Death by poor diet? Now you know

Knowledge, so the saying goes, is power. But even a cursory chew of the prevailing state of diet and health is cause for doubt about the power of knowledge, our knowledge of power, or maybe both. When my career in preventive medicine began some 30 years ago, we already knew that poor overall diet quality, fundamentally, everything other than “[real] food, not too much, mostly plants” – was among the top three causes of premature death in the United States. Actual causes of death in the United States was published in JAMA in 1993. Now you know.

In late 2005 and early 2006, The Chicago Tribune ran a four-part expose titled “The Oreo, Obesity, and Us.” This series culminated with “Where There’s Smoke, There Might Be Food Research, Too” — informing us that the same functional MRI machines were being shared between tobacco scientists and food industry scientists tasked with ever better formulations to propagate our addictions. If you missed that memo 15 years ago … now you know.

It was, believe it or not, more than 14 years ago, in January 2007 — when Michael Pollan told us, with signature lilt and panache, that our sequential fixation on one nutrient or another would doom us to miss forever the forest of eating well for the trees of silly titillation. Put another way: there is more than one way to eat badly, and we were apparently committed to exploring them all. Should you happen to be among the rarefied few to miss that memo … now you know.

Among the many studies demonstrating the power of dietary fundamentals to shift both years in life and life in years, “Healthy Living is the Best Revenge,” published in 2009, is among my favorites. That study, in over 23,000 adults, associated the venerable trifecta of feet, forks, and fingers — not smoking (renouncing bad use of “fingers”), being routinely active (making good use of “feet”), and eating well as defined simplistically yet adequately by habitual intake of vegetables, fruits, and whole grains (making good use of “forks”) — with an 80 percent lesser incidence (or risk) of all major chronic disease. If you didn’t know already, now you know.

Michael Moss reprised and embellished the earlier revelations evinced in the Chicago Tribune in “Salt Sugar Fat.” The book was excerpted into a New York Times Magazine cover story titled “The Extraordinary Science of Addictive Junk Food” in 2013. Here, for those who missed the news nearly a decade earlier, was our second bite at the ultra-processed apple. Once again, we were apprised of the reported manipulation of our food supply to maximize the eating required to feel full, and in effect, the intentional propagation of obesity in deference to profit.

In 2019, we learned that “suboptimal diet is responsible for more deaths than any other risks globally, including tobacco smoking ”; that “our food is killing too many of us”; and that

“improvements in dietary quality have the potential to reduce mortality rates substantially.” Now you know.

Finally, in 2021, we learned that the staggering, chronic sequelae of eating poorly were massively compounded by the acute liability of elevated risk for adverse COVID outcomes, mediated by (mostly) dietinduced cardiometabolic disease. For that matter, boondoggles in the sourcing of human food likely account for the origins of this pandemic, most others in recent history, and … the next. On the off chance all of this were not yet enough to deliver a powerful kick to our seemingly complacent backsides, we learned as well that the same dietary practices cooking our personal goose are doing much the same to the planet.

To sum up, then, the ravages of dietary intake at odds with the health of people and planet alike – exacting a massive, perennial cost by every measure that matters, are neither covert, nor inadvertent.

Gertrude Stein told us “a difference, to be a difference, must make a difference.” If the knowledge at our disposal now about diet and health — what’s broken, why, and how to fix it — is insufficient to empower our routine, corrective action — to say nothing of outrage — what would be? What difference does it make to know so much when doing so little with it?

I’ve been battling these forces for 30 years, and quite frankly, I wish I knew.