Earlier this year, the Institute of Medicine launched a groundbreaking report on “Solving the Weight of the Nation.” In it (and in the accompanying HBO documentary), public-health officials argued that structural elements in our society rather than individuals are mostly responsible for the nation’s obesity epidemic.
To slow down or reverse the epidemic, the IOM report stressed, we need to make major changes in our schools, workplaces and communities. Simply scolding (and stigmatizing) individuals to eat less and exercise more will not solve the problem.
Of course, as I’ve noted here before, the structural message is not one that Big Food wants to hear, as it would curtail their sales and their profits. So the pushback against actions like taxing soft drinks has been loud, strong, and mostly successful.
But the structural message is not one that the American public wants to hear, either.
In a commentary published Wednesday in the New England Journal of Medicine, three health-policy researchers, including Sarah Gollust of the University of Minnesota, ask the question, “Are Americans ready to solve the weight of the nation?”
Sadly, their answer is no. For as they point out, public surveys consistently find that most people blame individuals rather than society for obesity.
“Only 18 percent of Americans identify external factors (exposure to junk food, lack of safe places for children to play, and limited availability of healthy foods in some neighborhoods) as the biggest causes of childhood obesity,” Gollust and her colleagues write, “whereas 64 percent identify personal factors (overeating, lack of exercise, and watching too much television) as the biggest causes.”
Beliefs about how the childhood obesity problem can be solved also tend to focus on individual rather than joint responsibility — especially among people who identify themselves as politically conservative. When asked who bears the most responsibility for childhood obesity, conservatives are more likely than moderates or liberals to point the finger at parents and children than at the food and beverage industry or government policies.
Reprinted with permission of the New England Journal of Medicine
These misconceptions about what has fueled our obesity problems hinder efforts to combat it, write Gollust and her colleagues. What’s needed, they add, is a more comprehensive effort to inform the public about the real causes of the obesity epidemic:
Rigorous evaluation research has been conducted in the past decade to identify effective interventions and policies for combating obesity. A similar research-driven effort is needed to identify effective communication strategies that encourage the public to accept the evidence base regarding the environmental determinants of obesity and the necessity of a collective response.
Getting the public to accept evidence-based research is easier said than done, however. After all, we live in a country where, according to a recent Gallop poll, 46 percent of its adults reject the overwhelming and incontrovertible evidence of evolution — a percentage that’s actually increased by 2 percent over the past 30 years.
Unfortunately, the NEJM commentary is behind a firewall. The U of M has provided, however, a brief video of Gollust discussing the paper. Her co-authors are Colleen Barry of Johns Hopkins University and Jeff Niederdeppe of Cornell University.
find another path to the same result…
Perhaps rather than taxing sugar we should kill the subsidies that incent growers to produce so much extra corn, which is turned into the cheap food that makes so many of us fat.
Sadly, I agree
While individual choice certainly – absolutely – plays a part (I’ve never heard a credible source suggest that individuals bear NO responsibility for their own diet-related health), the RANGE of dietary choices available to some is far greater than the range of choices available to others. More importantly, individual responsibility has to be based on INFORMED choice – the one doing the choosing has to have all the relevant information available to him or her in understandable form in order to make a reasonable decision. That information is often unavailable, or is available only in a form that is easily decipherable to a biochemist, but few others.
No aspect of this situation is helped by the seemingly endless series of conflicting reports about what’s “good” for us and what’s “bad” for us. This month, eggs are terrible, and eating butter is like putting a gun to your own head. Last month, eggs were “good” protein and butter was actually better for you than margarine. Even when a TV station tells you who did the study they’re presenting to their audience, almost never is the funding source of that study revealed, and that makes a huge difference in terms of credibility, especially in areas where the results of peer review are generally NOT reported to the public.
An occasional order of fries and a burger isn’t likely to kill you – we’re omnivores, after all – as long as it’s truly occasional, and not 4 or 5 meals in a given week. Healthy diets that I’ve seen recommended pretty much fall in line with the ancient Greek ideal of “moderation in all things.” I’ve yet to see either a “public service” health-related ad or a corporate food-sponsored ad that says fairly plainly that moderation is a good thing. Don’t super-size those fries. Don’t buy the 2-liter bottle of whatever-it-is. At the same time, don’t torture yourself with guilt over having an ice cream cone on a 95-degree afternoon.
From the food standpoint, as in several other areas, we live in a toxic culture where profit trumps every other value. Apologists fall back on the individual choice argument, neglecting to mention that sometimes other choices are unavailable, or if available, they’re not promoted, shall we say, with the same zeal that a fast-food conglomerate exhibits in promoting its latest product. American advertising is among the most creative and effective on the planet, and its effectiveness can be seen in the chart. Too bad it’s often used to promote products we’d frequently be better off without.
If America really wants to get serious about fighting obesity, the Federal Government should drop agricultural subsidies for corn. Then, your high-fructose corn syrup infused, diabetic coma inducing, 1.3 L Super-Big Gulp wouldn’t be cheaper than apple juice. Plus, the taxpayers will save a chunk of change.
Amen to that.
Somehow, the agricultural industry (for that is what it is) is able to think of lots of ways of bringing down the cost of stuff that’s n good for you and is bad for the environment, but cannot figure out how to pay growers of organic produce grown locally subsidies to lower the costs of that food? How can it even be legal for food manufacturers to lace almost every product that gets shelf space with “high fructose corn syrup”, one of many additives that perhaps adds so much to the bottom line of the corn manufacturers and growers but has negative health “benefits” (that is to say, it’s bad for your health) for the people who are expected to eat this crap. Cargill ADM and some of the other manufacturers ot HFCS have been sued, somewhat successfully I gather, for antitrust price fixing. That’s a bad thing only if you’re another HFCS manufacturer or worse, buyer/producer down the “food chain”, and you want to lace your product with this stuff for less money. In one lawsuit that went on about ten years ago, the court cited Pepsi and Coke as accounting for about 60% of the sales. That means 40% for the other unnamed users. Who knows what it is today? All I know is that when I buy bread in the grocery store or hot dog or hamburger buns, I have to look quite hard to find one that does NOT have HFCS in it, by reading the extremely tiny list of ingredients.
Only when the public wakes up to realize that their diets are not a function of individual choices but a function of corporate-industrial-agricultural policy can we begin to tackle this problem.
Looking at my elementary school pictures from 50 years ago
I see at most 2 chubby kids in each class and none who are actually obese.
But why is that?
We all grew up on meat and potatoes diets, and vegetables and fruits mostly came out of cans. We drank whole milk.
But eating out was reserved for road trips or shopping expeditions downtown, and although we drank pop or Kool-Aid with sugar, we did so only when traveling or at parties.
But more significantly, we walked more. My school in a medium-sized city in Wisconsin was five blocks from our home, and I walked there in the morning, walked home for lunch (sandwiches and canned soup), walked back to school, and 1/2 hour later, and walked home again at the end of the day. In other words, a twenty-block walk was part of my routine five days a week.
Furthermore, we played outside a lot unless it was raining or below zero.
Today’s suburban communities are not built for walking, and some parents are afraid to have their children either walk to school or play outside. Yet there were abductions and child molesters in those days, too. We didn’t walk to school alone; older kids escorted younger kids, as they had for generations.
The result: very few fat kids.
Would more focus on home life help?
You notice I say “home” and not “family”. I’m focusing on the actual abode and the activities which relate to it.
I grew up in the ’60s and ’70s in Rochester and of course the norm was still stay-at-home moms and limited after-school activity. I can’t speak for the large urban experience, so maybe my idea doesn’t bear out but here it is anyway:
Increasingly, parents/partners/adult singles are forced to work long hours away from the home thus giving them less time and less access to prepare thoughtful, healthy meals. (I’m thinking of my grandparents who worked hard on their farm but had easier access to organic food.) When rushed, they turn to processed, “easy” meals that are high in sodium and other unhealthy things. When they are home, they are frequently too tired or too disconnected from home life to engage in more physical activities related to home maintenance.
Children are increasingly choosing (or being “encouraged”) to maintain large levels of after-school activities which can frequently cut into mealtimes, keep them up late, force them to eat “on the go” and encourage fast food consumption.
Still-mobile elderly people who would have lived with offspring in previous generations now turn to likewise high-sodium processed foods due to ease of preparation.
And goodness knows we are all taught to worship at the alter of “convenience” these days. (I even read a blog comment touting e-books as being a godsend because the writer didn’t have to get up and cross the room to get a dictionary while reading a novel.)
My question is: what would happen if we could create an economy that would sustain one stay-at-home partner/parent (of either gender) who could take the lead on home management to create a thriving HOME life so that home is not simply somewhere you sleep when you’re not racing around doing 100 millions other things? Would more investment to a healthy, active family and/or community existence lower depression, encourage healthier choices and get people away from their “screens”?
Not sure. Obviously, the other factors people have mentioned here play an enormous role too. But I just remember more “home” focus when I was young and it resulted in more physical activity and engagement. The pity is that the current economy makes it hard for people to be like that again.