Do It Slow

Nina Simone is more than one of my favorite musicians; she was an absolute treasure, one of America’s finest exports. One of her most famous songs was famously performed at Carnegie Hall and it happened to be one of her more political songs: Mississippi Goddam.

Written in response to the Medgar Evers murder, Ms. Simone railed against the black establishment and their admonitions that equality takes time, to “do it slow.”

But that’s just the trouble
“do it slow”
“do it slow”
Mass participation
“do it slow”
“do it slow”
Do things gradually
“do it slow”
But bring more tragedy
“do it slow”
Why don’t you see it
Why don’t you feel it
I don’t know
I don’t know

Her frustrations are real, and I believe, completely justifiable. Medgar Evers was one of the rising stars of the equality movement, and a real American hero to boot. To accept his murder was to accept that black folks were little more than cannon fodder in the larger battle.

Now what the heck does this have to do with public health? Only everything. Because of a media article on one of the studies in the April edition of the International Journal of Obesity, the one on environmental affects on obesity. (I’m not writing the name of the study because it’s completely unreadable to real human beings.) The folks at The Salt, an NPR program on food and eating, covered that part of the study that focused on how food was stored in the house by talking to the lead author and soliciting comment from other public health researchers.

The upshot was that there is a real correlation between how food is stored in the home, and how fat the people who live there are. If you’re obese, it’s more likely that you’ve got food, like snacks, sitting out. It’s likely that that food is placed in the obese person’s favorite spot, like by the couch, or in the bedroom. The authors theorize that unhealthy snacks placed by a mindless place (like in front of a TV), makes them more likely to be consumed mindlessly, leading to or contributing to the person’s obesity. Skinnier folks tend to have food stowed away, and have less of it on hand.

Seems pretty simple, no? And not really a bad piece of advice, to boot:

If you’re looking to lose weight, don’t leave unhealthy food sitting out, where it’s easier to snack on.

But! Very August Public Health Thinkers tell us, “do it slow!”

James Hill, a physiological psychologist at the University of Colorado, says, “All [Emery’s study] does is point out a few things that seem to be different among people who are overweight and people who aren’t.” The NPR article attributes the idea that leaving a bag of chips by your favorite armchair doesn’t necessarily mean that habit will lead to obesity, just as being obese might not lead you to have chips by your side, to Dr. Hill.

Hill says that we shouldn’t be doling out advice based on these correlations, saying it “would be a mistake.”

Because heaven knows we wouldn’t want people to put the damn chips away!

Dr. Hill (whom I hold no enmity against; I’m sure he’s done tons of good work), and his Very August Public Health Thinker pals, ascribe to the idea that we shouldn’t be advocating for people to make changes to their lives until we know for sure that making a very specific change will provoke some specific, measurable change. Evidence-based, we call it.

Go slow! Until we have evidence!

Did Ms. Simone, when railing against the leaders in the fight for equality, counsel for us to wait until we have evidence that things would work out? Or did she simply point at the dead bodies and yell, “Shame! Despicable!”

Well I can do that, too. I can point at JAMA, AJPH, RWJF and the Trust for America’s Health, the US Surgeon General. I can point at the bodies. The millions of dead Americans and yell, “Shame! Despicable!” How dare we wait to tell people to put the chips away; wait while we search for funding for a study to prove that a bag of chips on your nightstand isn’t a particularly good idea.

This isn’t to say there isn’t a place for evidence-based recommendations. The cottage industry of academic research (and it is an industry) is safe. But this? Why isn’t this a full-throated recommendation? Why do we equivocate and delay and hem and haw and call for more study? Why do we wait while the cannon fodder of this war on obesity continue to be mowed down?

There is a place for common sense in public health. There is a place for good enough. There is a place to err on the side of the public. There is a place for public health on the mountaintop, shouting. To be unequivocal. To be an advocate. To be political. To be argumentative.

To not go slow. To stop the flow of bodies.