Saturday, July 09, 2011

Finger-Pointing Won't Change the Obesity Rate

ABC News hypes the "obesity epidemic", announcing "America Keeps Getting Fatter". But the story they're not sharing is that, as the developed world's diet becomes more "American", other nations are also becoming fatter. And once we reach a certain threshold of obesity, specific regions pretty much stop getting fatter. What we're really seeing is that, thanks to changes in diet and lifestyle, the baseline for how many people are obese or non-obese is shifting.

Should we be concerned that the waistline of the world keeps on expanding, and that things tend to settle with a bit more than a third of the adult population classified as obese? Yes, we should. There are health consequences to obesity, particularly if associated with low muscle mass and an inactive lifestyle, that are valid concerns both in terms of quality of life and cost to society. (For what it's worth, the same is true for people who are underweight, but we don't consider being "too thin" to be a sign of moral weakness.)

But here's the thing: When you see a trend that's not just nationwide, but is increasingly international in its nature, you gain next to nothing by focusing on individual lifestyle and choices. The fact is we live in a culture that is loaded (larded) with calorie-dense foods. The fact is that some of the most calorie-dense foods are among the cheapest. The fact is that it profits the food conglomerates that engineer and market those foods to convince us to eat more. The fact is that, even with information about calories and weight, most people will not make the long-term lifestyle changes necessary to lose a substantial amount of weight and maintain that loss. The fact is that the overwhelming majority of people who do lose a significant amount of weight ultimately regain it. The most likely means by which an obese person will lose a significant amount of weight and maintain the loss is surgical - bariatric surgery, banding and the like. The fact is that there is refined sugar in pretty much anything you buy at the grocery store that has even a small amount of processing, even if you are left scratching your head wondering, "Why does that have to be sweetened?"

At a certain level, yes, "Eat less and exercise more" works for everybody. But once you recognize that blaming and shaming are not effective (and can be counter-productive), education has little impact, and that most of those who attempt to lose weight will end up concluding that "that approach doesn't work for me" or "this is too hard." No, I'm not suggesting, "Throw up your hands and give up," but the type of changes that might work will take more than simply telling people that they need to lose weight or move around more than they do. We could take a look at how we, as a society, subsidize the means to be inactive and to eat a low-cost, calorie dense, high-fat diet. We could recognize that physical activity is good for kids and should be a routine part of the school day.

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