Starting 2019 Right, Lifestyle as Medicine: Dr. David Katz on Power of Nutrition in Prevention and Health

Dr. David Katz

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the healthcare of the future. This week, Mark and
Margaret speak with Dr. David Katz , Founding Director of Yale
University ’s Prevention Research Center and Founder of the True
Health Initiative. We're now in global expert on lifestyle medicine. Dr.
Katz is an Internist and Prof essor at the Yale School of Medicine,
seeking to build a global consensus on Lifestyle as Medicine. Lori
Robertso n also checks in , the Managing Editor of FactCheck.org , looks
at misstatement spoken about health policy in the public domain,
separ ating the f ake from the facts, and we end with a bright idea
that's improving health and well - being in everyday lives. If you have
comments, please e - mail us at [email protected] or find us on
Facebook or Twitter, i T unes or w herever you listen to podcasts, and
you can also hear is by asking Alexa to play the program
Conversations on Health Care . Now stay tuned for our interview with
Dr. David Katz, Founder of the True Health Initiative on Conversations
on Health Care.

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Mark Masselli: We're speaking today with Dr. David Katz , Founding Director of Yale
University ’s Prevention Research Center, which is focused on the signs
of nutritional epidemiology . Dr. Katz is an Internist and Professor at
the Yale School of Medicine, wi th the focusing on preventive medicine
in public health . He is also the Founder of the True Health Initiative ,
which seeks to build a global consensus on Lifestyle as Medicine. Dr.
Katz has published over 200 peer review articles and 16 books
including his latest, “The Truth About Food.” He holds five U.S.
patterns and is the principal inventor of the Overall Nutritional Quality
Index. Dr. Katz earned his MD from the Albert Einstein School of
Medicine. Dr. Katz , welcome to Conversations on Health Care.

Dr. David Katz: Than ks so much Mark, great to be with you.

Mark Masselli: Yeah, you know, just two questions, you are back at medical school
years ago. All of your friends are going off to some allergy, but you're
thinking about the work in preventive medicine and public health.
Love to know what the drivers were back then as you were thinking
about it, and then talk to us about the obesity crisis , its true impact.
It's having on the health, our health and the health system.

Dr. David Katz: You know that they'r e closely related questions really Mark . I think
ultimately we all do the best work and are most gratified if we satisfy
the native inclinations of the way we feel things, the way we process
information. When I did my training in internal medicine, I was

Dr. David Katz

s pending the expected 100 plus hours in the hospital taking care of
desperately sick people, but I think I saw what many of my colleagues
didn't see him and that was the view from altitude. So many of those
people who were desperately sick despite our best efforts, we're
never going to be truly well and that most of them had stuff that
didn't need to happen in the first place consequences of exposure to
tobacco or poor diets or lack of physical activity. Most hospital beds
were filled by people who never nee ded to get that sick , but to
prevent that from happening, you kind of needed to go back 10 years
in time, and so I decided after training in internal medicine to train in
preventive medicine, I still wanted the privilege of taking care of
patients, which I did for 25 years, but I really wanted to do something
about preventing that severe illness in the first place.

You know , it's interesting, Mark, I've long thought of the great
prowess of modern medicine and it truly is impressive as being a bit
like all t he king's horses and all the king's men , we can never really
put health back together again. We can delay deaths , we can treat
disease, but we're not really very good at restoring vitality once it's
lost so that's why I focused there , and we go back the be tter part of
30 years. The obesity epidemic really was the great imperative of
modern public health as it remains today because obesity is on the
causal pathway to every major chronic disease that plagues modern
societies, heart disease, cancer, stroke, di abetes, dementia , so if
you're going to focus on one thing that you could potentially fix in
order to prevent almost all of the bad outcomes that plague modern
societies, it would be the obesity epidemic , and I really wanted to
contribute all I could to re versing those trends.

Margaret Flinter: Well, we recognize we're up against a lot in addressing the obesity
epidemic. We have too many people probably within the healthcare
community as well th at see it as a personal failing, but you've noticed
there are m any factors apply . Certainly, the healthcare system hasn't
done all that it can do, but we also have the issue of food production
and marketing and the way the industry profits from things which are
not always really in the best interest of peoples health. Can you help
us understand what you've really developed as a lifestyle medicine
approach to health?

Dr. David Katz: So, I'm a Past President of the American College of Lifestyle Medicine
and probably my signature contribution , much of our focus as a
colle ge of health professionals is on what I think we should be calling
lifestyle in medicine , and that's basically better methods of interacting
with patients in clinics, in hospitals and essentially in the healthcare
system to convey good information about us ing physical activity to
promote health, prevent and reverse disease, using sleep patterns to
promote health, prevent and reverse disease, managing stress,
cultivating strong social interactions, avoiding toxins like tobacco, and

Dr. David Katz

drawing on the science of behavior modification. But I really think
we're going to accomplish relatively little if we limit the solution to a
cultural problem to the clinical setting. In addition to lifestyle in
medicine, we all need to be advocates of Lifestyle as Medicine. With
r egard to diet, we've got essentially a vast, huge industry that profits
from making people fat and sick. The foods with the highest pr ofit
margins are junk foods. We’ve been told in very high profile venues
like for example, a New York Times Magazine cover story written by a
Pulitzer Prize winning investigative journalist Michael M oss that the
entire U . S . food supply is booby trapped to be something very much
like addictive , and to maximize the calories people eat before they
feel full. In fact , that the fo od industry has practically told us that
when we had Lay's Potato Chip ad saying that you can't eat just one.
Essentially they were saying, and they meant it. We've had food
engineers designing this so that you can't stop eating this stuff until
your arm g ets tired from lifting it to your mouth.

So in that story , basically describes how all the major food companies
hired teams of PhDs , give them functional MRI machines and
marching orders to design food p eople can't stop eating. Then we in
the clinical sett ing are giving advice about eating better and portion
control and well, I mean that that's just not a fair fight. You've got the
average busy parent who's getting 10 minutes of clinical counseling
and then she goes out into a food supply that has been desi gned by
highly paid executives and scientists who basically get a bonus if they
can figure out how to make food , she and her kids cannot stop eating.
We need to acknowledge that this is not a failure at the level of
personal responsibility that there has t o be some public accountability
for the nature of the food supply. Ultimately , the choices people make
are subordinate to the choices people have and so my view was
lifestyle in medicine is important, but we really need to be agents of
culture change.

Mark Masselli: You know I just want to pull the thread a little on what you just said,
Dr. Katz that it's not a fair fight for patients and then patients struggle
with what diet one should go on and there's so many of those fad
diets that are out there for the public and you say that we need more
of a consensus on what qualifies as evidence - based nutrition
guidelines and also that patients and clini cians need some effective
tools, and you've been a creator of a couple of tools that are being
widely utilized , an d I wonder if you could just talk to our listeners
about the Overall Nutritional Quality Index and how they can help
people sort of regain some control ove r the next steps that they take?

Dr. David Katz: Sure. Yes, we need more consensus, but the reality i s we have it.
Although all we ever seemed to talk when somebody puts a
microphone in front of us is why my view of diet is better than your
view of diet an d we sound like we don't agree. There actually is

Dr. David Katz

massive common ground. It’s just that when you invi te experts to
opine they tend to opine about their particular area of expertise.
Experts are probing the frontiers, so they tend to talk about the
frontier. What they’re overlooking is the vast amount of common
ground right behind this, so I created the tr ue health initiative a global
coalition of very diverse experts in the diet space ranging all the way
from vegan to paleo and one - by - one I’ve asked these colleagues from
40 countries that would you agree that people would be better off if
they ate a diet o f minimally processed food mostly vegetables, fruits,
whole grains, beans, lentils, nuts and seeds and mostly drank plain
water when thirsty. We can leave out the rest. We can agree or
disagree about adding in some meat or some fish or some dairy or
some e ggs, but would you agree that those are the fundamentals of a
healthy dieting. There’s massive global consensus. The weight of
scientific evidence and the global consensus of experts all point in the
same direction.

Once you’ve established Mark, where the re is then it does become a
matter of developing tools to help people get there from there so the
overall nutritional quality index algorithm basically this was a system
to score the overall nutritional quality of foods on a scale from 1 to
100 the higher the number the more nutritious the food. I think those
kinds of efforts are really important because when you go shopping
for a bread or breakfast cereal or a pasta sauce those choices all add
up to make a huge aggregate difference to the quality of your d iet but
how do you choose this cereal is higher in fiber but also higher in
sodium if you’re really trying to choose the best overall products for
you family you need a summary judgment based on science and so we
provided that in algorithm and scored over a 125,000 foods and at its
peak this system known as NuVal was in 2000 supermarkets
nationwide and I’m very proud of that work done wit h a team of
leading scientists.

You'd asked about evidence mapping. This is more of a research tool
essentially it's a w ay of looking at the scientific literature and
determining where there is evidence and where there is not. This is
something that that I've devoted much of my career to looking at the
evidence about diet. I've written three editions of a leading nutrition
textbook and then most recently just published the truth about food
on behal f of the true health initiative. One new tool I've actually
founded a startup company , we have invented a whole new way of
assessing diet and tracking diet changes called Diet ID. But essentially
we can determine your current dietary pattern, the quality of your
diet measured objectively the nutrients you're getting from diet in
about 30 seconds as opposed to say a food frequency questionnaire
which will take you an hour or more and it's ve ry tedious and memory
dependent. Then we can use the same tool to identify a goal diet and
help navigate you from here to there. We're very excited about the

Dr. David Katz

potential of this new tool. I definitely agree with you we need to
clarify the consensus a nd we then need to develop tools to empower
people so it's not quite so hard to get there from here.

Margaret Flinter: Well, Dr. Katz , I'm struck by the contrast between a quote that I think
you have put forward of what Michael Pollan says with his mantra,
“ Eat foods, not too much , most plants”, the kind of simplicity of that
and at the same time we have your latest book, The Truth a bout
Food, which is just an encyclopedic book on evidence based nutrition
guidelines. The book almost feels like a responsibil ity of everybody
who's engaged in health and healthcare to really dig deep and
understand this topic in its depth . Tell us what drove you to write that
book with all that you've been writing and all your projects, why this
book and what were you hoping to achieve with it?

Dr. David Katz: Yes , and in the book I definitely do cite Michael Pollan's, pithy
wisdom, Eat food, not too much , mostly plants , and I specifically say
that's the truth about food , it’s seven words. This could be a very,
very short book. E at Food, not too much , mostly plants , thanks for
coming , but it's not a very short book. In fact, it's 750 pages and as I
explained the truth about food is simple, but the lies are extremely
complicated. The reason I felt like I had to write this book afte r having
written many books on nutrition already was it just occurred to me
that no matter how many times I or other experts with good
intentions told people what's true and reliable about food someone
could come along tomorrow with some new theory, either they really
believe it or they're just hucksters and they don't even believe it, but
they know they can sell it and they'll tell us, all you have to do is cut
carbs or gluten or fructose or lower the glycemic index of the foods or
whatever the latest craz iness is just do this and all will be well and it’ll
be the for gazillions fad diet to come over the transom but people will
sign up for it. I thought it's not good enough to tell people what we
know is true today what we have to do is actually transmit to people
how nutrition science works, how real experts around the world know
the difference between what's reliable and what's not. What I want to
do, and I don't think any book has ever done this is immunize people
against tomorrow's fad diet without knowi ng what tomorrow's fad
diet even will be and the only way to do that is to lay out not just
everything I know . I went into a great level of detail about what's true
about coffee and lectins and gluten and the Keto Diet and veganism
and calories and saturat ed fa t and unsaturated fat and Omega - 3s and
all of that.

I went into considerable detail about why do I know something is
true? How can we experts tell when something is false? How can you
use this thinking so that you're not vulnerable to the predations of
charlatans in the future because there are an awful lot of entities out
there that want to cultivate confusion about diet and that profit from

Dr. David Katz

it and then I go into all of that. A lot of the book is about the lives ,
what are the fallacies that trip peop le up and who's behind them?
Some people are, I think misleading the public with good intentions
that they're just wrong, but there are a lot of entities that directly
profit from making us fat and sick. Big Food, absolutely profits from
making us fat and sick. Big Pharma profits from treating diseases we
never needed to get in the first place. Big Media profit by keeping us
confused about diet. Big Publishing profits from confusion about diet
because there's always a new fad diet book to sell. I wanted to lay all
of that out and people who will get a copy of the truth about who
would have access to everything I know about diet and I tried to make
it as actionable as possible.

Mark Masselli: We're speaking today with Dr. David Katz, Founding Director of Yale
University's Prevention Research Center, focused in on the science of
nutritional epidemiology. Dr. Katz is a leading global expert on
nutrition and disease prevention and an internist and professor at the
Yale School of Medicine . Dr. Katz, you are a tren dsetter, if you will, in
promoting lifestyle as the best preventative medicine approach to
improve health and wellness and you're on a recent panel at Virgin
Pulse with Deepak Chopra offering some predictions for promoting
wellness. I wonder if you could t alk with our listeners about the
predictions you shared for the coming year that point to a growth in
lifestyle medicine practices.

Dr. David Katz: Mark, there are so many forces that obligate us to move in this
direction. The cost of business is usual or un sustainable , the
healthcare, so called healthcare sector in the United States is simply
too big a chunk of the economy and that's because it isn't really a
healthcare system. It's a disease care system. We do a lot of things to
make people sick and then we spend a ton of money to treat people
who have disease, so I think if there's a unifying theme among the
predictions, it's the recognition that's no longer tenable, it's not
sustainable. We need to shift in the direction of promoting vitality and
maintai ning wellness and drugs don't do that , surgery doesn't do that ,
lifes tyle can do that. What I emphasized as a growing confluence
between the imperatives of public health and the imperatives of
planetary health and the fact that we would see those two field s
coming together.

I've given a series of talks to gatherings of thousands of colleagues in
different cities at a conference called Pri - Med , these are my
colleagues in primary care. You cannot really call yourself a health
professional and not be advocati ng for the health of the pl anet, our
most important patient because there are no healthy people on an
uninhabitable planet and with what's happening to the climate and
with what's happening to fragile ecosystems the planet is in peril and
so this then beco mes a mandate. I think everybody who flies the flag

Dr. David Katz

of health professional this is a critical issue of our time, so I predict
that we will see far greater involvement in the environmental space.
This is something we have to do if we're going to protect the health of
people, we have to protect the health of the only home we have so
that it's conducive to the health of people. I think health professionals
should be at the tip of the spear. We should be leading the way to
change thing s, and this is the critica l issue of our time.

Margaret Flinter: Dr. Katz I can't tell you how happy I am to have you address that along
with the need to integrate the education, the training, the motivation
and the encouragement of the next generation of health professionals
to un derstand that this is truly a huge responsibility both to the
people and to the planet. We've been speaking today with Dr. David
Katz, Founding Director of Yale University's Prevention Research
Center and founder of the True Health Initiative which seeks t o build a
global consensus on lifestyle as medicine. You can learn more about
his work by going to truehealthinitiative.org . You can follow him on
Twitter @DrDavidKatz and of course check out Diet ID that Dr. Katz
talked about this morning. Dr. Katz, thank you so much for your
dedication, your persistence, your groundbreaking work, and for
joining us on Conversations on Healthcare.

Dr. David Katz: Oh, you're both very kind. Thank you so much. It's been a pleasure.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org a nonpartisan nonprofit consumer advocate
for voters that aim to reduce the level of deception in US politics.
Lori, what have you got for us this week?

Lori Robertson: The US Census Bureau officially estimates that close to one million
fewer people were in poverty in 2017 compared with 2016. President
Don ald Trump called the decline a record but it's not. The drop in the
number of people in poverty was larger in 2016, an estimated 2.5
million fewer people and in 2015 a 3.5 million drop. The largest
estimated decline was nearly 4.7 million people in 1966. T rump made
his statement about poverty when he signed an executive order
creating the White House Opportunity and Revitalization Council
which intends to focus on private and public investment in low
income communities. “ Last year alone, we lifted 1 million Americans
ou t of poverty, which is a record” Trump said in his December 12,
remark . There were 39 .7 million people living in poverty in 2017
according to the Census Bureau's official estimate that is calculated
based on the current population survey, annu al social and economic
supplement. That's about 918,000 fewer people than the 40 .6 million
who were estimated to be living in poverty in 2016, but that's not a

Dr. David Katz

record and the White House didn't respond when we asked for an
explanation . There were at least 16 years when the estimated number
in poverty declined by 1 million or more. In fact the Census Bureau
noted that the 2017 estimate “ was not statistically different from the
number in poverty in 2016 ” . Also, the official poverty rate or the
percentage of t he US population in poverty was 12 .3% in 2017. That
was 0.4% points lower than in 2016 but the drop in the rate was
larger in the two previous years. In fact, according to estimates that
date to 1959, the largest one year decline in the poverty rate was
2. 6% point from 1965 to 1966.

That's my fact check for this week . I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenb erg Public Policy
Center at the University of Pennsylvania . If you have a fact that you'd
like checked, e - mail us at CHCRadio.com we will have FactCheck.org
Lori Robertson check it out for you here on Conversations on Health
Care .

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Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. During the
school year, some 21 million American children receive free or
reduced price lunches through their schools. Often the heal thiest
meal these children eat during the school day. Yet one school is out,
only 10 % of these children participate in the free meal programs
during the summertime and studies have shown that many of these
kids tend to gain a significant amount of weight o ver the summer as a
result . A group of researchers at the University of South Carolina
sought to tackle that issue with the program they developed called
the Healthy Lunchbox Challenge. They deploy ed the program at a
number of large community based Summer Day Camps and lead
researcher Dr. Michael Beats says they relied on a simple known fact
about kids. They love competition.

Dr. Michael Beats: Staffers during the first snack period would ask kids to hold up the
fruits or vegetables or water that they broug ht and then at the end of
the week, they announced the winner of the Healthy Lunchbox
Challenge for that week.

Margaret Flinter: Dr. Beats says the simple competition and group reward system
created a dramatic shift in the average campus lunchbox from chip s,
cookies and sugary drinks to more fruits, vegetables, and bottled
waters.

Dr. Michael Beats: Kids are not just bringing additional fruits, vegetables, and water

Dr. David Katz

they’re substituting these healthier items for the less healthful items.

Margaret Flinter: T he study published in the Journal of Nutrition, Education and
Behavior showed a dramatic shift in the kids ’ homemade lunches with
this really simple and inexpensive incentive program. They see this as
a model for summer day camps across the country which s erves some
14 million children per year often in underserved areas. The Healthy
Lunchbox Challenge a simple competitive challenge and reward
system designed to get kids to switch out high fat, high sugar, high
calorie foods from their diets in favor of hea lthier snacks and
beverages. Now, that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli .

Margaret Flinter: I’m Margaret Flinter.

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