Nine Questions for the Author: Leonardo Trasande, Author of Sicker, Fatter, Poorer

Here’s a terrifying fact: conservative estimates say that household hormone-disrupting chemicals are costing the US $340 billion annually in healthcare costs. This statistic received the attention of Leonardo Trasande, which led to his latest book, Sicker, Fatter, Poorer (Houghton Mifflin Harcourt, 2019). Here, the internationally renowned leader in environmental health investigates the pervasiveness of dangerous hormone-disrupting chemicals in our everyday lives.

Leonardo Trasande MD, MPP is the Jim G. Hendrick MD Associate Professor, Director of the Division of Environmental Pediatrics and Vice Chair for Research in the Department of Pediatrics at NYU School of Medicine. He also serves on the faculty of the NYU Wagner School of Public Service and the NYU College of Global Public Health. Dr. Trasande is an internationally renowned leader in environmental health. His research focuses on the impacts of chemicals on hormones in our bodies.

Orion’s Reviews Editor Kerri Arsenault recently asked Trasande nine questions about the book’s central concerns, environmental health, and what to do about it all.

KA: The “Precautionary Principle” is the European Union’s approach to regulating chemicals, meaning companies have to prove a product safe before it’s distributed. In the US the burden falls on the consumer to prove a chemical unsafe. What can the average citizen do to combat this kind of regulation?

LT: Don’t underestimate the power of the pocketbook or wallet. BPA was banned in baby bottles and sippy cups a decade ago based on much less science than we have now. Consumer concern and media attention fueled industry change – and ultimately industry went to the FDA to insist on a ban. These types of consumer campaigns aren’t perfect – we know BPS and other bisphenols replacing BPA are as estrogenic, toxic to embryos, and persistent in the environment. But it does speak to the opportunity for progress when regulation is waning.

Think about the power of employers, schools, and companies as force multipliers. Two major supermarket chains insisted recently on their providers of food packaging to swap out all buffet containers because they were found to have the thyroid-disrupting perfluoroalkyl acids, the non-stick Teflon-like compounds. That was driven by a study finding these chemicals in five – yes, five – containers. A little data goes a long way.

KA: I read Kate Brown’s Manual for Survival, and she suggests that such catastrophic events like the Chernobyl disaster actually affect us all at some level and the consequences were whitewashed so that nobody really knew what was going on. This was similar to what happened at Love Canal. The long-term uncertainty of what was going on led to traumas like neurosis, hypervigilance, PTSD, non-empirical beliefs, distrust, fear. Did you address the social, cultural, and psychological consequences in your book?

LT: Our estimates of EDC (Endocrine-Disrupting Chemicals) costs do not address the pain, suffering, and other consequences associated with diseases due to these chemicals. This again reinforces how conservative an estimate we got – and yet EDCs costs the US $340 billion (2.3% of US GDP) each year.

KA: Doesn’t it boil down to policy and transparency?

LT: Yes. Information about ingredients – from what’s in products to what we know about the effects of these chemicals – starts a discussion about tradeoffs. Without basic information about chemicals in cosmetics and personal care products, researchers can’t even sort out the effects to guide consumers. It’s not as if the basic ingredient composition is so precious that it’s needed to maintain an advantage in the marketplace.

KA: How do you think this kind of injustice affects people from different socioeconomic groups?

LT: We know these exposures disproportionately affect racial and ethnic minorities. We just published a study in the Journal of Clinical Epidemiology finding that African Americans bear nearly 17% of disease burden due to EDCs even though they only comprise just over 12% of the population. Similar disparities also exist for Mexican Americans.

KA: What was the most surprising thing you learned about how toxins affect the body?

LT: The science has accelerated most quickly to suggest chemicals as “obesogens.” The leader here has been Bruce Blumberg at the University of California at Irvine, who has written his own book The Obesogen Effect. There are fifty known obesogens – take BPA, which makes fat cells bigger and is a synthetic estrogen, which means it can have sex-specific effects on growth, especially in puberty. Perfluoroalkylacids have been associated with greater weight regain after weight loss, and it appears to be due to a slower burn rate, literally slowing metabolism down.

KA: A health official in Maine said once that contributing to the state’s high cancer rates are “lower levels of education, high rates of poverty, unemployment, and lack of health insurance.” What do you think of that statement?

LT: It’s an antiquated understanding at best. The World Health Organization conservatively suggests that 23% of deaths worldwide and 22% of lost lifespan are due to environmental factors. And that estimate came before we did our work on endocrine disruptors.

KA: What were your main goals in writing this book?

LT: Roughly 1% of the public knows about hormone disruptors, yet it affects 99% of the population. And the safe and simple steps we can take now to limit exposure aren’t that hard and don’t bust budgets. My goal, above all, is to start a broader dialogue about these issues. I won’t convince everyone, but everyone knows someone affected by one of these conditions that are influenced by chemicals that mess with the endocrine system – obesity, breast cancer, autism, and ADHD, to name a few.

KA: Has your own life changed because of the things you learned and if so, how?

LT: Our kitchen is small like most Manhattan residents, but has been completely transformed over the years. It has much less plastic, no more nonstick surfaces, and a lot more glass.

KA: While your prescriptions offer sage advice on how to reduce toxins in our body, will humans think that’s enough and not push to change policy?

LT: There’s always a place for regulation. That said, I’ve seen from my experience working in the Senate that change comes through opportunities that open and close based upon many factors. And these factors aren’t just political – these issues cut across Democrat and Republican lines. Evangelicals and atheists get these issues, perhaps for different reasons, but we can all get to the same place: lasting solutions for the health of everyone.  

For more, visit Dr. Leo Trasande’s website.