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The Conversation

The “You Docs” – Is the Surgeon General Too Fat for the Job?

The You Docs are syndicated columnists whose articles appear in the Oregonian. In a recent column, titled “Leading healthier, happier lives is largely your choice,” they in discuss the role of lifestyle in controlling health care costs. While they provide familiar statistics, they don’t offer any solutions beyond “the solution begins with you.”

They frame the discussion by asking if Dr. Regina Benjamin, the surgeon general nominee, is too fat for a job that should require setting a good example for lifestyle.

They begin with the same type of statistics that most everyone cites when connecting lifestyle with health costs: Three-quarters of health care costs going to chronic diseases, the U.S. spending twice as much on medical care as the ten developed European countries, etc. They point to the cause the experts all agree on: “too many of us are inactive, eat poorly, smoke and live with undermanaged stress.”

Seems logical so far. Next they discuss “upstream” prevention, using, in their case, the analogy of a leaky faucet one of them recently experienced: “We could have run for a mop and a bucket to clean up the mess, or we could have turned off the faucet first,” adding that “so far, the politicians, and even our president, have been trying to make more mops available and the insurance industry has proposed better mops and faster mopping.”

“Wouldn’t it be much better to turn off the faucet first?” they ask.

So far so good. Then they point out that “over five years, getting people with chronic diseases to make those basic lifestyle changes - eat better, exercise more, stop smoking and learn to manage stress - could eliminate more than 80 percent of the surgery and drugs they’d otherwise be treated with.”

But then they turn off the idea faucet. No ideas for how to deal with these behavioral factors beyond getting people to change their own behaviors. They conclude that “nothing is stopping us non-nominees from doing our part. That means us, and that means you!”

Just change your lifestyle everyone and health costs will be under control.

Oh, and the surgeon general dropping a few pounds will make a big difference.

Is something missing from the You Docs’ proposal?

Is controling costs by merely cajoling people into changing their lifestyles akin to controlling unplanned pregnancies through abstinence-only sex education?

If “leading happier lives is largely our choice,” why have health indicators declined so much in recent years?

What has affected our ability to choose?