By Bill Bogart
On 15 October 2013, the New York Times carried an article on President Taft’s struggle with his corpulence many decades ago. This “massively obese” man pursued weight loss into his old age. But long-term shedding of pounds eluded him. Instead, his ceaseless efforts produced frustration and repeated cycles of loss and regain. Writer Gina Kolata suggests that there are many similarities between Taft’s battles with his obesity and the challenges of weight loss in contemporary societies. A point well made.
The statistics available regarding obese individuals and their battles to lose weight are sobering. Of those who can shed pounds something like 95% gain back the weight that has been lost (and sometimes even more) within five years. Yet countless numbers of individuals are caught up in such doomed struggles. Why?
First, the censure visited upon fat people by society. Many surveys document that the vast majority of obese people have been subjected to humiliating comments and treatments not only by strangers but also by friends and family.
Second, the real but exaggerated physical consequences of obesity. There is some relationship of weight to such aliments as heart disease, cancer, joint problems, and so forth. Yet such concerns are often overblown or insufficiently evidence-based. Take mortality rates: it has long been thought that any excess weight places a person at risk for dying prematurely. Yet research now indicates that moderately overweight individuals have the lowest mortality rates; thin people have higher ones. When people are very obese there is an elevated risk of mortality; the exact extent of it remains in dispute.
Third, the relentless marketing of a welter of products and programs by the diet and equipment industries. For example, the Himalayan Diet Breakthrough pills promise significant and rapid weight loss without diet or exercise.
There is no easy and straightforward way to surrender our collective obsession with fat, but some strategies may point the way. Regulation, when used properly, has a role in such efforts.
First, the prejudice against fat people needs to end. We need to accept individuals of many shapes and sizes; judging them by their qualifications and not their weight. To achieve such acceptance we may need to amend human rights legislation to protect the obese from discrimination.
Second, there should be more curiosity about the causes of obesity than just “calories in/calories out”. For example, we should follow the lead of the White House Task Force on Childhood Obesity in urging more examination of the impact of endocrine disrupting chemicals (EDCs) on the health of individuals and their weight.
Third, we need to shift the emphasis from weight loss (and even prevention of weight gain) to health. That change would prompt us to tax junk food and beverages (while assessing the actual effects of such measures) but also push us to subsidize healthier alternatives. That underwriting would specifically focus on the diets of the poor but go on to question the regulatory measures in place for the entire food system (a huge challenge). That change would encourage not just talk about physical activity but also concrete measures, through the tax system and otherwise, to promote a variety of exercises.
Fourth, we should discuss issues relating to weight in the larger context of “health equity”: the fair distribution of determinants of well being regardless of social or economic standing. Lower income children often eat fewer fruits and vegetables and are frequently less active. But, critically, ask why the lives of such kids are that way. Examine the distribution of supermarkets, the availability of transportation, the safety of neighborhoods, access to parks, and opportunities for recreation and other factors that bound the day to day existence of deprived children.
The foregoing make up a tall order. Progress is unlikely to be quick or easy. A great deal of effort, debate, and just plain trial and error will be necessary. Whatever the outcome, embracing these and related strategies is better than obsessing about calories, invoking extreme measures in the name of weight loss, and beating up on the “fatties”.
W.A. Bogart is the author of several books including Permit But Discourage: Regulating Excessive Consumption and Regulating Obesity?: Government, Society, and Questions of Health.