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Elephant in the Room

September 27, 2021

Keywords: education top-down; obesity and Covid; government intervention; personal freedom and responsibility; health care management; dopamine, and education bottom-up

Elephants in the room are easy to ignore when doing so takes our eyes away from nagging reality.

Our surveys invariably include a section on the transfer of skills to students. Of parents, we ask: “How successful has the School been in contributing to your child’s growth in each of the following?” Then we offer a list of skills like the one below, used in a recent survey.

“But I’m a Math teacher; I’m an English teacher; I’m a Science teacher; I’m a (fill in the blank) teacher… I don’t have time to deal with all that social-relational mumbo jumbo.”

Clearly, we’re not all on the same page here. Fully one-half of this list of skills is not of the core academic variety. In my observation over the past 25 years, school administrators place more weight on these so-called ‘soft’ skills than many teachers do. Everything I see and everything I read supports the notion that the core academic side wins when appropriate attention is paid to the ‘soft’ side. Balance and synergy in program. So… why do we ever witness this kind of pushback on the development of the whole child? Is it disbelief? Perhaps for a small number, but I really don’t think that’s it. From where I sit, operationalizing the ‘whole child’ concept in education is not easy. The soft side is an elephant in the room. It’s complex and it’s hard. What’s more, it’s hard to measure. And finally, if my own performance ‘as a teacher’ were measured on core academic success, and if I was being graded on the short term, not the lifelong experience of my students, I’d be seriously tempted to focus on the short term.


I’ve told you that ‘story’ so I could tell you this one.

Public discourse over the past year and a half has largely ignored a sizable elephant in the room. Covid has touched us all directly or indirectly. Three of four members in my household contracted the virus, including me. Hospitalized with oxygen saturation levels falling to 84% (my norm is 98-99%), I was at risk for compromised brain, heart, and lung function. It took me three months to fully recover, so if you have someone tell you that Covid’s a hoax, give them my number.

Enough about my own personal Covid adventure. Suffice to say that, while I was voraciously consuming Covid data before this past May, my information consumption levels have risen even more since then. The more I learn, the more I realize there is to learn. I still have many questions.

What fascinates me greatly is that our attention has been trained on masks, on hand hygiene, on social distancing, and more recently, on vaccination. I’m a fan of all four mitigation strategies, and will be lining up for my booster shot as soon as I’m eligible. While there has been much debate on the merits of these strategies, and while the topic will continue to be litigated, my exploration today centres not on the short-term, but rather, on how we might prevent future such global disruptions.

One recent conversation I had yielded the suggestion that our tax dollars should be invested in a serious upgrade of healthcare facilities, and that we ought to build excess capacity in preparation for the inevitable next pandemic. This may be true, but I’m inclined to back up a couple of steps to take a view of the big picture.

I ask: Why are our hospitals bursting at the seams? Is this virus more transmissible and more deadly than past viruses? Certainly, it’s more transmissible than most, and that accounts in a meaningful way for the higher hit rate in ICUs and mortuaries. Is there more? I think so, and here’s why.

Age is the strongest correlate to complications and death from Covid. While aging is theoretically preventable, such prevention is generally not high on anyone’s wish list. Let’s stick to variables we can control.

Obesity is the major elephant in the room, and the titular target of today’s entry. With the able assistance of my daughter, Alana, I’ve built a spreadsheet showing Deaths/1,000 Cases across 26 leading industrialized nations. We used Deaths/1,000 Cases rather than by population because there is wide variability in the incidence of Covid across countries. Of course, there’s no guarantee of consistency in the reporting of cases or deaths, but it’s still something to work with. Next, we asked, “How are these countries different?” Well, they are different in many ways – geography, population density, health care facilities, type of government, mitigation efforts – so, there is plenty of opportunity for ‘confounding’ variables.

This said, our next column of data shows the adult obesity rate for each country. What did we learn? What we learned was that the half dozen countries at the top of the mortality ranking averaged 24.2% in adult obesity and 36.2 deaths per 1,000 cases. Those at the bottom of the mortality ranking averaged just 15.7% in adult obesity and 7.0 deaths per 1,000 cases. This difference is huge.

Earlier this year, the American CDC revealed that 78% of those hospitalized with Covid were overweight (27.8%) or obese (50.2%). While obesity shows no greater incidence in contracting the disease, studies indicate that obesity almost triples the probability of death from Covid, once contracted. After age, obesity is the next strongest correlate to complications and death from Covid.

As an avid consumer of ‘news’, I’ve heard little from public health officials about obesity and its connection to Covid. So much talk about mitigation strategies and management of hospital capacity. I’ve made the argument, myself, about Canada’s sorely missing ability to manufacture its own vaccines. Looking to the longer-term horizon, though, I ask, “Shouldn’t our focus be on eliminating the pre-conditions that lead to hospitalization and death from Covid… and other viruses yet to come?”

Much of the death we’ve seen from Covid has been avoidable. If we would only face up to this elephant in the room… if we could only address the primary avoidable reason for hospitalization and death, we would not need so badly to shore up our hospital capacity.

Last week, we got 100 mm (4 inches) of rain in one day. For a half hour during the peak of the storm, with a bucket, I continuously bailed out the garden at the side of our house, hoping to avoid a breach of water through the basement window. Halfway through this effort, my wife kindly pointed behind me to announce that the downspout extender had become disconnected from the downspout. It was a classic case of treating symptoms instead of causes.

Obesity is the Number 1 avoidable risk for complicating illness and death. Obesity, on its own, may steal back our recent gains in life expectancy. Since 1975, obesity around the world has tripled. This tripling was not inevitable. Obesity in Japan is just 4.3%, in South Korea 4.7%.  So… some nations are successful in minimizing obesity. Both of these countries are in the bottom six in our ranking of deaths per 1,000 cases. What’s wrong with the rest of us?

Will our efforts to reduce obesity mirror those designed to reduce smoking and the resulting incidence of lung cancer? What about alcohol consumption? On one level, it should be very simple. Reduce calorie intake and increase calorie expenditure. Unfortunately, reality is not that simple. We don’t need to smoke or drink alcohol to survive, but we do need to eat. Some people are not able to control obesity with this simple formula. Our brains have been shown to respond to food addiction in ways similar to other addictions (dopamine triggers), so that’s another complicating factor. Obesity is viewed by many as a disease, not as a behavioural challenge. Pituitary and thyroid gland issues, for example, can place bodyweight control way out of whack. What proportion of obesity incidents fall into this category? I don’t know, but my sense is that there are more of us who can positively influence our outcomes in this effort than those who cannot. I don’t see enough evidence to suggest that there is a genetic pre-disposition for some countries to exhibit near 10x the rate of obesity in comparison to others. There must be something else at play here. I’m not interested in weight-shaming, to be clear, but I believe strongly that, for the most part, obesity is preventable. The question is: How?

I see three main categories of approach available in the battle against obesity. Education, taxes, and regulation.

First… always first, education. We need to do a much better job in educating our kids about lifestyle choices that lead to healthy living. It makes health sense and it makes economic sense. With 29.4% of adult Canadians and 36.2% of adult Americans classified as obese, we can do much better.

When I attended high school in the early 1970s, the walls were plastered at times with two Cancer Society photos, side by each. One was a healthy set of lungs. The other was the grotesque shriveled up pair of lungs of a smoker who had died from lung cancer. The difference was stark, and I think, rather effective. The rate of smoking in Canada has been reduced since 1975 by 60%. As with successful campaigns against smoking, our education efforts must highlight the significant risks tied to obesity. In my book, this is a given.

Cigarette smoking in Canada was reduced by education but also, in part, by higher taxes. Provincial governments varied in their taxation of cigarettes. Declining smoking rates correlated closely with higher taxation. Reduction in the consumption of alcohol has not been nearly as successful. Why? Well, for one it costs no more (adjusted for inflation) to buy alcohol now than it did fifty years ago. Why is that? In Ontario, the liquor stores are run by the provincial government as a monopoly. With huge markups, our government takes in literally billions of dollars in profit from the sale of alcohol. Do you think there might be another elephant in the room? Short-term report card… short-term focus.

Unhealthy food represents many billions of dollars in profit for businesses. The more our bodies become addicted to these foods, the more money they make. There’s a straight line between corporate profits and obesity rates. There’s a straight line between obesity rates and health care costs… as well as economic losses from sickness and death. Why is there no straight line between corporate profits that make us sick and the coverage of costs from related consumption?

The easy… and wrong… answer is that we all have freedom of choice. We each have our own responsibility to eat healthy food. Why should businesses be held responsible for our choices, even if those choices lead to unhappy outcomes? Well, we’ve been through this conversation before with the tobacco companies, haven’t we? We’re still immersed in that conversation on the topic of gun control. Clearly, we are not all capable of making healthy decisions. Some of us need to be protected from ourselves, myself included.

Forty years ago, I presented to a hospital emergency room with severe chest pain, having collapsed at my desk, unable to take a deep breath. My weight, aided by a liberal expense account from my employer (literally, all-the-steak-you-can-eat), had ballooned in one year from 180 lbs. to 248 lbs. I was the elephant in the room. At the age of 24, I was admonished by the emergency room doctor that, if I wanted to make it to 25, I’d need to make a serious change in lifestyle. My responsibility. My choice. Forty years later, I still struggle with my weight, holding the line presently at about 185 lbs. My responsibility. My choice. I’ve been fortunate enough to find the strength to carry this off… for now. It’s not easy and not everyone can do it. Those who cannot do it on their own deserve our help where we can offer it.

Why do we set ourselves up to be manipulated into consuming foods that are, quite honestly, as addictive as alcohol and tobacco? Why is our government not taking a more active role to regulate and tax those businesses that so blatantly display disregard for our individual and societal well-being? Why was the federal food guideline created under the influence of businesses that do not have our best interests at heart? Why do school cafeterias still serve garbage to our children? These are just a few of the many questions that nag at me.

Just as the gun industry hides behind the ‘rights and freedoms’ narrative, I’m sure that the junk food industry would advocate for our ‘rights’ to kill ourselves with obesity. Profit works that way. So many elephants in the room.

Finally, I return once again to education. Education initiatives must come both top-down and bottom-up. I’m nobody’s victim. I take full responsibility for my own successes and failures. I know of no other way to live. This path requires that I read and listen and watch… and study, and think, and synthesize. The path is not an easy one to navigate, and the perils are many and frequent. If I stop learning, I’m done.

Now, where’s my stash of Haagen Dazs? Bring on the dopamine!

With respect,

Kevin Graham

I welcome your feedback. Feel free to contact me by e-mail.

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