Aristotle once said that “the guest is a better judge of the feast than the cook. (1)” Since his time social psychological research has shown that viewing oneself through another’s lens is an invaluable assessment tool (2). Following this principle, Americans should look to other countries to gain clues as to where our health policy problems lie. In 2005, some American college students asked a sampling of Australians what they thought of Americans. The Australian’s answers fell into three categories: arrogant, stupid, and fat (2). This video is not the only indication of our poor public appearance; indeed, these descriptors turn 40,000 Google search results ranging from fallible blogs to news articles citing the United States government reports (3).
While arrogance is an arbitrarily defined characteristic, education and obesity levels are quantifiably measured and compared. The American military recently corroborated the assertion that Americans are unintelligent and overweight. This report estimates that up to 75% of 17-24 year old Americans are ineligible for military service, despite recently relaxed enlistment requirements (4). These deferrals are primarily due to educational limitations and physical issues, primarily obesity (5).
This high proportion of weight based rejections is to be expected, after all, obesity rates have steadily climbed since the 1970’s (6). Fortunately this obesity epidemic has plateaued during the past five years (7). Recent reports establish that American obesity rates have leveled at 32.2% of men and 35.5% of women (8). Unfortunately this stagnation may be indicative of a saturation point and not a move toward better eating and exercise habits (7). Other sources indicate that these rates are still climbing and may reach 40% by 2018 (9). Regardless of whether the rates are increasing or leveling, they do not show a decrease. It is imperative that the United States reverse these trends as obesity is causally linked to many health-care intensive conditions, including heart failure, diabetes, stroke, and psychological distress (10).
When we examine the “stupid” part of the conjecture, we find that consumers are in an untenable situation. First, the American public school system does not ensure that people possess the reading comprehensive levels required to successfully navigate the health care system (11). Second, the medical system is rife with bureaucratic red-tape. A Journal of General Internal Medicine report found that comprehending the legislation set to protect patient rights requires two years of college level reading (10). To put this in perspective, approximately 70% of the United States population over the age of 25 cannot understand the laws which govern their health care rights (11). This ambiguity has created a market of confused individuals who receive substandard care while being melded into padding the bottom line for insurance companies (15). Current legislation proposals do little to simplify this language and often lead to increased confusion (12).
These two issues are obviously complex and change will require legislative action coupled with personal initiative. In regard to obesity, law makers can impose “sin taxes” on items which are high in calories and low in nutritional value, such as soda and candy, to discourage their consumption. This approach has shown positive results in the tobacco industry and shows promise for junk food items (12). Furthermore, fast-food chains should be required to post calorie and fat content on their menus. Studies have shown that while this does not decreased the number of calories adults consume, it has led to parents to make healthier decisions for their children (17). Hopefully, with targeted advertisements, adults also will make healthier decisions for themselves.
Yet these measures will likely fail without building a supporting infrastructure through public educational changes. If the public school systems limit their menus to wholesome, palatable options, children will learn from an early age what foods are wholesome. Additionally, candy and soda should be eliminated from schools. Often junk food vendors provide schools with funding to peddle their products. By legislatively eliminating this perverse incentive, children will be pushed to choose healthy options (18). These legislative changes coupled with increased nutritional education and physical activity will instill healthy values in our children.
Americans must take personal responsibility for our bodies and change our eating and exercise habits instead of making excuses. Experts show that only 2% of individuals become obese as a result of underlying metabolic disorders, a fact which renders the “it’s genetic” excuse a moot point (14). If we spent more time cooking for ourselves instead of watching cooking shows, our eating habits would significantly improve (13).
In regard to health systems comprehension, the government must require health insurers and providers to communicate effectively. Admittedly, the health system is not responsible for the population’s reading abilities; but they are responsible to meet the needs of their clients (10). This means that insurers and providers must provide culturally competent information to their patients at a reading level they comprehend. Some insurers have successfully implanted “words we use” lists in their call centers to translate the complicated jargon (22). If organizations were required to utilize these words and provide all materials at an 8th grade reading level, comprehension and compliance would increase (12).
Finally, on a personal level, we must increase our involvement in our own health care. We, the patients, must educate ourselves concerning our conditions and treatment options. This will allow us to maximize the time we spend with our physicians and ensure appropriate treatment.
If we couple legislative changes with personal agency to our food delivery system and health systems comprehension we can slow and prevent future ill-health. By making these changes, hopefully the next five years will lead to Americans being known as something besides stupid and fat. After all, our health, and national reputation, depend on it.
1. Masaoka, J. A 360-Degree Look at the Organization: Seeing Ourselves as Others See Us. blueavocado.org. [Online] December 16, 2008. [Cited: February 8, 2010.] http://www.blueavocado.org/content/360-degree-look-organization-seeing-ourselves-others-see-us.
2. Hanson, R. For the Truth, Ask a Friend. Overcoming Bias. [Online] June 9, 2009. [Cited: February 8, 2010.] http://www.overcomingbias.com/2009/06/forthetruthaskfriend.html.
3. fatawesome. Stupid, Fat, Arrogant Americans. YouTube.com. [Online] 2005. [Cited: February 8, 2010.] http://www.youtube.com/watch?v=r1aRzoXRPuA.
4. Google.com. Search Terms: stupid, fat, arrogant, American. [Online] [Cited: February 8, 2010.] http://www.google.com/search?ie=UTF-8&oe=UTF-8&sourceid=navclient&gfns=1&q=stupid%2C+fat%2C+arrogant%2C+American.
5. Noti, Yaran. Terrorists: 1, Fat, Stupid Americans: 0. The Details. [Online] November 11, 2009. [Cited: February 8, 2010.] http://www.details.com/blogs/daily-details/2009/11/terrorists-1-fat-stupid-americans-0.html.
6. Stone, Andrea. 75 Percent of Young Americans Are Unfit for Military Duty. aolNews. [Online] November 2009. [Cited: February 8, 2010.] http://www.aolnews.com/article/70-percent-of-young-americans-are-unfit-for-military-duty/19260560.
7. CDC. U.S. Obesity Trends. Centers for Disease Control and Prevention. [Online] November 20, 2009. [Cited: February 8, 2010.] http://www.cdc.gov/obesity/data/trends.html#State.
8. Belluck, Pam. Obesity Rates Hit Plateau in U.S. . The New York Times. [Online] January 13, 2010. [Cited: February 8, 2010.] http://www.nytimes.com/2010/01/14/health/14obese.html.
9. Prevalence and Trends in Obesity Among US Adults, 1999-2008. Flegal, K., et al. 3, s.l. : AMA, January 13, 2010, JAMA, Vol. 303, pp. 235-241.
10. CBS. Study: 40% of U.S. May Be Obese by 2018. CBSHealth. [Online] November 11, 2009. [Cited: February 8, 2010.] http://www.cbsnews.com/stories/2009/11/17/health/main5683256.shtml.
11. uwaifo, G. and Arioglu, E. Obesity. WebMd. [Online] May 21, 2009. [Cited: February 8, 2010.] http://emedicine.medscape.com/article/123702-overview.
12. United States Government. CIA Factbook. [Online] 2010. [Cited: February 8, 2010.]
13. Gardner, A. Patient's Bill of Rights Too Tough to Read. U.S. News and World Report. [Online] March 27, 2009. [Cited: February 8, 2010.] http://health.usnews.com/articles/health/healthday/2009/03/27/patients-bill-of-rights-too-tough-to-read.html..
14. United States Census Bureau. Educational Attainment: 2000. census.gov. [Online] August 2003. [Cited: February 8, 2010.] http://www.census.gov/prod/2003pubs/c2kbr-24.pdf.
15. Vogin, G. Dealing with Rejection. MedicineNet.com. [Online] March 22, 2002. [Cited: February 8, 2010.] http://www.medicinenet.com/script/main/art.asp?articlekey=51313.
16. Ashkenas, R. Let's Simplify the Language. Harvard Business Review. [Online] October 2, 2009. [Cited: February 8, 2010.] http://blogs.hbr.org/cs/2009/10/lets_simplify_the_language_of.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%253A+harvardbusiness%252Fconversationstarter+%28Conversation+Starter+on+HBR.org%29.
17. Halting the Obesity Epidemic: A Public Health Policy Approach. Nestle, M. and Jacobson, M. 1, 2000, Public Health Reports, Vol. 115, pp. 12-24. http://www.jstor.org/pss/4598478.
18. Reuters. Parents Cut Kids' Calories when Menus are Labeled. Fox News. [Online] January 25, 2010. [Cited: February 8, 2010.] http://www.foxnews.com/story/0,2933,583808,00.html.
19. Gorman, L. Junk Food Availability in Schools Raises Obesity. The National Bureau of Economic Research. [Online] January 2010. [Cited: February 8, 2010.] http://www.nber.org/digest/sep05/w11177.html.
20. Bariatric Weight Loss Center. What Causes Obesity. St. Vincent Health. [Online] 2006. [Cited: February 8, 2010.] http://www.stvincent.org/ourservices/bariatrics/about/causes/default.htm.
21. Pollan, M. Out of the Kitchen, Onto the Couch. New York Times. [Online] July 29, 2009. [Cited: February 8, 2010.] http://www.nytimes.com/2009/08/02/magazine/02cooking-t.html?pagewanted=1&_r=1.
22. Meyer, H. Confusing Insurance Jargon Prompts Call For Reform . Kaiser Health News. [Online] September 16, 2008. [Cited: February 10, 2010.] http://www.kaiserhealthnews.org/Stories/2009/September/18/communications.aspx.
23. United Health Foundation. The Future Costs of Obesity. [Online] November 2009. [Cited: February 8, 2010.] http://www.fightchronicdisease.org/pdfs/CostofObesityReport-FINAL.pdf.
24. California Nurses Association. California's Real Death Panels: Insurers Deny 21% of Claims. National Nurses Organizing Committee. [Online] September 2, 2009. [Cited: February 4, 2010.] http://www.calnurses.org/media-center/press-releases/2009/september/california-s-real-death-panels-insurers-deny-21-of-claims.html.