Why Being Sick and Overweight Is Not a Personal Choice

Episode 46 57m


Our food and healthcare systems are broken; they are not serving public health and are even putting certain communities at a disproportionate risk.

We are up against social, economic, environmental, and political dysfunctions that contribute to chronic disease.

Heart disease, cancer, and stroke are the leading causes of death, and premature death at that, in the US. These diseases all have several risk factors in common, like smoking, physical inactivity, and poor diet, which policy often views simply as personal choices. But you can’t make healthy choices if you don’t have healthy choices available. There are social and cultural inputs at play and many reasons we need to begin looking at health beyond the individual and on a community and population-based level.

Today’s guest on The Doctor’s Farmacy is the perfect person to weigh-in on these issues. Dr. Sonia Angell is a Deputy Commissioner at the New York City Department of Health and Mental Hygiene (DOHMH), overseeing the Division of Prevention and Primary Care. Throughout her career, she has overseen nutrition-related policy initiatives, including restricting trans fat use in NYC restaurants, launching the National Salt Reduction Initiative, establishing food procurement nutrition standards for NYC government agencies, and establishing sodium warning labels in chain restaurants and expanding calorie labeling regulations. Dr. Angell is a practicing physician, board certified in internal medicine, and on faculty at the College of Physicians and Surgeons of Columbia University and New York Presbyterian Hospital.

The physical health of the community is related to its economic health, it is related to the resources that are available. Dr. Angell explains where the biggest challenges lie and how we can start approaching public health from a new perspective, one that accounts for community and shifting structural issues.

With our mutual friend Dr. Dariush Mozaffarian, Dr. Angell published an eye-opening article in BMJ, reviewing strategies that government can use to improve nutritional interventions in public health. We discuss their multidimensional approach which can be seen in this helpful visual:

When it comes to social determinants and what we view as cultural tendencies for food choices, Dr. Angell and I discuss how much of it has been imposed from outside influences like trade agreements to advertising and marketing. By getting communities involved to become part of the solution and promoting change directed by those that are affected, we can begin a new conversation about public health policy.

We discuss all this and more on this week’s episode. I hope you’ll tune in.

Host & Guests

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Ep. 46 - Why Being Sick and Overweight Is Not a Personal Choice