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The Daily Herald
Published in Provo, UT
Sept. 23, 2004

Healthy living influenced by more than genetics, will power
Jessie C. Gruman

When Bill Clinton went from ex-commander-in-chief to chief in-patient, the
media first placed the blame for his heart disease on his life-long love
affair with fast food.

After a couple days and some admonitions from scientists, coverage
revisited the old debate -- genes vs. behavior; which is the more important
determinant of health?

When the human genome was unveiled in 2000, every malady seemed at first to
be genetics-based, in the way that to a hammer everything looks like a
nail. But it turns out only about 3 percent of disease is caused by a
single faulty gene.

Craig Venter, the genome pioneer, said at the time, "I believe all of our
behaviors, all of our sizes and functions, clearly have a genetic component
but genes only explain a part of any process."

Thus, illness and longevity depend on the interplay between what we were
born with and what we have done since then. Because we can't choose our
parents, we cannot control our genes. But we can control our behavior.

What is behavior? It is what we choose to eat, drink and breathe and how we
exercise, manage stress and adhere to medical advice based on the best
available evidence.

It sounds so easy, because individual choices and willpower are relatively
inexpensive commodities. But even the simplest preventive behaviors can run
up against the barriers of cost, time and environment.

A recent study in the American Journal of Preventive Medicine suggested a
strong link between TV-watching and obesity among black girls age 6 to 9.
It wasn't about laziness; it was about safety. The children didn't want to
go outdoors, and their mothers didn't want them too, either, citing
traffic, unrestrained dogs, poor recreational facilities, lack of sidewalks
and a general unwillingness to let the girls play outside without
supervision.

Wealthier neighborhoods have more than three times as many supermarkets as
poor neighborhoods, limiting access for many people to the basic elements
of a healthy diet, especially when the quality of produce and vegetables is
so much worse in stores in low-income areas and people are less likely to
have cars to find better bargains.

There is another reason why poor people struggle with obesity, and it isn't
a lack of character. Foods that are cheaper (fats, sugars, carbohydrates)
are the most energy-efficient. In other words, throughout history, people
have maximized the caloric and energy value and minimized the cost of what
they put on the family table. It isn't going to be radicchio, salmon,
raspberries or merlot.

Good disease prevention, like good medical treatment, is expensive. A
recent article in Investor's Business Daily cavalierly suggests six steps
anyone can take to prevent obesity. Let's look at the simple suggestions:
Join a gym or get a personal trainer; buy top-of-the-line workout shoes
once a year; buy home exercise equipment; do yoga, Pilates, meditation or
massage therapy; quit smoking; change your food-buying habits.

Now let's look at the costs: A gym membership can cost between $600 and
$1,200 a year; personal trainers ask $40 an hour; good shoes run $100 a
year; a home treadmill can cost between $700 and $1,700; people who already
engage in alternative forms of medicine spend an average of $300 a year on
things including yoga, massage and Pilates; smoking cessation may require
patches, gum, Smokenders sessions or $150-an-hour hypnosis; changing
food-buying habits might be easier and more affordable for the average
family that spends 7 percent of its disposable income on food, but what of
the poor family whose food bill is 25 percent of disposable income?

All six suggestions make perfect sense for those with time and several
thousand dollars at their disposal. But the reality is that poverty in this
country is growing and the cost of staying healthy is rising.

As in all forms of consumption -- whether eating or purchasing health care
-- balance is the ideal. We have to balance personal responsibility with
the obligation of social institutions to make achieving health a choice
available to all. It means a larger public investment in safe
neighborhoods. It means public agencies promoting health information that
reaches people at their level of understanding. It means changing U.S.
agricultural and trade policies and getting the sugar industry out of the
regulation-making process. It means greater reliance on company-sponsored
prevention initiatives.

In short, it means helping people who want to change their behavior to do
so with as few barriers as possible.

Jessie Gruman, is a health psychologist and president of the nonprofit
Center for the Advancment of Health in Washington, D.C.

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