The Root Cause of What Ails America

Media focuses so much on today that we lose sight of the societal changes over the past 50 years that have contributed to America’s current state of health. Let's compare where we came from and where we are now.  

Portrayal of American family life in post-World War II television depicted paternalistic families with stay-at-home mothers. "Leave It to Beaver”, "Father Knows Best”, “Lassie”, “The Andy Griffith Show”, “I Love Lucy” and “The Dick Van Dyke Show” and others were idealized depictions, but that mentality is far removed from the current prevalence of dual-income and single-parent households. 

The absence of a full-time homemaker has had significant consequences, increasing reliance on convenience foods that thereby has reduced role-modeling on healthy eating. 

While serving on a committee for my local high school, students attesting that their families rarely had a sit-down meal together. The problem was that their after-school activities didn’t coincide with their sibling’s activities. It took both parents to shepherd the kids, with nobody having time to make meals, much less dine together. One student’s only sit-down “family meal” was lunch at the district’s alternative school where the entire school ate lunch together one day a week. These stories confirmed what I was hearing from my adult patients, that parents “don’t have time to exercise” or “make a salad” because parental time is spent ferrying kids to various functions - school sports, band, debate, travel teams for cheerleading and other interests. 

This role, coupled with the rising costs of housing, education and raising children has placed enormous pressures on parents. Pursuit of college admissions has intensified, with youth participating in numerous extracurricular activities, particularly organized sports, in hopes to improve their college applications. [Fry]

Recreational activities have also changed, as no longer do parents feel safe telling children to “Go outside and play”. Increased societal fears over harm befalling unsupervised minors has led to less low-cost backyard stickball or other unstructured play, and more scheduled, supervised activities - sports leagues and (expensive) travel teams. [Aspen Institute]

Time and again I have had parents (and even grandparents surprised to be raising grandchildren because of a daughter or son who is a single-parent) describe to me taking their child to some practice or game and where the parent just watched. There they sat, at an athletic facility, the child supervised, but rarely using that opportunity to do their own exercise. Even rarer, play with that child, supporting his or her interests. 

We’ve become a helicopter society, shepherding our children and depriving them of social learning from unfettered peer interactions. But the impact isn’t limited to the kids - the adults “fly the helicopters” and deprive themselves of personal time. 

From taking this “history of present illness”, my diagnosis is that the following four factors have culminated in the cardiometabolic epidemic now afflicting 2/3rds to 3/4ths of Americans:

Time scarcity: Almost universally, patients cite lack of time as the primary reason for not doing physical activity or preparing healthier meals or _______.  

Decline in cooking skills: With less time available and families increasingly relying on convenience foods, we’ve suffered a loss of culinary knowledge across generations – it’s sobering to learn how many people don’t even know how to select good produce, much less prepare and season vegetables to make them taste good. [Lichtenstein] Historically, most people learned how to cook from their mothers (back in that idealized life of the 50s and 60s), but reliance on convenience foods has replaced home cooking. 

Eating on the run is definitely not the Swanson TV dinners of my youth - you had to heat up the oven, take the dinner out of the freezer and wait 20-30 minutes for it to cook. They must have been heavy on salt, but they were real food. And sit-down fare, not for eating in the car. [Biakolo]

Rise of highly processed foods: The food industry has responded to the demand for convenience with food products – Michael Pollan’s “edible food-like substances” – that are easy to prepare and high in starch, fat, sugar, and salt, leading to taste preferences that contribute to overconsumption and solidification of poor dietary habits. [Pollan; Kessler] While there are good reasons to blame “Big Food”, to some degree the food industry has just made products that met market demand. 

Reduced family recreation: Parents often spend their free time watching their children's activities rather than engaging in their own activities (or with their children). Is there anything more precious to a child than having a parent spend time doing what the child wants to do? 

The reasons America’s health is ailing is thus deeply rooted and, therefore, not easily overcome. In Part II, we’ll look at what health care systems might do to address this crisis, something beyond expensive polypharmacy and medical procedures. 

Citations

R Fry, D Braga, K Parker. Is college worth it? Pew Research Center, May 2024.  https://www.pewresearch.org/social-trends/2024/05/23/is-college-worth-it-2/

Aspen Institute. Project Play. State of play 2022. https://projectplay.org/state-of-play-2022/costs-to-play-trends

Lichtenstein AH, Ludwig DS. Bring back home economics education. JAMA. 2010;303:1857–1858. https://jamanetwork.com/journals/jama/article-abstract/185818

K Biakolo. A brief history of the TV dinner. Smithsonian, November 2020. https://www.smithsonianmag.com/arts-culture/brief-history-tv-dinner-180976039/

TE Leonce. The inevitable rise in dual-income households and the intertemporal effects on labor markets. Compensation & Benefits Review, 2020; 52(2), 64-76. https://doi.org/10.1177/0886368719900032

M Pollan. In Defense of Food, An Eater’s Manifesto. Penguin House, 2009. 

DA Kessler. The End of Overeating: Taking Control of the Insatiable American Appetite. Rodale Press, 2009.