As the nation struggles to create a health care program we can all live with, an important part of the equation seems to have gotten lost. The vast majority of our health problems are self-inflicted. All too often, we are our own worst enemy.

Preventive medicine, measures taken to prevent diseases before they manifest themselves, is something that most people don't address. For example, one of the most basic things we can do to promote health is to eat a proper diet and get sufficient exercise.

In my practice I see too many people, who if they took care of themselves better, would never be in my office. I am deeply concerned about the trends in obesity among Hawaii's adults and children, which carries with it increased risk for a litany of maladies including Type II diabetes, hypertension, cardiovascular and kidney disease, certain cancers, gallstones, osteoarthritis, rheumatoid arthritis, and respiratory problems, to name a few.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending goes to treat "preventable chronic diseases." Of course not all diseases are linked to diet (smoking of course isn't) but most of them are. It's estimated that 30 percent of the increase in national health care spending over the past 20 years could be attributed to the mushrooming rate of obesity.

Here in Hawai'i obesity has reached epidemic proportions. This impacts a broad spectrum of our population, with consequences that reverberate throughout our community. This includes the health care system, state and city government, and private industry.

This is well understood by policymakers but nothing we are currently doing is stemming the spread of obesity which is in many of Hawai'i's communities.

As I see it, the root cause is that we claim the right to dispense with responsibility if we can get away with it.

The truth is we really can't, especially when it concerns our health.

The results of making unhealthy choices in diet, exercise, and poor habits inevitably escalate into disease conditions, suffering, and finally, the end of life.

Conversely, small improvements in health and wellness behavior will be compounded with time to make net gains in quality of life for future years.

So what can we do?

Obviously charity begins at home. There is no shortage of nutritional data and healthy diets available to people who seek them out.

And for those who don't choose a healthy diet?

I don't as a rule like government to dictate how I live, but on the other hand, public policy can be compelling. We fine people for not wearing seat belts and highly tax cigarettes. Why not tax junk food such as soda and encourage children to eat right?

Here are some examples where public policy has been put in effect on the Mainland:

• Connecticut has strict standards for school lunches.

• New York requires school districts to report on students' Body Mass Index and weight status starting in Kindergarten and ending in 10th grade.

• California has mandated calorie labeling on chain restaurant menus.

• Texas provides funds for community vegetable gardens, work site wellness programs and encourages mothers to breast-feed — a sure-fire way to reduce childhood obesity.

• Insurance companies offer discounts to safe drivers.

Should we consider state tax incentives for citizens who take care of themselves? Should we subsidize community vegetable gardens or tax junk food purveyors?

I'm not sure what the answer is, but I'm convinced that in addition to taking control of our own diets, when it comes to stemming the obesity epidemic, enlightened public policy must be part of the equation.

Our children's lives are at stake.