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The Pilgrims celebrated their first successful harvest and bounty of crops with the Wam­pa­noag Indians in 1621 by eating wild fowl, venison, corn, grains, and nuts. Unlike this “first Thanksgiving,” today’s celebrations are feasts with spreads quite different than the Pilgrims’.

Food has become a public health issue. When social issues aren’t adequately addressed, they become health issues. A characteristic unchanged over the centuries is that one’s socioeconomic standing dictates the quality of food available. Lower incomes force families to make choices in foods, not nutrients. Some communities and neighborhoods have limited access to affordable, high-quality, nutritious foods. These areas are called “food deserts.”

The unfortunate paradox is that those who can least afford higher-priced nutritious foods end up paying the most. How did this happen? As food shopping became suburbanized, large superstores replaced traditional “mom and pop” shops, making food more affordable. But rural residents who once resisted commercial supermarkets now find themselves miles away from stores that sell high-quality food. Many inner-city neighborhoods also suffer from lack of healthy alternatives.

Americans’ love affair with food—the pleasures of acquiring, sharing, exchanging, and eating food socially—is reaping unintended consequences. The Centers for Disease Control and Prevention estimates that 17% of children and 30% of adults are obese—an increase of 37% over the last decade. Americans are eating one-third more calories than we did 40 years ago. Obesity often leads to increased blood pressure, higher cholesterol levels, type 2 diabetes, sleep apnea, and cancer. These diet-related diseases disproportionately affect people of color and those with lower incomes.

The government has been helping to provide nutritious food options for low-income families for decades. Since 1974, the Women, Infants, and Children (WIC) program has helped low-income perinatal women as well as infants and children up to age 5 to acquire food to meet special nutritional needs. The number of persons benefiting from WIC has grown from 88,000 to 9.3 million in 2009. The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, began in 1939 and now helps more than 33 million children and low-income persons obtain healthy food. Currently, the Health Resources and Services Administration is creating a Prevention Center for Healthy Weight to accelerate the implementation of evidence-based actions to prevent and treat obesity in our communities. Earlier this year, the government launched a $400 million Healthy Food Financing Initiative to bring healthy food retailers to underserved urban and rural communities.

The private sector is doing its part, too. Chain retailers, such as Wal-Mart, Target, CVS, and Walgreens, are bringing fresh produce into underserved communities to alleviate “food deserts.” First Lady Michelle Obama started the “Let’s Move” program (, whose goals include healthy eating, being more active, and encouraging families, schools, and communities to take action to ensure a healthier generation of children.

With growing concerns over public health, one possible approach to changing eating behavior is to levy higher taxes on unhealthy foods. Research suggests people consume less of a product when it’s taxed at a higher rate, as occurred with tobacco. Some models suggest lower consumption of unhealthy foods equate to weight loss, although the evidence isn’t conclusive. In a backlash against government intervention or control, Americans Against Food Taxes ( is using TV ads to try to rally Americans against threatened taxes on soda, juice drinks, sports drinks, and flavored milk.

Meanwhile, obesity is raising healthcare costs. Growing girths have necessitated the development of larger-bore openings in computed tomography and magnetic resonance imaging scanners. Bariatric equipment purchases have surged 20%—and this gear comes at a premium of 20% to 50% with no commensurate reimbursement. Musculoskeletal injuries from handling larger and heavier patients have contributed to injuries among healthcare workers.

Debate on the causes of and solutions for obesity—and the public health consequences of being overweight—is emotional. What’s the main culprit—fast food? Food fads? High-fructose corn syrup? We’ve gone from a country obsessed with being thin to a country struggling to meet basic needs. Michael Pollan, best-selling author of The Omnivore’s Dilemma, describes the fluctuations in our eating habits fueled by constantly changing nutritional wisdom as our “national eating disorder.”

It’s time for therapy. As individuals and community leaders, we can step up and help restore a path to healthier eating and lifestyles.

Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC

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