What is the Solution to Obesity?
Dystopian futures have obesity figured out.
In the science-fiction big-gubmint hyper-controlled libertarian-nightmare future we’re all implanted with activity monitors and receive painful electric shocks if we don’t meet our daily exercise requirements, and all our calories are carefully allocated based on our specific metabolic and health needs.
But freedom tho.
The reason why the horrible fat shaming game show The Biggest Loser works is because it’s a lot like that dystopian future. The contestants have no freedom, and they lose weight because they’re forced to via the rigid controls of a labor camp on a starvation diet. It’s no surprise that once they regain their freedom they regain the weight.
Is there a way to effectively battle obesity without infringing on personal freedom? Probably. A lot of these are hypotheses that I (and others) think will work. The thing is, it’s not any one thing that is going to solve this problem – and yes, obesity is a problem, no matter what Health at Every Size tells you.
The reason why there is no one single solution to obesity is because …
There is no one single cause to obesity
We live in what’s known as an “obesigenic environment,” which is scientist speak for “it makes you fat.” Sedentary jobs, busy schedules and easy access to nutritionally compromised yet calorie-packed “food” we don’t have to cook is what modern life is all about. There is 24/7 access to highly palatable (treat) food that’s hard to resist. We used to be more about a regular meal pattern with only rare snacking, but near-constant eating has become so ingrained in our culture that it’s difficult to withstand the call of the cookie, the Krispy Kreme or the cheeseburger. As a result, the pounds pack on, and they don’t come off easily.
Fast food used to be rare, now it’s not just everywhere; it’s been super sized.
But there’s more to the situation than abundance and inactivity. The truth is, there’s no one cause for people being overweight. Some shout, “It’s all carbs’ fault!” but sorry, that ain’t why we’re fat. The root causes of overweight and obesity are as diverse as the people carrying those extra pounds. It’s only the charlatans who will point out a universal cause and say, “This is why you’re fat.”
Long work hours spent in a chair, high stress levels, overuse of screen-based entertainment, lack of cooking skills, lack of desire to cook after a long day, the ability to hit a drive-through or dial for delivery at any time of day, emotional trauma, misinformation promoted by the weight loss industry, gigantic portions, government subsidies to fattening foods, food marketing run amok (much of which specifically targets children), ever tastier concoctions created by brain scientists working for food corporations that makes their treat foods ever more compelling, a society that places emphasis on eating for pleasure instead of fuelling your body … all these things just scratch the surface.
And so, there will be …
No single solution to obesity
If the problem is complex then the solution will be equally so.
In a post by my friend Dr. Yoni Freedhoff he defended so-called “fat taxes,” which are additional taxes on fattening foods and drinks, by writing: “there will be no singular intervention that will have a remarkable impact.” Freedhoff explained that no single sandbag stops the flood.
Look at how there has been a dramatic decrease in smoking in the United States, which fell by more than half (42% of the adult population down to 17.8%) between 1965 and 2013. This dramatic reduction in smoking happened for a number of reasons, including:
- Changes to laws regarding advertising claims about smoking, as well as the type of media in which smoking could be advertised.
- Changes to laws regarding the selling of cigarettes to minors, and ever more strict enforcement of those laws. Additionally, cigarette advertising that was deemed targeted at children was increasingly banned.
- Public information campaigns about the dangers of smoking.
- Increased assistance provided to those looking to quit.
- Pharmaceutical aids were developed for quitting.
- Psychological based aids developed to assist quitting.
- Over time, cigarette smoking was banned in offices, stores, restaurants and bars.
- School education programs to discourage children from taking up smoking.
- Direct legal attacks against the tobacco industry (which were successful).
- Significant taxing of cigarettes to increase price.
The two biggest impacts, according to this New York Times article, was the creation of smoke-free environments, specifically workplaces, and higher taxes. When you’re constantly forced to go outside and stand away from the doors to get your cigarette fix, it reduces the amount you smoke, making it easier to quit, and it also creates that all-important pain-in-the-ass coupled with stigma factor that makes you want to quit. Making them extra expensive increased the motivation to quit as well as priced them outside the range of many children. My best friend used to smoke, and he said his original impetus to quit 20 years ago was simply that he couldn’t afford it any longer.
Nevertheless, cigarettes are different than food. You can’t live without food, and you can’t ban eating in public environments. You can’t ban certain types of eating either, because someone eating French fries while sitting next to me isn’t going to make me second-hand fat, so there is no logic to it.
But there is still a lesson to be learned here, one of them being that it was a multi-pronged effort that led to the reduction in smoking, and that a lot of government intervention was involved.
Early on I mentioned libertarian nightmares. American politician Ron Paul once said, “The most basic principle of being a free American is the notion that we as individuals are responsible for our own lives and decisions.”
You’re fat? That’s on you and your bad decisions. According to Ron, at least.
Sorry, Ron, but when you allow capitalism to run amok, it does. And in this case, it helped create an epidemic of obesity. The government isn’t just letting food corporations run amok, it is often in collusion with them.
A big part of the solution to obesity involves governments growing a damn spine and protecting the citizens who elected them from the soulless corporations looking to exploit our hunger.
I have an MBA and I know that the #1 goal of any corporation is this: maximize shareholder value. They will do so by any legal means necessary, and they must, because if they don’t, their competitors will destroy them. The “ethical” food corporation that decides not to market to children or make food “fun” and doesn’t use brain science to make their products hyper palatable leading to overeating and repeat business goes out of business.
Again, food corporations will push the limits of what is legal in order to sell calories, because those that don’t go out of business.
Unrestricted capitalism would have allowed cheap tobacco sold and marketed to everyone to smoke everywhere, and we’d still have those high smoking rates. It changed because the government decided to intervene to rein in a profitable business.
Governments did it before with smoking because it was a public health issue, and they can do it again. Libertarian thinkers may protest, but the reality is that unless you stand to directly profit from exploitative practices from food corporations, government intervention and tighter regulation in this regard actually enhances individual freedoms; it provides freedom from the influence of unethical corporations that profit from making people obese. It gives people the freedom to have access to better food choices and better information about those choices.
But before we get into that, let’s look at:
Prevention vs. Treatment
The world is full of people with obesity. It’s also full of people who are not yet obese. It’s a helluva lot easier to stay lean by never getting fat in the first place than it is to keep weight off after having been obese.
“We have to look at obesity as a chronic disease,” Dr. Arya Sharma, who is chair in obesity research and management at the University of Alberta, told me.
When I first heard of obesity being classified as a disease I was unsure of how to react. But Dr. Sharma explained it to me in a way that, as someone who has kept a significant amount of weight off for over two decades, I now understand.
“I’ve never met anyone who has been cured of their obesity,” Sharma said. “They’ve lost weight and kept it off, but most people are doing something to keep that weight off every single day. They are treating the condition, and if they stop that the weight will come back.”
Now it makes sense. I treat my obesity every day via a regular exercise regimen and thoughtfulness about my dietary intake. If I stop either one of those, the weight will sure come back. Quickly. I will be in treatment for the rest of my life if I wish to stay lean.
Obesity has officially been declared a disease in the U.S., which is why they have billing codes for it. (UPDATE: On October 9, 2015 the Canadian Medical Association also recognized obesity as a disease “requiring enhanced research, treatment and prevention efforts.”)
There are millions of people requiring treatment, and millions more who would benefit from preventative measures by ensuring they never become obese, and therefore not require such treatment. This is yet another reason for the multi-pronged approach.
What is the solution?
Again, it’s not some miracle pill flogged on Dr. Oz. It’s a lot of different things that will require government intervention, like with smoking.
To battle obesity effectively, governments must take the side of the citizen over the corporation for the health of the populace, by doing things like:
Subsidizing the right foods, and taxing the wrong ones
A 2012 release from the US Public Interest Research Group determined that government subsidization of treat-food additives pay for 21 Twinkies per taxpayer per year, but those same taxpayers only get half an apple paid for. There is something seriously wrong with that math. Making healthy food less expensive and treat food more expensive can go a long way to improve eating habits.
Placing tighter restrictions on food labeling
The average consumer is easily fooled; they don’t understand how often they are misled by food corporations via tactics such as “health washing” (also called nutritionism): making an unhealthy food seem healthy by promoting a certain ingredient it contains. Sorry, but macaroni and cheese from a box where the noodles are made from hyper-refined cauliflower is just as bad for you as the regular kind, and just because the cereal with the cartoon character on the front says it is made with whole grains doesn’t mean it makes for a healthy breakfast. And we’re supposed to believe that Fruity Pebbles are healthy because they have added Vitamin D? Come on!
Corporations also mess around with their labeling so they include four different types of sugar to keep sugar from being listed as the first ingredient.
Restricting food advertising to children
Again, it will require government intervention to do this, just like they did with smoking. Right now it’s the Wild West, where anything goes. Food advertising to children of unhealthy treats is over the top. Not only that, but it’s all about making food fun. Food that tattoos your tongue, is shaped like bugs, has cartoon promotion … and don’t forget about the movie partnerships with fast food restaurants. You can’t get the latest Avengers toy unless you buy the kids’ meal at the burger joint, and all their sports and movie heroes are chugging Coke these days, so if you want to be like them, just drink this sugar water.
Stop corporate-government partnerships and rein in lobbying
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by myriad food companies such as Coca-Cola, PepsiCo and Kellogg’s, and the National Restaurant Association is a strategic partner to promote the United States Department of Agriculture’s (USDA) “MyPlate” (which replaced the “food pyramid” in 2011). Restaurants, like food corporations, are also vested in repeat business, which means making food taste great, which translates to “irresistible and high in calories.” Having an association whose raison d’être is to promote the interests of restaurants partner with the USDA on guidelines for how Americans should eat is ludicrous.
These are just a couple of examples. The dairy industry has a long history of influencing the food pyramid, and Coca-Cola is very active in lobbying government to keep regulations lax around the sale of sugar water.
Revamp home economics in school, and make it mandatory
Cooking at home using fresh ingredients purchased from a grocery store is a powerful tool for battling obesity. My kids had the option to take home-ec, and mostly what they learned how to make was cookies and cinnamon buns. Here is a better approach.
Place tighter controls on the weight loss industry
As I pointed out in this piece, the weight loss industry is so full of crap its eyes are brown. Outlandish weight loss scams run rampant, making it the #1 form of fraud in the US many years running. Consumers are brainwashed into believing the quick and easy miracle cure from people such as Dr. Oz, and so rational and evidence-based approaches to weight loss (the kind that actually work) have a hard time reaching the public through all the noisy snake oil.
Stop promoting physical activity as the solution for weight loss
While exercise can play an important role in sustained weight loss, much of the messaging that persists gives a false impression that it is possible for you to outrun your fork. The amount of exercise it takes to compensate for poor dietary choices is impossible for most people.
Create better access to evidence-based weight management programs
“Better access” means government funding. It’s a worthwhile investment that will not only decrease healthcare costs, but also improve productivity, as obesity is shown to have a negative effect on workplace productivity.
Create national advertising campaigns that promote healthier eating
Some campaigns exist, but they could be done better, and they could be done more. Like with smoking cessation, the message needs to be hammered home again and again.
Make prejudice against people with obesity against the law
As it stands, we have laws to prevent prejudice against people based on race, religion, gender and sexual orientation, but no laws exist to protect the obese against unfair treatment. The reality is that shaming and mistreatment of the obese has the opposite of the intended effect; it leads to weight gain, not weight loss.
Create greater access to bariatric surgery
Weight loss surgery has by far the highest success rate of any kind of weight loss intervention, but it is hard for the public to get access to it. The risks are low and the rewards are high, and surgical techniques are being improved all the time. Read more about bariatric surgery in this article of mine.
Continue research into weight loss pharmaceuticals
Pharmaceutical intervention hasn’t shown a lot of promise yet, but improvements are being made and one day it could prove to be an effective treatment for sustaining a reduced body weight that in turn makes people healthier. The greatest thing about drug interventions is that while you can’t give millions of people bariatric surgery, you can put millions on an effective and relatively safe weight loss drug.
Conclusion – What can you do in the meantime?
These are all solutions that have yet to come to fruition. They are solutions that can significantly lower the percentage of the population that is overweight / obese, as well as help prevent future generations from becoming obese.
But if you have weight to lose now, what is your solution?
A good first step is to realize that food corporations and most weight loss programs are lying to you. Any time something sounds too good to be true, it is. When it comes to weight loss, calories are all that matter, so feel free to read my Caloric Deficit Cheat Sheet along with understanding more about your exercise choices and their effect on both metabolism and dietary intake.
Beyond that, there is a lot of information available in my book, which provides a comprehensive strategic plan for losing weight and keeping it off. As a selling point, it has the words “brutally honest” in the subtitle. It tells people what they need to know, not what they want to.
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James S. Fell is an internationally syndicated fitness columnist for the Chicago Tribune and author of Lose it Right: A Brutally Honest 3-Stage Program to Help You Get Fit and Lose Weight Without Losing Your Mind, published by Random House Canada. He also interviews celebrities about their fitness stories for the Los Angeles Times, and is head fitness columnist for AskMen.com and a regular contributor to Men’s Health.