Why is the surgeon general silent on the American diet?

On Sept. 9, the surgeon general of the United States, Vivek Murthy, issued a call to action “to address major public health challenges such as heart disease and diabetes.” The campaign “calls on community planners and local leaders to create more areas for walking and wheelchair rolling and to prioritize the development of safe routes for children to get to and from schools.”

In the campaign’s press release, Murthy states:

We know that an active lifestyle is critical to achieving good overall health. And walking is a simple, effective and affordable way to build physical activity into our lives. That is why we need to step it up as a country ensuring that everyone can choose to walk in their own communities.

Since April, when he was sworn in as the 19th (and at 38, the youngest) surgeon general, Murthy has not been one to shy away from controversy. In his first days in office, he defended his well-known support for gun control laws. (His confirmation was delayed for one year because of strong opposition from the National Rifle Association.) Yet when it comes to addressing heart disease and diabetes, Murthy, a practicing internist and a faculty member at Harvard Medical School, has thus far ignored the politically charged elephant in the room: the American diet.

First, a caveat. Murthy is still in his first year of a four-year term, and the walking campaign isn’t an indicator that he won’t more substantively address nutrition issues over the next three years.

Also, don’t get me wrong. Physical activity confers a host of benefits for both physical and mental health. Walking has been shown to improve blood sugar and blood pressure values, increase the size of the hippocampus (the area of the brain involved in learning and memory), help reduce negative emotions and stave off osteoporosis. The walkability of a neighborhood even has a positive impact on crime rates and democracy. Unfortunately, many communities do not provide safe and well-designed walking spaces. Millions of Americans can certainly benefit from environments that are conducive to walking.

However, our current health statistics — heart disease is the leading cause of death in the U.S., 1 in 3 American adults has high blood pressure, and 50 percent of Americans have Type 2 diabetes or prediabetes — point to a nation in the grips of a nutritional deficit disorder. It is thus troubling that a surgeon general who has no qualms standing up to the National Rifle Association has yet to touch on this country’s broken food system. 

There is no dearth of food-related issues to which Murthy could lend his voice — denouncing predatory marketing of junk food to children, supporting the Food and Drug Administration’s push to note added sugar on nutrition facts labels along with a daily value percentage, strengthening the Dietary Guidelines Advisory Committee’s call (PDF) for Americans to eat less red and processed meat or calling for taxes on sugar-sweetened beverages, as the Canadian Diabetes Association recently did.

Instead, throughout the day on Wednesday, Murthy tweeted factoids about walking, such as, “The science on this is clear. It tells us an avg of 22 min of walking a day can significantly reduce our risk for chronic disease.” That is correct. But science has also demonstrated the many negative health effects of sugar-sweetened beverages and red and processed meat. (About the latter, the American Institute for Cancer Research states that “eating even small amounts of cold cuts or other processed meats on a regular basis increases the risk of colorectal cancer” and recommends “avoiding these foods, except for special occasions.”)

However, it is important to note that ignoring dietary causes and emphasizing physical activity when discussing chronic disease is a well-honed food industry tactic to deflect blame from its unhealthy offerings. In a 2010 interview with Fortune magazine, PepsiCo CEO Indra Nooyi nonchalantly said, “If all consumers exercised [and] did what they had to do, the problem of obesity wouldn’t exist.”

And as The New York Times reported last month, Coca-Cola has funneled millions of dollars into the Global Energy Balance Network, a nonprofit that enlists academics and scientists to consistently push the message that the conversation on health has been too centered on food without acknowledging physical activity.

Health officials must be careful to not let soda and fast-food giants ride their messaging coattails as a convenient way to avoid more serious topics. Earlier this year, in an interview with The Washington Post, Murthy mentioned that his focus “is going to be on the issues that are costing us the most in America, in terms of lives lost, in terms of disability, in terms of dollars spent. And those are on obesity and chronic diseases like diabetes and cardiovascular disease. It’s on substance abuse and mental health.” It would be a feather in the cap for the country’s youngest and first Indian-American surgeon general if the promotion of health also consisted of standing up to the food industry and demanding that it take responsibility.