We are a fat nation. As physicians dedicated to health promotion, we will be called on to take sides in this most partisan of battles.

Michael Bloomberg, mayor of New York City, recently attempted legislation ^[1] that has been derided as heading toward the ”nanny state.” I’m not sure we have many choices.  We’ve all had the diabetic in our offices with the 3 liter soda (sugared, of course) and 2 pound bag of chips (in the bag, of course — half consumed while waiting), snacking.   We can blame the victim, the consumer. But in reality we have little chance.

I’ve watched the super sizing of America ^[2]. I suppose we can’t blame the corporations whose only goal is to raise more money for their shareholders. We can’t blame the nameless minimum wage servers who serve up larger and more caloric portions. It’s part of the American dream: Give them what they want.

We, on the sharp end of the knife, dare not say, “you hurt because you’re fat.”  It is just not politic nor good practice. We cajole, we inform, we educate. It is a Sisyphian challenge. We fight against all the odds, against the advertisements, the media, the American ideal of bigger is better. ^[3] In hard times, it’s worse.

There was a Doonesbury cartoon in which Zonker, working in a fast-food establishment, is forced to tell the customers the caloric value of their foods. He tells his customer that the ‘big boy breakfast is 5,800 calories — but then,” he says, “you won’t have to eat until Thursday.” Yup.

I concur with Dr. David Katz of Yale, who said: “The real issue here is the calories feeding the obesity epidemic, and what actionable steps will help slow their seemingly inexorable flow.” It is an argument hard to dispel. Although there are some attempts at 100-calorie packaging, the main servings are 2.5-5 servings in a container/bag.

So where do we — the physician community — stand? We recommend, but they advertise. We suggest, but they sell. In my community, where there are no regular grocery stores but mostly tiendas and convenience stores selling prepackaged (and expensive) foods, agri-business has a captive audience.

We also have a captive audience each time a patient enters our sphere. We have made things like vaccination a priority. Perhaps we need to put that energy and that focus on this crisis.

Dr. Buchbinder is a board-certified Podiatrist practicing within an FQHC (Federally Qualified Health Center) in Hartford, CT.   He is director of the FreeMED Software Foundation, a non-profit dedicated to making accessible and extensible medical records available worldwide.   Dr. Buchbinder also blogs at  A view from the provinces. A new Yankee’s view of the world. ^[4]