America’s Epidemic

By Mike de Lota, M.D. – June 1, 2021

The late Anthony Bourdain once said, “I think food, culture, people and landscape are all absolutely inseparable.” From the ingredients in signature dishes to the preparation, down to the details of presentation, food tells a story about a society’s customs, traditions, values and way of life. When I travel, it is by far my favorite way to learn about the culture and people. But how would a traveler document their culinary voyage throughout America? While American cuisine with its rich flavors, creativity and unique, regional nuance should be appreciated and applauded, one cannot deny that fast and processed foods have become a prominent presence in Western cuisine, leaving an indelible footprint on our culture.

What Our Food Says About Us

According to the 2015-2020 Dietary Guidelines for Americans, published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health & Human Services (USHHS), the current U.S. eating pattern was low in vegetables and fruits and high in calories, processed meat, added sugars, saturated fats and sodium. This has become known in scientific circles as the “Western Diet” or “Standard American Diet.” So, why has our food become so calorie-rich and nutrient-poor? Some blame soil depletion from over-farming, others blame mass production and commercialization practices, and still others blame special interests in the food industry promoting unhealthy products. The answer is complex and multifactorial, but it is a scathing indictment on our food supply.

Not only has our diet become less nutritious, but we’re also consuming more of it. A CDC statistic notes that, from 1999 through 2018, the prevalence of obesity in America increased from 30.5% to 42.4%, leading to a rise in issues such as heart disease, diabetes, stroke and certain cancers. The estimated annual medical cost of obesity in the United States was $147 billion in 2008, and the medical cost for people who have obesity was $1,429 higher than those of normal weight. Fast food, with its high-calorie, high-fat and high-sodium content, has paved the way for this epidemic. During 2013-2016, 36.6% of U.S. adults consumed fast food on any given day. 

Many of these trends stem from rising food insecurity and increased convenience. Processed, pre-packaged foods, “heat-and-eat” meals and fast food tend to be cheaper than shopping in the organic or artisanal food aisles of your local grocery store and, when families are short on time, quick meals tend to be the solution.

The 2019 Bloomberg Global Health Index ranked the United States as the 35th healthiest country in the world, while countries like Spain, Italy, Iceland, Japan, Norway and Israel ranked among the top ten. So, what lessons can we learn from these countries?

Pass the Salt

Perhaps one of the oldest cooking seasonings, salt (or sodium chloride) has been used for centuries for its properties as a preservative and to enhance flavors. In small amounts, sodium is an integral part of our diet, but we consume too much of it. The average American consumes 3,400mg of sodium per day, way over the recommended daily intake of 2,300mg per day. This has negative implications on health as salt attracts water, which leads to increased fluid volume in the bloodstream, leading to increased blood pressure. High blood pressure can then increase risk of heart attack, stroke, heart failure and kidney disease. In my practice, patients with high blood pressure are often perplexed when I tell them to cut back on salt from their diet. Often, patients tell me, “But I don’t even use salt in my food!” They’re shocked to learn that over 70% of American salt intake comes pre-packaged in our food, not from a salt shaker, and according to the CDC, half of our sodium intake comes from foods that might not necessarily taste salty — foods like breads and rolls, pizza, sandwiches, cold cuts, cured meats, soups, burritos and tacos, snack foods, chicken (including processed chicken), cheese, egg dishes and omelets. 

Perhaps we should follow the lead from our cousins across the pond. In 2003, the British government implemented a program to gradually reduce salt in processed food by raising public awareness to the dangers of a high-salt diet, and they also worked with the processed food industry to lower salt content in their products. The reduction was so subtle that most people could not tell it was happening. The result was a 15% reduction in sodium intake over eight years leading to a corresponding drop in blood pressure, stroke mortality (which dropped by 42%) and heart disease (which dropped by 40%).

We could also follow the lead of Spain whose Mediterranean-style diet emphasizes healthy fats like olive oil, seafood, fresh fruits and vegetables, whole grains and legumes, and is recommended by the American Heart Association. Spain is also among industrialized countries that spend the least on fast food each year. In 2014, Spaniards spent €1.98 billion on fast food, which works out at a mere $47 per Spaniard, per year. Contrast that with America where the average American spent $1,200 per year on fast food and, as a whole, Americans spent $50 billion on fast food annually. It’s little wonder that Spain was named the Bloomberg Global Health Index’s healthiest country — tapas anyone?

Sugar High

What’s salt without a little bit of sweet? Perhaps a lot of sweet. In 2015, the average American consumed 126.4 grams of sugar per day, and that doesn’t include high fructose corn syrup (HFCS) — a synthetic sugar derived from corn. Consumption of excessive amounts of sugar, especially HFCS, can lead to disruption of the gut microbiome and can then lead to liver inflammation, fatty liver disease, liver fibrosis and cancer. HFCS consumption has also been linked to high blood pressure, weight gain, obesity and type 2 diabetes.

 Although the obesity epidemic is not uniquely American (the worldwide number of obese adults has quadrupled to 422 million over the last 30 years), the United States is leading the way with 42.4% prevalence. Compare that to Switzerland, Norway and Sweden whose obesity rates are 11.3%, 12%, and 14.1%, respectively, among the lowest of developed countries. These have helped them earn 5th, 9th and 6th healthiest country awards on the Bloomberg Index. 

In Switzerland, the average daily sugar consumption is only 76.1 grams per day. The Swiss diet is a reflection of their food pyramid, which places unsweetened beverages, like water, at the base and emphasizes fresh fruits and vegetables. It also calls for only one protein serving daily. The Swiss keep their portions small, traditionally eating five meals per day. Further north on the European continent, the average Norwegian adult consumes 83.1 grams of sugar per day, while the average Swede consumes 86.1 grams per day. The typical Nordic diet is a reflection of their landscape as miles of coastline provide plentiful, fresh seafood, while the cold weather allows only hearty root vegetables, greens and berries to grow. It is the combination of their diets, cultural emphasis on physical activity, and excellent healthcare systems that allow these three countries to be counted amongst the healthiest in the world.

Travel Tips

When traveling, we often concede poor eating habits, over-eating and minimal physical activity. Although traveling does cause us to deviate from our normal nutritional routine, there are still ways we can keep healthy.

For starters, eat local. Author Deborah Cater says it perfectly: “To understand a culture, you must taste it,” so resist the temptation of eating at the familiar (i.e. the golden arches of McDonald’s, the double-tailed mermaid of Starbucks or Colonel Sanders of KFC), and eat where the locals eat. Try avoiding large, national chain restaurants in favor of smaller places that source their ingredients locally. If you’re buying ingredients to cook, try going to local markets and smaller grocers versus large, national or international chains where the food is more likely processed or pre-packaged. 

Consider the Japanese practice of Hara Hachi Bu or, “eat until you are 80% full,” and keep track of your intake. If you can’t decide what to eat, order tapas-style or a la carte dishes to sample the local cuisine. Document what you’ve eaten to track calories and macros and to help you recall your favorite dishes to recreate later. Who knows, maybe you can turn it into a successful blog or cookbook?

Finally, ditch the rental car and walk or ride a bike. Most of the countries on the Bloomberg Health Index have cities that are thoughtfully built and have invested in infrastructure to reduce urban sprawl and instead promote walkability and bicycle use. Places like Norway, Sweden and Switzerland have a rich culture of outdoor physical activities year-round and the majestic scenery to boot. So, look around, explore and get lost! Sometimes, the best memories are made when your travel plans don’t work out the exact way you want them to.

If our food tells a story about who we are, how would your story read and what changes would you make? Whether your travels take you to the Mediterranean coast, the historic streets of London, the Swiss Alps, the fjords of Scandinavia or elsewhere, draw influences from other cultures and weave them into a story that is uniquely your own. 

About the Author

Dr. de Lota is a family medicine physician working at Austin Regional Clinic. He enjoys treating people of all ages and has a passion for preventative care, evidence-based medicine and patient education.

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