Interview with David Katz, MD, MPH, FACLM, as he concludes his term as president of the American College of Lifestyle Medicine at the conclusion of Lifestyle Medicine 2016 in Naples, Florida.
Has your time as president of ACLM met or, perhaps, even exceeded your expectations?
Serving as president of ACLM involved more work than I ever imaged. I had the mistaken idea that it was something of a figurehead role; it is not! But while the investment was greater than I imagined, the return was much, much more so. What an extraordinary privilege to be in this position just as lifestyle medicine becomes the global movement it so deserves to be. This role has been a privilege and inspiration in ways I had never thought possible, and has left an indelible mark on my career and professional legacy, in part by inspiring the True Health Initiative to which I anticipate devoting time, energy and passion for years to come. ACLM and I are forever part of one another now, and I, at least, am the richer for it!
How do you see ACLM and the lifestyle medicine movement impacting health and healthcare?
Nothing in all of medicine can do what lifestyle can do to add years to lives, and life to years. Nothing else in all of medicine even pretends to be about planetary health- but lifestyle pertains there, too, and powerfully! We are at or near the inflection point, where the power of lifestyle medicine in both clinical and cultural context is routinely expressed.
What's your call out to your fellow physicians and healthcare professionals across this country and around the world?
Disease care is a noble calling. But for anyone who wants to be involved in actual ‘HEALTH’ care, lifestyle medicine is the one, true path. All clinicians can, and should, find their place here. I would also urge my fellow clinicians to find their medical professional society home in the American College of Lifestyle Medicine. None of us can transform healthcare alone; yet, when united, we become a powerful force for change. Both ACLM and the True Health Initiative serve to unite those of us with shared passion and purpose.
In just over a week, Lifestyle Medicine 2016 will kick-off in Naples, Florida. It was at Lifestyle Medicine 2014 that you said on stage, “I’m going to dream, and I’d like for you to dream with me” as you first cast the vision for the GLiMMER Initiative that has now evolved into the True Health Initiative. What was the impetus?
I was giving talks as long ago as 1992 asserting that the “weight of evidence” about healthy eating/living was quite clear, but we only ever seemed to focus on the discord. That was in the days before the blogosphere took over our lives, so the problem is more acute now, but it was salient even then. So, to the extent this is all about getting past din and discord to reveal the hidden consensus, it goes back almost 25 years.
But the initiative itself is really a product of my ACLM presidency. I was due to give a keynote speech at our 2014 conference, my first as president, and wondering how to make it really matter. How could I avoid going from president-elect, to president, to past-president without any of it really making a difference? I thought to leverage the office to establish this campaign, which could take on a life of its own, and just maybe, win over hearts and minds around the globe. Now with nearly 350 True Health Initiative Council of Directors members, representing well over 30 countries, the game is afoot! These COD members represent one global, united voice- all agreeing about the foundational principles of healthful eating and healthy living, specifically outlined in our THI Pledge.
The Council roster is showcased on the True Health Initiative website, showing a convening of the best minds in America—and abroad—in the fields of nutrition science, health promotion, and preventive and lifestyle medicine. What did it take to attract such an extraordinary level of support from some of the busiest experts in the world?
There’s an adage: if you want something done, ask a busy person. There’s some of that going on. These people are so busy in the first place because they are seriously committed to making positive differences in the world. So show them something they think has a chance to do some serious good, and they make time. I’m the same way.
The key contribution each council member makes is to stand up and be counted. In other words, saying we agree about the fundamentals is enough. So I think it was novel to offer people a chance to be a meaningful part of something novel and important without having to invest too much. In essence, everyone has invested already, establishing himself or herself as an expert or influencer, which we are currently leveraging.
Finally, the Council is founded on relationships I have been cultivating for many years. I first called on people I know well, many of whom are highly esteemed. And then, inevitably, the “rich” get richer. When you see that a who’s who is already at the party, you think, “Well, maybe I should attend this one, too!” I think there was some of that, and there will continue to be.
I am extremely gratified by the caliber and influence of this council and very excited about the power of that unity and the good to which we can apply it.
As with the caliber of the experts you’ve attracted, the scientific papers and popular press articles you’ve posted are brilliant. What was your strategy for article inclusion and how do you see this section of the site being used going forward?
Thank you. I write rather prolifically, so we simply went “shopping” among my many hundreds of columns and blogs for some that were most directly relevant to the THI mission. Many of the other council members have written extensively on these topics as well, in both the peer-reviewed literature and pop culture settings. We polled members to recommend items to include and have been overwhelmed with great, relevant material. We are showcasing some of it now and will be adding ever more as our bandwidth (literal and figurative) allows. I’d also like to point out the Scientific Evidence page that’s featured on the ACLM website—another tremendous source of information.
While we must be better about educating the public about those tenets in lifestyle medicine where there is clear agreement, do you see any risk of squelching healthy disagreements?
I have had a few colleagues confront me with that, but I really don’t think so. I see no incompatibility at all in the pursuit of learning what we don’t know while putting what we do know to good use. That’s really the idea here. We know enough to prevent about 80% of all chronic disease right now—the evidence for that is all but incontrovertible. And, fortuitously, the lifestyle practices that can add years to our lives and life to our years are better for the planet, too. So why on earth would we not do everything possible to turn that knowledge into the power of routine action? Why should that interfere with new questions, new answers, new details, and filling gaps?
An engineering analogy works well. We are now up to iPhone 7, I believe. That means the engineering has advanced in at least 6 major steps since the first was released. So should the first not have been released because it could not do everything the 7th can do? Should the 7th not have been released because some day the 16th will make it seem antiquated? Did the release of the original in any way inhibit the advances that have brought us to the 7th?
Let’s learn what we don’t know, but use what we do. Not only is there no conflict, but I don’t think anything else is sensible.
As you continue to champion for True Health, especially in nutrition, are there scholarly areas of disagreement that you think deserve rigorous debate and continued skepticism given current evidence?
Absolutely, but they are details. Is fish good for us even when added to an optimal vegetarian diet? We don’t know. For those who eat dairy, are net benefits greatest with full fat, low fat, or nonfat? We really don’t know. For that matter, is there net benefit, or net harm, from including dairy in the diet at all? This is a very controversial area. What really is the optimal intake level of omega 3 fats, and how important is the total intake of omega 6 fats? And on and on.
But despite what we don’t know, the basics—the things we do know most clearly and reliably—are enough to get us both longevity and vitality, as they do in the Blue Zones. Let’s embrace and propagate those fundamental “truths” of healthy living that constitute a basic theme. And then, while living “on” them, let’s explore all the variations. At present, we place such emphasis on the unresolved issues, we fail to see the theme at all. It’s as if uncertainty about some particular aspect of some particular leaf on some particular tree made us blind to the forest. We will never see our way out of the dark wood of modern epidemiology in which preventable diseases steal years from lives and life from years from millions upon millions of us around the world until we manage to see the forest through the trees! We are doing all we can to shine a light that makes that easier. But there is no reason this precludes learning ever more about the trees into the bargain.
NOTE: Portions of this interview with David Katz were excepted from an interview Paul E. Terry, PhD President and CEO, HERO, conducted with Dr. Katz for the American Journal of Health Promotion.
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