A Big Fat Crisis (3 page)
Authors: Deborah Cohen
Finally, the last section of the book offers concrete solutions, arguing that the most important and modifiable steps in the chain of
events that leads to obesity are at the point of purchase and the point of consumption—the supply side of the problem. I contend that we need regulations standardizing portion sizes in restaurants and laws prohibiting the sale of candy at all cash registers. We must demand that restaurants offer balanced meals as alternatives to the standard fare that increases our risk of chronic disease. We have to apply to unhealthy foods the kinds of regulations that have been successful in limiting alcohol consumption—a prohibition on “two for one” specials, for example, and limitations on “all you can eat” promotions.
Because some of my ideas may come across as overly intrusive or inordinately dismissive of the importance of personal responsibility, I describe several historical examples of even larger public health initiatives that were initially derided but eventually embraced. Two hundred years ago, for example, societies throughout the world had no regulations governing environmental conditions. The result was recurrent epidemics of infectious disease, including cholera, typhoid, tuberculosis, and gastroenteritis. At that time, prohibiting people from tossing garbage and human waste out the window and mandating indoor plumbing seemed like an invasion of privacy and an attack on individual rights. Prohibiting butchers from dumping animal carcasses and their entrails on the public streets was considered undue interference with private business. Implementing regulatory controls required long, contentious political battles. Now, because we recognize that integrated sewer systems and restrictions on dumping protect us from infectious disease and exposure to toxic chemicals, we find it hard to sympathize with those who resist these kinds of environmental regulations.
Like cholera and typhoid in the nineteenth century, obesity is the twenty-first century’s public health crisis. Our major approach of exhorting individuals to be more responsible is just not working. Ending obesity requires solutions that transcend individual behavior.
In the 2012 US presidential campaign, Bill Clinton summarized two perspectives on governance. He juxtaposed one philosophy, “We’re all in this together,” a view that indicates that as a society we must take steps to care for one another, with the diametrically opposite view, “You’re on your own,” which suggests that each person has to make his
or her own way in the world, without any special help or protections from an unfettered marketplace.
In my view, the reason we have the obesity epidemic is because we’ve been on our own for way too long. Change begins with a fresh perspective and a clearer vision of what we need to do. Let me take you on a journey through the obesity epidemic and show you how we can end it.
*
To meet the technical definition of “overweight,” the ratio of one’s weight to the square of one’s height (kilograms/meters
2
) must be equal to or greater than twenty-five but less than thirty. One is obese when the ratio is equal to or greater than thirty. For example, a five-foot-eight person who weighs more than 164 pounds is overweight; if that person weighed 197 pounds or greater, he would be classified as obese.
“After 6 months of diet success, I can’t control how much I eat. I am a 6’2” tall 19-year-old man. Since May 2008, I lost 50 lbs. from 210 lb to 160 lb. Now, in the last two weeks, I just can’t control how much I eat. Some days, it’s ~2000 calories and other days 4000. Because of that, I put on 10 lbs in two weeks. I am pretty much in depression right now. I can’t think about anything else. What is wrong with me?”
1
“I feel so out of control. I think I am doing good and then the cheetos call my name or a burger and fries from McDonald’s. I do not need this kind of food. I need healthy food, but there are days that I cannot help myself. Mostly when I am away from my family like when I am at work. I think of different things I can eat and it does not help that I work at a grocery store where I have access to all kinds of junk food and things. But you would think I would eat fruit or veggies at the store, but no not me I get in this kinda trance like state, thinking I am hungry and on the hunt for something that tastes good. I cannot seem to stop this.”
2
“I eat. A lot more than I should. I’ll just finish eating a meal, and suddenly, I want more, but I don’t want just any food. I crave junk food. I know that I should start to eat less and exercise more, but I can’t find the motivation. When I think about how unhealthy this is for my body, I just eat more. It’s gotten to the point where it’s hard for me to control. Please help.”
3
Struggling with obesity is not a rare, personal story—it is the problem of our time. More than 150 million Americans are overweight or obese, and across the globe an estimated 1.5 billion are affected.
4
One-quarter to one-third of all cancers can be attributed to obesity.
5
Being overweight and/or obese is also a strong risk factor for type 2 diabetes, heart disease, hypertension, joint and back pain, and a host of other medical problems.
6
The diseases associated with obesity cost our medical system an estimated $147 billion per year.
7
Even beyond the physical toll of obesity, the emotional pain makes this condition difficult to bear. Not only are overweight and obese people stigmatized by others, but those who struggle with their weight often stigmatize themselves—they feel inferior, ashamed, unhappy, and even depressed. One obese colleague told me that she felt like a blob; mortified by her condition, she started to withdraw from others. She and others like her believe their lack of self-control is an inherent character flaw they may never be able to overcome.
The perceived link between lack of self-discipline and obesity has become so strong that overweight or obese people are often judged as less competent than their thinner peers. US Surgeon General Regina Benjamin was initially criticized for being overweight. What credibility would a health expert have if she couldn’t practice a healthy lifestyle? When New Jersey Governor Chris Christie first began exploring a run for the presidency, his ample girth led many to question his fitness for office. To defuse the charge, he joked about his size by eating a doughnut on the
Late Show with David Letterman
. However, more recently, he admitted to getting LapBand surgery to help control his weight.
Yet the stereotypical view of obesity—that it is a marker of low self-control, deep character flaws, or serious psychopathology—is plain wrong. Yes, dozens of studies—some of which I will explore in the next chapter—show that overweight and obese adults have much more trouble resisting food than their thinner peers. Obese adults have more problems with self-regulation, they are more impulsive, they have higher levels of urgency, they lack perseverance, and they are more sensitive to rewards.
8
This is neither novel nor particularly helpful to the two-thirds of American adults who are already overweight or obese.
What is needed is an entirely new way to think about and frame
the obesity epidemic. We must recognize that an individual’s ability to resist overeating is limited when excess food is constantly available. Why else would so many people have trouble controlling their weight? If it was so easy to maintain a normal weight and everyone had the capacity, then logically, many more people would have a normal weight. Why suffer the stigma of being overweight? Why rack up chronic diseases that make us feel miserable and force us to take medications if we didn’t need to?
Everyone wants to believe that we all can accomplish whatever we want, if only we try hard enough. Unfortunately, no matter how hard many of us try, we cannot always achieve our goals. Most of us will never be movie stars, rock stars, prima ballerinas, astronauts, the president, or even president of our local parent-teacher organization.
That is because talent, skill, intelligence, and even self-control tend to be distributed across our population like a bell curve. Most of us are average, and by definition only 5 percent of us are at the top 5 percent of anything. We tend to think of a glass as half full rather than half empty, yet the sad truth is that half of us are below average. Although we expect to be treated equally by others and have equal rights under the law, our abilities are anything but equal.
More than that, each person’s abilities vary over time and across the day. In the morning some of us are fresh and energetic, but others get their best work done late at night. The point is that no matter how competent we are, there are days and times when all of us are less competent. Sometimes we feel happy or sad, and these feelings influence our behaviors too. We are not machines, and we do not perform the same way all the time. One quality we can count on is variability. Although some may seem to be able to navigate through the modern world effortlessly without putting on an extra ounce or missing a single day of exercise, this does not prove that everyone has the same capacity.
Because our moods and desires change throughout the day, many people claim their weight problem is the result of emotional eating. They say they eat when they are stressed, lonely, or anxious—whenever they are not at their best. Yet others claim they eat too much when they are happy.
Catherine Morgan, a writer, nurse, and mother, wrote this confession on her blog:
Are you an emotional eater? If it’s any consolation, you’re not alone. I have to confess. . . . I am an emotional eater. When I’m upset I eat. When I’m stressed I eat. When I’m worried I eat. And let’s be clear, these are the times I have uncontrollable urges to eat junk (candy, cookies, ice cream), all the stuff I know is bad for me. I could be eating healthy for months, then something upsets me, and it’s all over.
The crazy thing about being an emotional eater is that you know that eating isn’t going to make what you’re upset about any better, but you do it anyway. In fact, you know that eating the junk that you’re craving is actually going to contribute to making you feel worse, but you do it anyway.
9
When we have a problem, we usually find a plausible reason to explain it. We look to psychological explanations for our behaviors because we don’t have a way to see the big picture of what is really causing us to eat more than we need.
The conventional advice for those who suffer from “emotional eating” is first to recognize the triggers and then to find distractions to avoid eating. The medical website WebMD recommends the following alternatives to counter emotional eating impulses: “Read a good book or magazine or listen to music, go for a walk or jog, take a bubble bath, do deep breathing exercises, play cards or a board game, talk to a friend, do housework, laundry or yard work, wash the car, write a letter, or do any other pleasurable or necessary activity until the urge to eat passes.” The article continues: “If distraction doesn’t work, try relaxation exercises, meditation, or individual or group counseling.”
10
