The Hastings Center Report for January/February of 2013 contained an interesting editorial on obesity. The article, written by Daniel Callahan, identifies obesity as being much harder to treat than the serious conditions it causes. The author alludes to obesity as being the “most difficult and elusive public health problem” ever faced by this country. Callahan suggests that the low treatment success rate associated with obesity is likely because people need to commit to changing patterns “deeply woven into social fabric, food and beverage commerce patterns, personal eating habits, and sedentary lifestyle.” He asks, “How can government and business go about modifying the behaviors that harm health and what are the limits of market freedom for the food industry?”
He makes a number of comments in his editorial that I would like to address:
The percentage of Americans who describe themselves as overweight (35% men, 42% women) has not changed in 20 years despite the fact that Americans have gotten heavier. Gallup polls also suggest that parents have “notoriously poor judgment when it comes to judging their kid’s weight.”
My comment: YES on both – Denial is hugely at play in this condition called obesity. Adults don’t recognize how overweight they are, and they are incredibly unwilling to recognize weight issues in their kids. Pediatricians, who gently raise the issue, often face belligerent behavior from parents, who may choose to leave the practice rather than work on the weight issues in the family. There seems to be time for everything except meaningful change of family dynamics when obesity is the prevailing disease in a family or family member.
Callahan identifies the assessment of the WHO (World Health Organization) that now calls obesity a global health epidemic with the US and UK at the top of the list. Almost every nation has some level of trouble, though.
My comment: YES, obesity may actually outpace hunger as a global issue and every country that succumbs to increasing statistics among its populace, often follows the US template of: more fast food, more sedentary time.
Callahan readily identifies the causes of obesity:Aging, gender differences (women at greater risk for weight issues), genetics (it does run in families), illness (hypothyroidism can contribute), poverty and race, sedentary habits, poor diet, the luxuries we possess (from escalators to cars, to electric can openers and remote controls) that have us moving less.
My comment: YES and to add to that – even when I encounter kids involved in school and after-school sports, their parents typically bring the worst food possible before and after the exercise effort. If a parent is willing to complain about this and suggests establishing healthier snack rules – he or she can face Alice in Wonderland – “off with their heads” attitude from those I will bring what I want to bring parents.
Callahan says that when you look at all the efforts and treatments currently available and the success rate, it is dismal. One therefore is left to conclude that little progress is being made. He acknowledges the role of hope in this crusade, but says, “it will take a big dose of hope to brighten this dismal scene.”
My comment: I am hopeful but I tire of all the excuses. Maybe that’s because I figured it out at age 16 and it basically required some education, a huge amount of willpower and treating obesity like a disease and not a temporary condition “that could be fixed.” That meant changing my life to reflect the habits and behaviors needed to sustain my treatment plan. And that treatment plan required: daily vigorous activity, menu and meal planning, no temptations on the home front, planning ahead of restaurant eating, staying in touch with a support group, working on my relationship with food in an ongoing, meaningful way.
Callahan cites the roles that government and business must play in curbing obesity rates. They include: taxing sugary beverages and processed (unhealthy) foods, banning unhealthy food ads to kids, posting calories and nutrition information in restaurants, reducing the cost of healthy food. As a corollary, he proposes stopping the food lobby – completely. It also means getting “rid of the liberal cohorts that oppose government regulation.”
My comment: Quite simply, I agree
Callahan acknowledges the Partnership for a Healthier America (helmed by Michelle Obama) that has 20 food companies willing to make some of the changes he mentions earlier (reduce kid ads, change the nature of kid food served in restaurants, etc.), but recognizes that companies won’t do things that affect their bottom line. They are, after all, for profit and their shareholders expect profits. The author also suggests that even corporate America, recognizing that incentivizing health among employees means a better bottom line, tip toes between suggestions of lifestyle change and mandating change.
My comment: I would kill to work for a company that has an onsite gym or helps me to pay for gym membership, that offers healthier cafeteria food, that incentivizes my efforts to be healthy. I have looked at the statistics of employees lucky enough to have these “gifts” and that actually utilize these offerings, and the numbers are dismal. Frankly, that pisses me off.
Callahan then gets to the sensitive discussion of children. He notes that “to help the children means winning (over) the parents.” We are modifying school food, but kids spend most of their waking hours at home (if you include the weekends).
My comments: And right now government can’t mandate limits on TV and video gaming time in the home, nor demand “x’ number of exercise hours a month, nor require that water and skim milk be the beverages of choice in the home (my words, not Callahans). Despite the fact that once obesity entrenches in the childhood or teenage years it is likely to become a lifelong disease, parents still rule the roost. So though I would offer that if a parent knows better and perpetuates running their home in a manner that likely results in fat, unhealthy children, it should be called parental abuse, I am part of the minority. Please remember, I was a fat kid and my parents were educated and knew better, and still I had to go it alone at age 16, so frankly I get to assess parents and the home situation, this way.
So now we come to the very controversial suggestion by Callahan. He offers that somehow we need to get the message through, loud and clear, that obesity is not just a personal problem, it is a national problem. It is contributing to rising health costs that everyone bears. It is a disease that causes other lethal diseases and shortens lives. So part of the solution requires a “popular uprising to help force change.” Just maybe that popular uprising needs to mirror the approach when society finally decided that smoking hurts all of us. And that model included shaming the smoker because he (or she) is “costing us money, polluting the air, hurting us secondarily, causing health care costs and workplace costs to rise unreasonably." Shaming and stigmatization typically targets one’s character, but in the case of smoking, people were really talking about the habit of smoking, and not the person. Stigmatizing an obese person really goes after the internal self of the person, not just the person's habits. And it can ultimately lead to discrimination in many life sectors – job, healthcare, education. It insinuates that the person is: lazy, unattractive, lacks discipline, is weak, sloppy, insecure. Callahan suggests there is a way around that by simply asking the person certain questions that will lead him (her) to self-evaluate. They include:
- Are you pleased with the way you look?
- Are you happy that the excess weight makes ordinary activities harder?
- Would you like to reduce your risk of or obvious health conditions associated with your weight?
- Are you pleased with the fact that your kids have to deal with bullying?
- Fair or not, are you aware that most people look down on you and discriminate against you because you are fat?
Callahan references a book that suggests that there is a place for “libertarian paternalism,” which essentially means, nudging you into behaviors because you will be better off if you see the light. He believes there are people out there who need to be shocked into reality, especially those who really have convinced themselves that their weight is just fine, when it’s not. He calls it empowering the individual, despite the fact that many will call it shaming the individual.
My comment: I will merely ask, what do you think?
Published On: January 27, 2013