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The structural forces behind obesity

M2X00018_9.JPG"Obesity is an almost inevitable consequence of living with our cultural norms, our history of agricultural production and subsidies, our long-standing socioeconomic inequalities, and the impact of technology on our behavior and bodies," writes Marc Ambinder in a terrific Atlantic piece on the obesity epidemic. "Against this formidable dynamic, America has erected two lines of defense: name-calling, and hectoring about diet and exercise."

As Ambinder argues, those two lines of defense are the product of our unquestioned sense that obesity is what happens when willpower fails. But that doesn't describe what’s actually driving the rise in obesity.

The people most vulnerable to obesity, however, do not have access to healthy food, to role models, to solid health-care and community infrastructures, to accurate information, to effective treatments, and even to the time necessary to change their relationship with food. And if that is true for fat adults, it is even more true for fat children, many of whose choices are made for them. Their vulnerability to obesity is much more the result of societal inequalities than of any character flaw. Indeed, for all the attention paid to fat’s economic costs, the epidemic’s toll on children is a stark reminder of its moral dimension. Without some form of intervention, researchers worry, large numbers of black and Hispanic children in the United States will grow up overweight or obese and lead shorter, less fulfilling lives. Is that a legacy we want to live with?

Obesity is much more structural than it is personal. That's why it's so depressingly predictable. It afflicts certain communities, with certain socioeconomic characteristics, and it has only really emerged across a certain time period. Those communities contain a lot of different individuals, but their environments and their time and money stresses and their transportation and grocery options and their street safety and exercise opportunities are broadly similar. How we live has changed much more quickly than who we are, and no effort to turn back the tide on obesity will succeed without an accurate understanding of what's made us obese.

Photo credit: Screen capture from “The Biggest Loser”

By Ezra Klein  |  April 13, 2010; 5:26 PM ET
Categories:  Health  
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Comments

I know it drives my conservative friends crazy when I say this, but I'd really like certain fast/grotesquely unhealthy foods to be treated like cigarettes as far as marketing goes.

Take KFCs new Double Down sandwich for instance. We shouldn't be advertising that on TV. Especially not on shows youngsters watch. That kind of food just shouldn't be marketed to youngsters any more than Camel Lights should be. And, the sight of it makes me want to barf.

I'm not implying that America's obesity problem is the solely the fault of marketing. But marketing IS a big part of the problem.

I didn't notice how much marketing of really bad food there was until I went on a strict diet.

Posted by: nisleib | April 13, 2010 5:49 PM | Report abuse


this was good:

http://content.healthaffairs.org/cgi/content/full/29/3/551

anecdotal, but still reassuring..

Posted by: ThomasEN | April 13, 2010 5:53 PM | Report abuse

I dunno. Perhaps this is irrelevant, but if being poor and black is such a good predictor for obesity, then why don't you see any fat Haitians? And staying in the US, you have to explain how all of these structural issues supposedly causing obesity have appeared in only the last generation or two -- obesity was not an epidemic problem in this country more than a few decades ago. Issues like access to information, role models, food availability, etc. were only worse back in the "good old days."

Posted by: simpleton1 | April 13, 2010 6:03 PM | Report abuse

Seriously, you want to blame environment? And that commenter says marketing? Look. I used to be skinny and muscle. Now I am fat n chunky. It is totally my fault. I become self employed and work entirely from my laptop. I eat fast food, and lots of pasta, potatoes, and junk snacks. My metabolism has shrunk to about nothing. We need to stop blaming companies for marketing, and people's environments. People need self control and when they do not have it, they need to blame themselves.

Posted by: brandonconnell | April 13, 2010 6:09 PM | Report abuse

I think brandonconnell touches upon an important point: the increasing use of technology as a possible contributing cause of obesity. Many people spend a lot of time at work on the computer, and then afterwards at home playing NintendoDS or XBox360 or Wii. Before computers became so commonplace we used to go outside and bike and walk. (Wii Fit is not a good substitute for real, heart-pumping exercise.)

Maybe we need to turn off the computer and go get some exercise. Sure couldn't hurt.

Posted by: Policywonk14 | April 13, 2010 6:23 PM | Report abuse

"Obesity is much more structural than it is personal...It afflicts certain communities, with certain socioeconomic characteristics..."

Which helps explain why certain other folks are so uninterested in doing anything about it. The simplest, least intrusive, least coercive common-sense steps get branded as nannyism, Nazism, or both (and folks, incredibly, seem to be rapidly losing the distinction between the two).

I speak as someone who struggled to lose 70 pounds and has been able to keep them off for several years now. I consider myself very fortunate. I am NOT morally superior to those who haven't been able to achieve the same results. "Personal responsibility" and "just say no" can be demonstrably shown NOT to work for tens of millions of people, maybe more. Simply telling them that's all you have to offer them (unless they happen to be rich enough to pay for bariatric surgery) is not good enough.

Posted by: bcamarda2 | April 13, 2010 6:31 PM | Report abuse

@ Policywonk14: Exercise has little to do with obesity. Exercising more is not an effective means of losing fat.

@nisleib: There's nothing particularly wrong with the Double Down sandwich, in fact it's probably healthier, and would contribute less to obesity than a Quarter Pounder with cheese, which has four times the carbohydrates, about the same amount of fat and calories, and less protein.

http://tinyurl.com/y42uxkm

A study a few years ago demonstrated that it was the carbohydrates in fast food meals that led to weight gain, not the fat or the calories.

Poor people are obese largely because their major source of calories are simple, processed carbohydrates, because those calories are cheap and available. They don't work less hard, or have easier lives, quite the contrary. It's not gluttony or sloth. It's poverty and insulin.

Posted by: sbguy | April 13, 2010 7:25 PM | Report abuse

Welcome to the liberal plantation. You're eating too much. We're going to do punish everyone for it.

Posted by: msoja | April 13, 2010 8:14 PM | Report abuse

I have access, through the US base commissary, to both American and local British food and packaged food products.

When I shop on base, I try to avoid products that contain HFCS--high fructose corn syrup. That severely limits my choices, particularly in the breakfast cereal aisle. Expensive organic products are just about the only packaged products I buy there.

Alternatively, in British supermarkets, I have never even seen HFCS on a label, though sugar is certainly an ingredient. I can only conclude, that although Brits are creeping up on Americans when it comes to weight, the main reason Americans weigh more than their UK counterparts has to do with food subsidies.

Posted by: KathyF | April 14, 2010 2:10 AM | Report abuse

Worth a thousand words on why we're fat: http://why-youre-fat.notlong.com

-- MrJM

Posted by: MrJM | April 14, 2010 9:05 AM | Report abuse

I believe that it is our wealth and lack of physical labor that has made us overweight. Food is cheap and affordable in the United States- and we'll buy it for you. The poverty studies that claim huge numbers of people in America are hungry are ridiculous. Maybe if food stamps were only good for healthy food...and you had to earn them on the treadmill.

We have also been driven for decades by government lies about what is healthy for us. Simple carbohydrates were put at the base of the USDA food pyramid, and sugary fruits were next on the list. We were told by doctors to avoid fat- and people were loading up on pasta and avoiding necessary proteins.

Posted by: staticvars | April 14, 2010 9:09 AM | Report abuse

here's more good news on this front. If all the "players" involved took this approach it could only help.

The devil is helping.

http://www.nytimes.com/2010/04/14/health/14diabetes.html?hpw

Posted by: visionbrkr | April 14, 2010 10:06 AM | Report abuse

Obesity is an addiction. It is because people are addicted to junk food. Food additives present in junk foods triggers our mind which leads in overeating. Healthy food is something which we all try to avoid as it is tasteless though full of nutrients. Our brain is more partial towards less healthy, oily and fried foods. I like reading health articles and I came across an interesting article by Dr Arya M. Sharma. He is a very famous doctor and obesity researcher in Canada and he regularly writes articles on Obesity and other health related issues. Obesity is an Addiction http://www.drsharma.ca/is-obesity-an-addiction.html is one of his articles which was quite attention-grabbing.

Posted by: DrAryaSharma | April 14, 2010 10:39 AM | Report abuse

KathyF,

HFCS is 55% fructose. Sugar is 50% fructose.

Posted by: tomtildrum | April 14, 2010 1:46 PM | Report abuse

It's NOT really the HFCS, or pesticides, or addiction, or lack of availablity of healthy food, or lack of information (all part of the picture however, but really excuses). Like a lot of things in modern world, it's capitalism vs. the uninformed. TV (now color and HD and 52" diagonal, soon to be 3D) has given corporations an incredible way to form the opinions of consumers. Those most vulnerable to the propaganda are those who are least educated. Advertising forms most of a lot of people's world view. After glamorizing fast food etc., modern capitalism delivers the fat, salt, and carbs cheap and easy. Plus those mesmerized by TV plus the internet and video games aren't moving.

Anyone watch the Jamie Oliver series on Friday nights? Check it out. Watch previous episodes on abc.com. The kids are being served pizza and chicken nuggets for breakfast and lunch at school. What did they have for dinner at home? Pizza and chicken nuggets.

I see people from all over the world and the US, mostly in family groups, at my work. Every day I see obese parents with obese children (and no, I'm not skinny myself, except compared to average Americans). If I could I would stop them and ask them why they are setting up their kids for diabetes and heart attacks and not fitting in airline seats besides doing it to themselves. Corporations shouldn't be able to advertise food OR prescription drugs on TV or the internet, if such a prohibition were possible legally and politically. The culture has shifted disastrously in terms of eating and exercise in the post WWII era mainly because of corporate propaganda and capitalism taking advantage of human drives (like for tasty calories) for profit.

Posted by: emjayay | April 14, 2010 3:02 PM | Report abuse

For several hundred thousand years of human history the ability to store body fat meant you lived long enough to pass your genes to the next generation. Humans were lean because they simply could not hunt and gather enough food to eat. When they found food, they gorged until they were full because you never knew when you would get another meal.

Fast forward a few hundred thousand years to 2010. Food is abundant and really cheap. Any person in America can eat an unlimited amount of calories for a few dollars (i.e. Taco Bell, Burger King). Combine that with human beings’ natural craving for calorically dense foods and you have a recipe for obesity.

Americans are obese because evolution designed us with the ability to store body fat or else we died of starvation and our genes could not be passed down.

Posted by: kingstu01 | April 14, 2010 7:58 PM | Report abuse

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