Gary Egger argues obesity and type 2 diabetes are epidemics shaped by environment and economics, not just individual choices. He calls obesity a canary in the coal mine for deeper systemic problems, and advocates for lifestyle medicine to address upstream causes.
When I look at the epidemiology of a particular problem, I like to go back to look at the span out, if you like, and look at the big picture. Ultimately, when a new epidemic starts, and let's talk about obesity and type 2 diabetes, for example, as the big chronic diseases of the era, you can say that the immediate and proximal causes are an individual's behavior, and that is particularly what they eat, how active they are, whether they get good sleep, whether they're highly stressed, all these sorts of things. But these are really just the immediate causes. There are causes of those causes, and then there are causes of those causes of those causes. And if you track these causes back, it becomes very interesting because it leads not just to the individual behavior and an individual response, but it's the environment that drives that response. And when you take it right back, the big driver of all of this is the modern environment in which we live, which is really economic growth beyond a point, because there's no doubt that growth and development in all countries has tremendous advantages up to a point. But beyond a point, you have to get negative returns when you've got exponential growth in anything. And none of the early economists would ever admitted that this can go on forever. And now we're starting to see the consequences of that, particularly in obesity, which is probably a warning sign that there's other things going on in the community that are not helpful. I don't think obesity in itself, after many years of working in that area is necessarily all that important. I think in some cases it is, but I think in many cases it's a warning sign. It's a canary in a coal mine, if you like, that there's other things going on in society that we need to look at, and that's basically where the whole lifestyle medicine approach comes in.
