It is estimated that 44% of Americans will be obese by the year 2030. The AMA warns that increasing obesity rates will lead “to millions of additional cases of type 2 diabetes, stroke and coronary heart disease, as well as arthritis and hypertension. Billions of dollars will be wasted through lost economic productivity and skyrocketing medical costs.”
And yet, a funny thing is happening in consumer land – efforts to normalize obesity are gaining momentum via social media platforms. Take the “beauty comes in all sizes” ad for example. This was shared with me by an old grade school friend on Facebook. And while I can appreciate the sentiment that women of various genetic predispositions are beautiful, I stopped short at the idea that obesity itself was attractive. There is a growing movement among obese men and women to promote acceptance of their size, and if they win this argument they could substantially undermine efforts to help Americans become healthy and avoid disease. I know this sounds harsh, but to me, promoting beauty of all sizes – when that includes obesity- is tantamount to promoting a “smoking is cool” campaign.
Smoking rates in the United States have dropped from 42.4% in 1965 to 19% in 2010. Although one-in-five people still smoke, we have successfully reduced the smoking burden by more than half. The reasons for this reduction are complex, but they include public awareness campaigns regarding the harmfulness of cigarette smoking, increasing taxes on cigarettes, and public policy regarding where and when people can smoke in public.
The same exact approach can’t work for obesity because while people can simply quit smoking, we can’t quit eating. And what we eat is less important than how much we eat. I personally do not favor “fat taxes” on specific food items because almost any food could cause weight gain if consumed in large enough quantities. I also don’t favor singling out obese people for portion reduction at restaurants (this has actually been proposed), or other policies that are similar to what we’ve done with smoking in public spaces. Promoting prejudice against the obese is not constructive.
So that leaves us with public perception/education and peer pressure as our primary national strategy for reducing obesity rates. (Of course smaller initiatives can help: employers can incentivize weight loss and wellness, policy makers can encourage new housing developments that promote active lifestyles, and local groups and non-profits can promote fitness initiatives and healthy eating behaviors.)
My concern is that if too many people decide that normalizing obesity is better than fighting it, America will lose this battle. Obesity-related disease is already costing us about twice as much as smoking-related illnesses. And both smoking and obesity are nearly 100% avoidable.
Obesity is not beautiful, and we must redouble our efforts to win the hearts and minds of the public on this subject without resorting to the other extreme (idolizing anorexia). Good health lies somewhere in the middle – and keeping our middles within a reasonable range is the most important health goal we have.
The American Medical Association (AMA) voted today to endorse taxation of sugary beverages as a means to raise money for anti-obesity programs. Interestingly, a recent physician survey at Medpage Today suggests that only 50% of physicians think that a soda tax is an effective public health strategy.
I am one of the 50% who feels that this policy will not be effective. In short, this is why:
1. You can become obese by eating and drinking almost anything in excess. Targeting sugary beverages is reductio ad absurdum. Did America become fat simply because of an excess supply of sugary fluids on grocery shelves? What about the super-sizing of our food portions, the change in workforce physical requirements, the advent of cars, escalators, healthy food “deserts” in poor neighborhoods, video games, and cutting gym class from schools?
Holding Coca Cola, et al. responsible for our own over-consumption of calories is both unfair and tantamount to spitting into the wind – something bad is going to come back at us. Consumers can easily get around the soda tax by buying sweet alternatives – which may have even more calories than soda. (Caramel latte anyone?) And then what? Are we really going to play public policy, food and beverage whack-a-mole?
Carmelita Jeter's Shopping Cart
2. You can be thin and fit while eating and drinking almost anything. Obviously nutrition science has shown that a diet rich in fresh fruits and veggies, lean meats, low-fat dairy, whole grains, and healthy fats is the best for our health. However, please consider that the world’s fastest woman, Olympian Carmelita Jeter, eats Hostess cup cakes, Teddy Grahams, Welch’s grape juice, whole milk, and Gatorade. How do I know? Because she posted a photo of her shopping cart on Twitter (see image to the left). I obviously have no idea how much of this she eats – or when she eats it – but if the world’s fastest woman is powered (to some degree) by “Twinkies” then I think we should all think twice about demonizing certain foods/beverages in our anti-obesity fervor.
3. You can’t regulate good behavior. Human behaviors that may lead to obesity are simply too complex to regulate. Who would want to live in a world where government becomes the de facto “Nutrisystem” for its citizens, mailing out pre-packaged, ingredient-controlled meals to 312 million people per day, three times a day, seven days a week? While that may save the post office from its imminent demise, we can neither afford to do that, nor do we need to.
People who believe that policy should drive behavior point to smoking bans that have cut down on smoking rates. While I agree that small improvements have been made in reducing smoking rates, roughly one in four people still smoke (depending on your source, this number could be as low as one-in-five), and one in every five deaths is still attributed to cigarette smoking. Hardly a resounding victory, alas.
But beyond the fact that policy changes (and the billions we’ve spent enacting and enforcing them) have resulted in a disappointing decrease in smoking rates, is the issue that cigarettes and food ingredients (such as sugar) are not analogous substances. While there is no safe minimum amount of cigarette smoke, our bodies need salt, glucose, and fat to survive. They cannot be cut out of our diet completely – nor should they. And the only way to force people to optimize their intake is to enact Draconian measures.
So instead of starting a food-fight, it’s important to accept the complexities associated with this particular health scourge and promote a broader, more-nuanced approach to wellness incentives. We have to attack this problem from the ground up, because a top-down approach requires our government to become an invasive, food and exercise nanny.
The good news is that one-third of Americans are not overweight or obese, despite our current “toxic” food/inactive lifestyle environment. Perhaps these thinner folks can be ambassadors for the rest of us, and reveal their secrets of healthy living despite our current limitations. Even with our best efforts, we need to understand that (like smokers) we will always have a segment of the population that is overweight or obese.
And as for the Olympians among us – they help to illustrate that obsessing over every morsel of food or cup of soda that we consume is not the way forward. Sorry AMA, I’m with Carmelita on this one.
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Kim Jong Il: Of course we’re going to highlight the lowlights of the North Korean leader’s health: CNN has the scoop on the dictator’s cause of death and previous illnesses. Knight Science Journalism Tracker’s Paul Raeburn rounds up previous analyses of Kim Jong Il’s psychological profile.
Breast Cancer: Companies are trying to build a better mammogram as they compete for a bigger slice of the $6 billion-and-growing medical imaging market, Sierra Jiminez reports for Fortune. Nearly 300,000 American women have been diagnosed with breast cancer this year.
Health Reform: The U.S. Supreme Court will devote an unprecedented week of oral argument over health reform when Read more »
*This blog post was originally published at Reporting on Health - The Reporting on Health Daily Briefing*
Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones.
Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.
The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.
The idea behind whole-body vibration makes sense. Like walking, running, and other weight-bearing physical activities, whole-body vibration Read more »
*This blog post was originally published at Harvard Health Blog*
I live on the West Coast, where it is rare to see a smoker. Because it is not socially accepted, smokers are not out in the open. They lurk behind buildings to take a smoke break at work and I don’t even own an ashtray for friends because none of my friends smoke. But San Francisco isn’t the rest of America. In 2010 there were 45.5 million Americans who smoke, with men smoking more than women. Tobacco remains the single largest preventable cause of death and disease in the United States. Each year approximately 433,000 people die of smoking-related illness.
Here are some more stats on American adult smokers. The highest prevalence is American Indians/Alaska Natives (31.4%) followed by whites (21%). Smoking incidence decreases with increasing education and improved economics. By region, the Midwest has the most smokers in Oklahoma, Arkansas, Mississippi, Louisiana, Kentucky, Ohio and West Virginia (22-27%). That is huge.
California and Utah have the lowest percentage of adult smokers at Read more »
*This blog post was originally published at EverythingHealth*