Honesty Insecurity


Most poor Americans are fat.  “Heresy you say? How dare you write that?  You are denigrating poor people!”  Well, it’s true. How do I know that?   Well, most Americans are fat and the poor are even fatter.  Why can’t we be intellectually honest about this issue?  This article in the WSJ at least was.  It discusses how the same organizations use their sound bites and tag lines like  “Walk for Hunger”, “hunger relief”, “1 in 7 Americans struggle to get enough to eat”,“America Can’t Be Great on an Empty Stomach” and so on but the truth is that we have an obesity problem that costs so much more than a hunger problem. In fact, if most Americans were 10% underweight we probably would be healthier.  Anyway, I have blogged about this smoke and mirror game before and you should read more about it here. Pat Conrad MD also blogged about it here. This is three years ago and finally mainstream media is talking about the elephant in the room.  No pun intended.  The WSJ article gave us some facts:

Today, obesity is the problem. Some 38% of Americans are obese, the Centers for Disease Control and Prevention reported last fall, compared with about 12% in 1969. The statistics are worse among the poor. Obesity rates in America’s poorest counties are roughly 12% higher than the national median. About 42% of Hispanics are obese, as are 48% of African-Americans, according to the CDC.

The advocacy organizations know this but continue their sham.  Now they use the term“food insecurity.” How do they get this term?

Every year, the Agriculture Department asks a sample of households 10 questions, such as if they had failed to eat or worried about running out of food for lack of money at any time in the previous 12 months. Households that answer “yes” to three of the 10 are classified as “food insecure.” A “yes” to six or more counts as “very low food security.” These aren’t measures of hunger or under-nutrition, but advocacy groups and the media nonetheless depict them as such. The survey results are also referenced to suggest that many Americans face food insecurity on an average day, even though the percentages actually measure those who experienced it on any single day in the past year. On a typical day, fewer than 1% of households have very low food security, but readers of the USDA report don’t learn this until page 10.

Do you see how this is such a joke?  But we all knew that.  Intuitively, we all know that obesity and the problems that come with it (heart disease, diabetes, etc) are the real issues that need to be addressed.  We see it in our practices.  America sees it as well.  How? Everyone has a cell phone and every You Tube video and Instagram clip shows….fat people. For once, let’s be honest about this and try to fix it.  The problem with the “hunger” complaint is that it doesn’t sit well with mainstream America because they know it is a lie.  Who wants to donate to a food insecurity and hunger problem for the person in the picture above?

So why is this “food insecurity” myth perpetuated?  The author in the article believes it strengthens political support for the nutrition programs it administers. The $74 billion a year Supplemental Nutrition Assistance Program—also known as food stamps—still allows recipients to purchase candy and soda with their benefits.  God forbid we force them to give healthy food to the poor.  Why would that be a crime?  I guess it would be discrmitiatve in some manner?

So, why don’t advocates for low-income and minority Americans support change in these programs to make sure the food that is given is healthy?  Your guess is as good as mine.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Honesty Insecurity

  1. May 28, 2016 at 9:13 am

    I’ve worked with “the poor”, and in situations where many of my coworkers would have been considered “poor”.

    I cook healthy, balanced meals, using basic ingredients. No, this does not need to take all of my time. Heck, I’m wasting my time on the Internet right now. What I mostly saw or heard of were people buying prepared food. Their idea of a “home cooked meal” were things out of a box – which my mother called “convenience foods” and felt they were poor quality and more than we could afford as well inside middle class.

    I’m running into people who tell me with a straight face that they “cannot afford” vegetables. That’s when packages of frozen vegetables which will feed a family for 1 meal are 79 cents, and cans are about the same price – if you buy store-brands. Even national brands are only about twice that. They don’t have the slightest idea what to do with a turnip or a bunch of spinach. They don’t know what to do with something like a round steak or a pork chop. These boxed meals are loaded with starch and saturated fats – and fast foods are even worse! I ran into someone with a whole cabinet full of dry beans when she said she “had nothing in the house to eat”, which had come from a commodity program. She had no idea how to cook dried beans!

    How about somebody teach people how to cook, how to select healthful ingredients, and how to read labels on food packages? Let alone gardening…. vegetable seeds can be bought with food stamps, and those can be used to produce a LOT of healthful meals by anyone with a yard.

    While we’re about it, how about changing those convenience stores with a limited amount and number of prepared and convenience foods back into neighborhood grocery stores with actual food in them? My grandmother, who never drove, could put a balanced meal on the table in 15 minutes with basic items from the neighborhood grocer. Why can people no longer seem to do that?

    The other complaint I hear is “I don’t have time to make home-cooked meals.” If I can make one “Just like grandma used to make” (when she got home 20 minutes before Grandpa, and he expected dinner on the table when he got home) in about 15 minutes, they certainly have time if they can make a boxed dinner that takes 20 minutes – or do they really not have the 10 minutes beyond what is required to microwave other nutrition-poor meals?

  2. Bridget Reidy
    May 25, 2016 at 1:58 am

    Doug I love you but I’m going to be a little harsh on you here, hope the humor comes through.

    Oh the assumptions in this article and the comments! The poor are lazy. They have kitchens. There is no reason to allow any kind of sustinence to be bought with food stamps.

    OK, where does the policing start, we already see lots of the brightest and best educated people in the US imply right here that there is such a thing as healthy food, seeming to mean food that makes you lose weight, so who is sure they have the right list? And if anyone thinks it’s possible to live on cheap healthy home made food when you’re working for minimum wage, I suggest trying it, as Barbara Ehrenreich did in Nickle and Dimed. And how is a poor person supposed to figure out that junk makes them hungrier when we’ve been telling them to eat low fat junk for decades?

    I say get rid of the food stamp program when all the skinny snobs who think they don’t also eat too much (pretending it’s not also destroying their health when we know well that the only ticket to long life is exercise, lack of abuse or abandonment in childhood, lack of psychiatric medicines, and calorie restriction) take their spare time to serve lentil and greens stew on street corners to the poor and overworked. Meanwhile don’t feed me your holier than thou menu, especially that low fat one I followed the year I gained most of this weight. And maybe when you calorie restrict yourself to the point that you feel a bit insecure of your ability to function well the rest of the day you can preach that healthy lifestyle/quit wasting my Medicare dollars stuff, and you can make up the loss of all those Medicare dollars with all the extra Social Security and Medicaid nursing home dollars you’ll get from living past 90, employing lots of minimum wage workers to care for you, and so the dichotomy continues.
    So who wants to be in the check out line behind the food stamp recipient who has to separate her groceries while the clerk rings her up and takes payment twice?

    • Doug Farrago
      May 25, 2016 at 9:13 am

      I appreciate the passion but again, people are missing my point. What we have isn’t working. We have a massive obesity and DM problem. Can we agree on that? We do not really have a hunger problem but a food, educational, habit, etc problem. The system now is broken so we can argue and give excuses or we can fix it. The “honesty” part comes in when we admit that.

      • Bridget Reidy
        May 29, 2016 at 12:51 pm

        I disagree Doug. I agree that the hunger problem is exaggerated and appreciate you showing us how, but if you live on cheap easily available foods, or the nonfat nonfoods many believe to be “healthy”, you get hungry and can’t function well. That’s true at least for those of us that have a metabolism similar to mine (and many obese women who’ve always tried to lose, even before we were obese – just to be desired or respected long before we had any health concerns – tell me they do). And I’m sure stress and sleep deprivation contribute to that phenomenon, especially for me that year as I was also single parenting a colicky infant and trying to keep up financially despite a career with no jobs that matched day care schedules – all problems similar to what the working poor experience. Never mind cortisol and what we know about that, adrenaline seems to empty the liver of glycogen, when sustained, as I personally discovered when working an ER where I had adrenaline filled days and days with barely any. Or maybe it was just that my microbiome changed that year from the wrong kind of fiber. Fact is, we still don’t know and if you look at the quality of our nutrition research it is no wonder.

        So yes the poor, or many of them, often feel insecure about getting enough calories to function well – even if there are plenty stored they are not always immediately accessible, especially to the brain, which does function better when glucose doesn’t suddenly drop. We should all understand physiology enough to know that. Anyone can calorie restrict themselves if they have nothing to do, (or maybe as in my case, find a few months of working conditions of only 10 hour days and little adrenaline and break all social norms about how to eat – doable but not easy).

        The other things I brought up may not have anything to do with what you wrote here, or do they? You brought up some great points, but most who would be attracted to an article making fun of the concept of “food insecurity”, myself included, have deeply ingrained cultural attitudes that influence their perception and might lead a person to do the research you did to write such an insiteful post. Hating fat people starts in the movies we show our toddlers, and persists through our “science”. It can be broken by logic in those who care to use it, which is why I emphasize the common cultural logical flaws. Why do we think fat people should get skinny for their health, but skinny people can eat all they want even though it is also killing them? That shows how much our cultural phenomenon of disdain based on appearance has influenced what should be purely scientific, our medical advice. And when we mention the cost of the care for the obese, especially when not considering the cost of living too long, it is more than disdain, it is scapegoating, and runs counter to our argument that we should practice medicine and not be the public health police. We all have these deep cultural misconceptions. I can hate fat people who won’t lose weight when they have nothing else they have to do, figuring they just don’t even care what the world thinks of them, but there’s probably something I haven’t figured out about them because their problem is different from mine. Most people want social approval, that is ingrained in human DNA, and women in particular lose it at a weight that is 50# less than men, which is why they usually have a longer history of having tried everything and the things we suggest don’t work. (The ones who have never tried just eating less are a modern phenomenon probably because of another growing cultural misconception which has crept into the scientific world, that there are magic foods they should be eating.)

  3. Madelyn Sieraski
    May 23, 2016 at 11:37 am

    Part of the problems is education in the home. If no one in your family cooks you don’t learn to cook. Maybe Home Ec is the solution? Here is how you shop, here is how you cook. 1st you have to learn to read. Then you have to have time to do all of this. You need a home over your head. So many reasons and so many excuses. Wish I had an answer for all of.

  4. Robert B
    May 22, 2016 at 3:26 pm

    You seem to be missing something that helps explain why this is. Healthy food costs more and spoils faster. Soda is cheaper than fruit juice, and much cheaper than fruit juice that isn’t high in added sugar. This is a trend you will see in every aisle of the grocery store. The healthy option is much more expensive while the cheap option has lots of sodium and sugar. Then there is the issue of spoilage. Cheap option that lasts a long time or expensive option that spoils fast. Eating healthy requires frequent trips to the store which many poor do not have the time or gas money for.
    All the food stamp purchase limiting laws or proposed laws that I have seen do not address any of that. In fact they often restrict food stamp users from purchasing healthy foods. A recent one I saw prevented food stamp beneficiaries from purchasing any type of fish. It also didn’t make allowances for any dietary restrictions a person might have (Lactose intolerant? Too bad, you can’t purchase any type of non-standard milk. And if you actually have Celiac disease… hahaha). It was very obvious looking at the restrictions that it was about forcing a spartan and time-consuming (that requires poor people to have a full well appointed kitchen and the skills to use it) diet on the poor as punishment for being poor than anything to do with health or abuses of the system.

    • Doug Farrago
      May 22, 2016 at 4:52 pm

      Some of your points I buy into but some of your points are just excuses which we need to stop. That being said, that still wasn’t the point of the piece. Why are we lying about hunger? Why are we not calling it what it is? It is an obesity issue.

  5. May 22, 2016 at 2:01 pm

    Although in theory I agree with restricting food stamp use to “healthy” foods, that will not work by itself. If you like in a “food desert” as I and many so-called “poor people” do, there is no real grocery store within walking distance. Our local Dominick’s left in December 2013 and has never been replaced. I strongly suspect intentional destruction of our neighborhood to make it easier for those who profit by gentrification to buy it and replace it with a more lucrative population. Here in Chicago’s South Shore, those powers include the mighty U of Chicago (which pretty much owns all of Hyde Park already), as well as other urban development interests. Politicians genuflect to that kind of money and power.

  6. Pat
    May 22, 2016 at 11:15 am

    I would end food stamps and WICC tomorrow if I could. And I think I have a way to fix all of this. – need to crunch some numbers, stay tuned.

  7. Steve O'
    May 22, 2016 at 10:24 am

    America the Trendy prefers to pursue improvement fads, rather than come to terms with the underlying systems that are defective. The Poverty/Obesity link is not trendy, because the fad must be epitomized by a cute photograph, and obese people are not cute.

    Obesity is the new Race. It has long been known that personal wealth is shown by the lack of serious obesity, for various reasons. Obesity fulfills many of the criteria that race used to. These people can bear comfortable assertions of contempt towards what “they” are like – shiftless, lazy, selfish. One need not understand any more than the superficial glimpse of the problem to wave it away.

    Obesity, unlike race, is very much in the province of medicine, although it still is in the dark ages of treatment, as compared to other processes. Hopefully, there can be treatments that can help the obese who care – and those who don’t, well, devil take ye, as with other diseases.

    My clinical experience is that I have stumbled on a remarkably effective treatment for obesity management. Quite a large minority of my obese patients are losing weight in a substantial way. I am pleased. At least once a week I see a patient who has achieved substantial weight loss, moving down from the BMI ranges of the 40’s into the 30’s, or 30’s to the 20’s, or the 20’s into normal range. Last week I talked with a ‘loser,’ 60 lbs.

    My secret? It has nothing to do with me. I wish it were from my brilliance, or from some miracle ingredient, or such. It is inaccessible to the pharmaceutical companies, but is the mainstay of direct primary care. It is continuity of care. Seeing the same person, addressing morbid obesity the same as other medical threats to wellness, and discussing my desire to make it better seems to be the magic ticket. Of course, many don’t care – but that’s the way many patients will be, no matter what I want. I find most of the obese patients experience a clinic visit as something different than what they get everyplace else. I have no prejudice against them. I see a behavioral problem to be addressed on medical terms, and I approach knee pain, almost universally, with a suggestion to lose weight, even 5 or 10 lbs.

    Without continuity of reliable human contact, medicine means nothing, and that is for hypertension, breast cancer and obesity. Pfizer and Merck just cannot purify that answer, or make a monoclonal against it. Obesity is epidemic because the treatment has been lost, and since we live in the Dark Ages, we replace reason with superstition. DPC is a refreshing alternative, but I fear it will be burnt out with the pitchforks and the torches, by the terrified mob – a heresy which cannot be permitted any more.

    Obesity is a symptom, but one far more serious than just fatness. It is societally end-stage.

  8. Benjamin Van Raalte
    May 22, 2016 at 8:09 am

    When I saw a teen buying chips and soda at a gas station with the food stamp credit card I knew we had a problem.
    I don’t buy chips in and soda at a gas station, because, 1. a waste of money it’s too expensive there 2. it has no nutritional value.

    Food stamps became a problem when it became a credit card. It took away the shame. Food stamps should not be able to be used for prepared foods, it should only be for raw foods and healthy foods. For those people who state they have disabilities so that they can’t prepare food then instead of food stamps it should be prepared meals delivered bid out by the lowest bidder. These would be healthy and restricted by calories.

    Computers should only allow those purchases or we should bid out and the lowest cost be delivered not the highest cost.

    The major type of food insecurity is kids missing meals because their parents are too irresponsible to even cook or prepare a meal for them. If they’re busy being drunk on drugs or watching TV or just lazy the kids miss a meal

    • Steve O'
      May 22, 2016 at 11:30 am

      How can we improve the subsidizing of BAD behavior, if we are unable to effectively subsidize GOOD behavior? How can our government and society even attempt to regulate food stamps, if we have managed to drive simple medical care into the dirt?
      We should bite the bullet, and back out of those things that we can handle. Maybe the Swiss or Swedes can run socialist programs decently, and good for them! We can’t. We should throw in the towel until we can find a way to do these things without stagnating in bureaucracy.
      The Soviets couldn’t. They’re rapidly disappearing in the rear-view mirror of history, like we’re about to.

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