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In this Conversation we’ll examine the mega-trends in smoking and obesity and then ask the question, “How can AI (Artificial Intelligence) help us solve such major obstacles to health?”

In the next Conversation we will conclude our series on AI by focusing on both the blind alleys as well as the real opportunities for AI.

The Plummeting Rate of Smoking

Here is one health area where America shines. In the early 1960’s, 42% of Americans over the age of fourteen smoked. By 2015, the rate had dropped to 15%. From 1960 to 2015 our comparative smoking ranking among countries dropped from being in the top five down to 57th. 1

Some reasons for this success include:

  • Increased cost (taxes),
  • Less social acceptability (fewer places to smoke), and
  • More emphasis on what helps people quit and less emphasis on what doesn’t.2

There is some clear data on what works and what doesn’t. Engendering a distaste for tobacco companies by reminding people that tobacco executives make millions by killing hundreds of thousands works; so do well-designed quit-smoking hotlines. On the other hand, traditional anti-smoking campaigns in schools and the early generation warning labels on cigarette packages don’t.

The Skyrocketing Rate of Obesity

With obesity, we’re heading in the wrong direction. Since 1990 our obesity rate in adults has gone up from 11% to 29%.3

Although efforts to maintain weight loss after successful diets usually fail, the National Weight Control Registry research of over 5,000 people who have successfully maintained long-term weight loss (averaging a 66 pound weight loss over 5.5 years) is helpful in understanding what works.4 The most successful strategies were:

  • 98% modified the types of food they ate (lowering the fat intake was the most frequent change),
  • 94% increased their physical activity (total average was nearly an hour a day five days a week),
  • 78% ate breakfast regularly, and
  • 75% weighed themselves at least weekly and then followed a definitive action plan if their weight was above a certain level.

Consistency was also shown to be important – those that ate the same during the week as they did on the weekends were 50% more likely to succeed at keeping off the weight.

These successful long-term strategies have been known for over a decade, and yet the obesity rate keeps rising. Why is there such a gap between our knowledge and the translation of that knowledge into better health?

It isn’t for the lack of trying. The impressive size of the $60 billion weight loss industry shows just how desperately we want to be thin.

Focus on What Can Be Changed

1. Consider the external factors

As far as smoking is concerned, our society has increased the cost of smoking, publicized some of the negative consequences (premature wrinkles), and made it illegal to smoke in public areas. These actions have occurred concurrently with a nearly 70% drop in the tobacco smoked.

Concerning obesity, we continue to support unhealthy foods (Farm Bill legislation subsidizes the less healthy foods more than healthy foods) and allow marketing to misrepresent foods that are unhealthy as healthy. Concomitantly, the obesity rate has increased 250% over the last 25 years.

For smoking, the societal factors that promote healthier decisions now outweigh the factors promoting less healthy decisions. For obesity, the opposite is true.

Throughout most of the twentieth century, the tobacco industry had been very successful in confusing the scientific evidence against smoking and combatting organized efforts to reduce smoking.5 However, starting with the 1964 Surgeon General’s report on smoking, the pro-health forces began winning major battles.

Despite the overwhelming health evidence against smoking, it took a large dose of collective courage and stamina to resist Big Tobacco in the courts and to pass federal anti-smoking legislation. Eventually this combination of science and public support turned the tide against the smoking forces.6

The unhealthy food industry (high fat, low fiber, highly processed, high salt, and high sugar) has borrowed the successful tobacco industry tactics of pervasive lobbying, marketing, and confusing the science. Changing the obesity trends will likely require tactics that are similar to the anti-tobacco efforts before the trends for obesity are reversed.

2. Consider the internal factors

Considerable evidence suggests that it is even more difficult to lose weight and keep it off than to quit smoking. These differences are rather complex.

For example, at the doctor’s office patients say they feel more cared for when their doctor spends time discussing their smoking. Just having a physician spend two minutes advising against smoking is the chief catalyst for around 7% of patients who quit.7

However, when physicians even mention weight issues, patients feel uncomfortable. One study showed that the more time a physician spends talking about weight, the less likely the patient is to take their medicines correctly or to come back for a follow-up visit.8

Researchers at Dartmouth found that just ignoring the weight issue and focusing on the importance of getting enough exercise instead was a more effective strategy.9 The sensitivity of the weight topic almost seems too much for the patient/physician relationship to handle.

Moms may be no more effective than physicians in the food arena.10

A 2016 poll showed that 97% of mothers believed that the food habits learned during childhood would affect children’s health throughout their life.11 The same poll also showed that 73% of moms rated their own kids’ diet as either healthy or mostly healthy. What are the facts?

Less than one in 100 children meet the minimum requirements of the USDA food standard categories,12 demonstrating once again how difficult it is to make good decisions when the external environment doesn’t support it.

We now live in an environment where eating unhealthy food has overtaken tobacco as our chief risk factor for preventable deaths and disability.13 Given this reality, where should we focus our AI efforts?

Let me reframe the question. Assume your three year old child is with you in the grocery cereal aisle. Yesterday you read this blog and it reinforced your wish to avoid your child’s favorite cereal, Sugar Coated Sugar Bears. She is now sobbing uncontrollably, holding the cereal box which you are refusing to put in the cart. You believe that it is the most important healthcare decision you will make all day, given your concern that her weight is clearly becoming a problem. How can AI help us in this real-life struggle?

The first answer that came to mind was – no way.

My second thought was more along the lines of just telling an upgraded Alexa, “Sara was in the 95th percentile of weight at her doctor appointment today. Can you work on that?” Alexa’s next grocery order automatically pops ups with whole fruit, raisins, berries, and oatmeal and cuts out the Sugar Coated Sugar Bears and Pop Tarts for breakfast. The menus and recipes to optimally use are available on your phone.

My third thought is that there is no way that Alexa would be programmed to order the low profit margin, healthy foods, so the order would include freeze-dried fruit, artificially sweetened Sugar Bears with Added Fiber and Acai Pop Tarts.

In the next Conversation we further explore the hype and hope of artificial intelligence.

Breakthrough To Better,

1List of countries by per capita cigarette consumption
2Why smoking rates are at new lows
3US obesity levels 1990-2015
4National Weight Control Registry
5“Don’t Smoke-Unless You Like It”: A 1950 case against anti-smoking
6A Question of Intent: A Great American Battle With A Deadly Industry
7CDC physician’s guide to helping patients quit smoking
8Discussing obesity may be counterproductive for physicians
9CDC recommends that physicians emphasize exercise rather than weight loss
10Parents struggle to keep junk food out of little mouths
11Poll shows parents failing to promote healthy eating with children
12Study shows Americans not meeting dietary guidelines
13Diet beats smoking for health risk (page 28 Fig. 11)


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Edition 2 – A Case of Dr. Jekyll and Mr. Hyde
Edition 3 – Best marketing tagline of all time?
Edition 4 – Post-Truth Killed a President
Edition 5 – What’s an employer to do?
Edition 6 – Profiting From the Opioid Epidemic
Edition 7 – The Keys to Unlocking Better Decisions
Edition 8 – When Difficult Things Need to be Done Well
Edition 9 – Fixing Healthcare
Edition 10 – Beware of a Singing Cow
Edition 11 – Wise Reflections
Edition 12 – Warning: Reader Discretion Advised
Edition 13 – Can AI save healthcare? (Part 1)
Edition 14 – Can AI save healthcare? (Part 2)
Edition 15 – Can AI save healthcare? (Part 3)
Edition 16 – Embracing Reality to Improve Healthcare
Edition 17 – Everything I Needed To Know…
Edition 18 – The Eighth Circle of Hell
Edition 19 – So… What’s Our Solution?
Edition 20 – Protecting Integrity as a Core Strategy
Edition 21 – An Unadorned Legacy
Edition 22 – Time to Grow Up
Edition 23 – Against All Odds
Edition 24 – When Everyone Has Stopped Listening
Edition 25 – Focusing on What’s Important
Edition 26 – Don’t Give Up Your Shot
Edition 27 – Join the Goodhood
Edition 28 – Fixing Healthcare (Recycled)
Edition 29 – Taming the Healthcare Beast
Edition 30 – Leadership
Edition 31 – Better Health Requires Good Sense
Edition 32 – Little Decisions With Big Consequences
Edition 33 – Transformational Courage
Edition 34 – Transformational Courage – Part 2
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Edition 35 – Transformational Courage – Part 3