductive Health from a wide range of sources.

Action

National funding is provided by the Maternal and Child Health Division of the Department of Health and Human Services. Their Title V Block Grant Program provides matching grants to the states to “ensure the health of the Nation’s mothers, women, children and youth, including children and youth with special health care needs, and their families.”

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The Issues

I believe that the emphasis on curbing population growth diverts attention from the more vital issue of pursuing policies that allow the population to take care of itself. —Muhammad Yunus

In the second chapter of For the Beauty of the Earth, Steven Bouma-Prediger seeks to “survey and explain a number of ways in which our home planet is being degraded.” The ways he surveys are found under ten headings: population, hunger, biodiversity, deforestation, water, land, waste, energy, air, and climate. Before turning to my own classification of the problems that we face as a society, let us briefly survey his survey.

The first topic is population growth. No doubt the human population of the world is increasing rapidly, following a period of slow growth that ended in the seventeenth century. Such growth has serious consequences, to which the world was first alerted by Thomas Malthus in his An Essay on the Principle of Population and more recently by the Club of Rome in their Limits to Growth. As Bouma-Prediger points out, “it is not just population but also consumption.” I would go further. It is all about consumption. The physical earth can sustain a huge number of people, especially if we build homes that reach to the sky. The issue is that we are unable, with current technology, to support even our current population at a level of consumption equivalent to that enjoyed by the developed world.

“Hunger is a grim reality for approximately one in five people.” Largely due to increased use of fertilizers and pesticides in the Green Revolution, even with our burgeoning global population, grain production per person increased from 1950-1999, according to the chart in For the Beauty of the Earth. I have plotted the data from the Earth Policy Institute through 2007, which shows that production has remained relatively steady and increased by nearly 25% since 1950. However, we discover in a blog analyzing economic indicators from the Earth Policy Institute, Bumper 2011 Grain Harvest Fails to Rebuild Global Stocks, that the current situation is more worrying. Global grain production has failed to keep pace with consumption in 7 of the last 12 years, resulting in a depletion of grain stocks and rising prices.

Global Grain Production 1050-2007

The issues are complex. It is clear to any sober reader that population explosion and hunger are of immediate concern to humanity and that we need to do something about it. Our next topic, the preservation of biodiversity, is more challenging to justify. It does not strike many as being of immediate concern to our survival and we often hear disparaging references to the preservation of the spotted owl. It is certainly true that we “have uprooted flora and fauna from their native habitat and, in all too many cases, extinguished them altogether” Is this loss of biodiversity, in itself, a serious problem? Or, does it signal a more serious underlying issue of which the loss of biodiversity is a reporter? “Loss of habitat, invasion of exotic species, pollution, and overhunting are the leading causes.”

Bouma-Prediger cites the Global Biodiversity Assessment, which begins with the remarkable claim that “Biodiversity represents the very foundation of human existence.” (see Genesis of Eden) That is a bit extreme. It is true that “the genes, species, ecosystems, and human knowledge which are being lost represent a living library of options available for adapting to local and global change.” An example is the drought-resistant Moringa plant that is a very rich and fast-growing nutritional source. Species preservation is also a sign of a healthy environment and that we are doing our part to cherish the world God has created for our use.

Forests are an especially critical ecosystem for survival of species, including Homo sapiens. In addition to important products, “the services forests provide include purification and regulation of water; decomposition of wastes; recycling of nutrients; creation and maintenance of soil…” Clearly we cannot get along without forests. Bouma-Prediger also points out that “existing forests may appear healthy when they are not,” citing the work of Charles Little in The Dying of the Trees.

“Water scarcity is perhaps the most unacknowledged ecological problem today.” Have you thought about the source of all the water you use might be? Most of my water comes from the Ohio River, which is constantly subject to pollution threats. For many others, water is shipped over long distances, at great expense and with significant evaporation, from pure sources in rural areas directly into the heart of the city. For example, “so much water is taken from the Colorado River that it no longer reaches the Gulf of California.” Not only are our rivers being depleted and polluted, many of our aquifers are being mined faster than they are replenished (see Sandra Postel, Dividing the Waters). “It is not just water but safe water— free from disease and parasites— that is so badly needed in many parts of the world.” And these considerations leave aside the important aesthetic and recreational aspects of freshwater lakes and rivers.

What are we doing to the land? “Worldwide annual erosion rates for farmland are twenty to one hundred times the natural renewal rate.” My Chinese friends who grew up near Beijing have shared horror stories of the encroaching desert. “Overgrazing, cultivation of marginal land, and deforestation, among other practices, have contributed to the growth of desert areas on the earth.” On top of this is urban sprawl. Suburban housing, big box stores, and giant parking lots replace precious forest and farmland.

One area where ecological awareness has been somewhat successful in its quest to inform the public of the harm we are causing is in the disposal of waste. I suppose that taking the garbage to the curb every week causes us to be more aware of our solid waste than we are of the pollution caused by our cars and industrial and agricultural practices. So, we recycle. At the same time, more and more foods are ready-prepared and come with far more packaging than is required to deliver the food if it were available unprocessed and we took the time to learn how to cook. Even so, only 1.5% of solid waste production comes from municipal sources (that is, from us). A whopping 75% comes from mining and oil and gas production. Do what you can to recycle, but it will have little impact on our waste problem.

This leads us directly to the problem of energy. Here we return to the central problem of consumption. “More and more people are striving to live at the same standard of living as those of us in the energy-profligate United States.” True, the United States also produces more goods than other countries and there is a direct relationship between energy use and industrial production. More productive countries use more energy. Renewable sources of energy are part of the answer, but may not be sufficient, no matter how extensive, to supply all our energy needs without a dramatic decrease in energy demand (see the video by Professor David MacKay, How the Laws of Physics Constrain Our Sustainable Energy Options). However, technology may come to the rescue if we can deploy solar collectors in earth orbits or find other novel solutions to the problem.

The burning of fossil fuels causes air pollution. Bouma-Prediger focuses on acid rain which is a direct result of our most common forms of energy production. The consquences of acid rain on aquatic ecosystems can be dramatic. “In the Adirondacks of upstate New York approximately one-quarter of the lakes and ponds” have substantially reduced fish populations. Of course, we must not forget ozone, carbon monoxide, and particulates.

The hot-button topic is climate (pun intended). It seems to me that almost all of our environmental issues have recently been reduced to discussions of climate change. The evidence for increasing global temperatures, especially in the Arctic is solid. However, focusing attention on climate change without regard to other critical issues is short-sighted. The argument will always be made that we are in that part of the climatic cycle where temperatures are increasing, but the causes are not the result of human activities. We are probably better off attacking pollution as a problem in itself rather than citing climate change as a reason to reduce pollution.

Although we will find out later, as we continue to read For the Beauty of the Earth, that Bouma-Prediger is concerned with humanity as individuals, the way he expresses the problems our planet faces, and his title, reflect a strong earth-centric view. That is, the Earth would be better off without humans. As much as I feel rather strongly about the state of the planet and am dismayed by our lack of care of the home God has made for us, my focus is on humanity. I want to concern myself with the needs of people. The Creation has no meaning without humanity.

When I first began this exercise of figuring out how I might make a difference, I looked at a lot of web sites. The United Nations and their five areas of concern: Peace and Security, Development, Human Rights, Humanitarian Affairs, and International Law gave broad hints about how to go about identifying the problems that face us as a society. I also found the various cabinet-level departments and executive offices of the United States to be fruitful sources for issues that especially impact U.S. interests. However, none really laid out the issues in the systematic way that interested me. Here, I am making an attempt to do just that.

My scheme classifies “The Issues” under the headings of energy, water, food, health, and community. We not only concern ourselves with the care of the earth. We also work to make our own lives better and extend our care and compassion to the greater human community. We realize that we are part of a larger earth system that must be protected for the sake of generations to come. Our faith causes us to believe that the Creation was made to be the habitation of humanity. It was established for our benefit and with the expectation that we would care for it, just as we care for our own children.

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Ecological Literacy

Literacy is a bridge from misery to hope. It is a tool for daily life in modern society. It is a bulwark against poverty, and a building block of development…the road to human progress and the means through which every man, woman and child can realize his or her full potential. —Kofi Annan

One of the dangers of developing my ideas through the forum of a public blog is that I may say something completely silly. As Steven Bouma-Prediger points out in his recent book, For the Beauty of the Earth, “an ecological frame of mind seeks to integrate, to bring together, to see things whole.” Gaining knowledge that is deep enough and broad enough to satisfy such a frame of mind is a great challenge.

This holistic view requires us to look at living individuals and their inter-relationships, as well as their dependence on the non-living world. Instead of focusing in on a particular problem that we might be able to solve, or at least contribute to its solution, it calls on us to envision the earth as a whole. This may well be an impossible task. Even God split up his creative activity into six days.

Professor Bouma-Prediger derives his definition of ecological literacy from the work of David Orr (Ecological Literacy), who “offers a list of five necessary components of seeing things whole.” He quotes from Orr’s list, but has his own spin on what each component means in practical terms. First, “ecological literacy…implies a modicum of knowledge about the inextricable interconnectedness of all creatures great and small.” I am not sure how much knowledge might be a “modicum.” Possibly a survey course in ecology would suffice. “Knowledge of keystone species and succession, entropy and energy flow, niches and food chains” are listed as examples.

Second, “we need to know the vital signs of our planet.” These include such things as population growth and deforestation. I would call this awareness. Here we discover that the world is not a stable place, but one where rapid changes are taking place and few of them are making the planet more habitable. We need “a sober assessment of the health of the earth.” Expressing it this way makes the approach especially cogent to me. Foundational to drug discovery research, in which I spent my working lifetime, is an assessment of the state of health of the population.

The third is expressed as a question, “What ideas and social pressures have brought us to where we are today?” That is, what are the root causes of our current situation? It is more than a biological question. It is also a social and political one. As such, we expect that the solution begins with us, as individuals willing to change our behaviors. Later, we will discover that this is the thrust of Bouma-Prediger’s argument.

His fourth point is philosophical and rather less concrete than the first three. “Environmental issues are laden with questions of value.” In a chapter near the end, Bouma-Prediger proposes a set of “ecological virtues” that directly address this question of values within a Christian context. But, we have a long way to go in reading his text before we get there. Like a good teacher, he first carefully lays the groundwork for what might be called a theology of the earth.

The fifth component is more practical. He mentions the Index of Sustainable Economic Welfare as a better measure of “overall welfare” than the Gross Domestic Product (see also, Beyond GDP). “Technology can and must be appropriate to the scale and needs of a people and its culture.” I would say that we need to examine the issues to find the most appropriate response, consistent with our values. Measures of well-being and appropriate technology are part of that.

Each of us has memories of place or circumstance that cause us to favor some issues over others. Bouma-Prediger talks of the wild places that speak to him. Like the good professor, I recall the pristine lake on which I grew up in Michigan and my discomfort when I discovered how polluted were the lakes of southwestern Ohio where I completed my formal training.

I also recall vacations on Lake Michigan when the beaches were clean and the dunes a delight. And I remember going to those same beaches when they were covered with dead fish. Those experiences drive my interest in freshwater ecosystems. But my mother’s headaches took precedence and I went in the direction of drug discovery, rather than ecology. Of course, you will have your own memories that focus your attention on particular problems.

What do I think is ecological literacy? The proper starting place for a Christian theology of the earth is our value system and not the science of ecology. However, the structure of Orr and Bouma-Prediger is useful. Reordering the priorities and merging some of the components results in three domains that constitute a functional ecological literacy:

  • Ecological Values: an analysis of our values as individual members of a global community and how these influence the decisions we make with regard to our environment;
  • Resilience and Sustainability: the basic science of ecology, which would include measures of the health of the biosphere and what science tells us about the pursuit of a sustainble future;
  • Global Issues: the specific issues that require our attention and potential solutions to the problems of humanity that can be addressed by improved policies and technology.

When we look at the issues, we merge our values with what science teaches us about how we can carry out our work in the world in a way that is consistent with our value system. Only by looking at specific issues can we discover viable solutions in the practical terms of policy and action. The foundation for making a difference in the world is study, reflection, and prayer. These lead us to work in education, research, and activism according to a set of values that takes into account all of humanity.

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A Life of Value

When I decided it was time to take early retirement and pursue a new and more holistic direction, I began blogging. I kept at it for about six months. Through the process, I discovered that I was most interested in helping others pursue a more purposeful and meaningful life through work that benefits the human community.

We all strive for personal success. We want better lives for ourselves and our families. I am convinced that we can only do so when our values reflect the needs of the global community. Central to this is concern for each other and the desire to build a better world.

How do we make a difference? We begin by examining our value system. Then, we apply our utmost resolution, industry, and confidence to carrying out a plan consistent with our values. By doing so, our lives are given meaning and purpose.

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