Individual responsibility not enough to heal what ails us

Slightly more appealing to me than being the team physician for Victoria’s Secret underwear models is the idea that we can solve America’s obesity problem by all of us simply being more responsible about personal health.

I love the idea because it is simple and true. Heck, I try to live the idea, but I, Dr. Responsible, fail at it every day. I sometimes eat stuff that would give chest pain to a heart surgeon. I take my Lipitor because I am never going to eat the green grass diet necessary to get my cholesterol where it should be on my own.

As a paragon of personal imperfection, I am in great company. We have but to look at our children for evidence of the limited effectiveness of individual responsibility; more than 20 percent are now overweight or obese. If individual responsibility would have worked anywhere, one would think it would have worked to save our children, and it hasn’t. Nor has it worked with adults; more than 60 percent of us are overweight, and most adults who lose weight slip back and regain most of what they lost.

Individual responsibility is part of the answer, but rarely succeeds as the only answer because most of us are not that perfect. Responsibility is a slippery slope that requires constant climbing, and without footholds placed by other individuals and society, most of us slip back over the long haul. Human beings have always needed help to act responsibly, sometimes from those who lead and inspire us, and sometimes from the pain and suffering that result from our irresponsibility.

We are a society of laws because we need them to place framework and limits around human interaction. We ban the advertising of cigarettes to children because we know children are susceptible to the blandishments of extraordinarily sophisticated and deceptive marketing, and cigarette companies would sell them to preschoolers if we let them. Religion is a belief system that helps us choose to do the right thing and at the core of most religions is the assumption we are all deeply flawed.

The lesson of previous experience with massive social change is that it requires a massive, multidimensional effort. Few of the profound social changes America has undergone in the last 200 years would have survived if fueled only by personal responsibility. Turning around our national lifestyle of too much food and too little exercise will require all of the elements of social change that were required to give equal access to the American dream to people of color and women, or reduce cigarette smoking from 40 percent to 25 percent over the last 60 years.

In order to get healthier as a society, we will need to change the message that surrounds us from one of constant leisure and eating to a message supporting less eating and more activity. We will need the new message to bombard us in the home, the schools, the workplace, the community and for our leaders to speak it to us every day. We will need laws that place restrictions on contrary messages, especially the advertising of junk food to our children. We will need financial incentives to eat and live right, and financial penalties for failing to be as healthy as we can.

We will need gas to cost us even more than $4 per gallon so we do not drive when we can walk, bike, or run, and so we stop building communities that require everyone to have cars. We will need to educate our children and ourselves about how to eat right, and force restaurants to post clear calorie information on the menus from which we order food. We will need to stop subsidizing the production of refined sugar, and if we are going to subsidize anything, make it locally grown fresh fruits and vegetables so that nutritious food is cheap and easily available.

We will only do all of this if we abandon the pipe dream that individual responsibility will step up and save us. It is to be cherished, nourished, expected and demanded, but not regarded as the mighty and powerful Wizard of Oz of personal health. Assuming nothing but personal responsibility is required to save us from our sedentary selves will doom us to failure, and would be, well … personally irresponsible.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.