Why Mozart In Shape

Who Will Beat Obesity?

There are many parties that could take some responsibility for responding to the problem of obesity, including central and local government, institutions such as schools and employers, charities and the voluntary sector, the corporate sector, and families and individual citizens. Given that the prevalence of obesity is expected to rise in the next few years, to bring about any large reduction in mean BMI might require very coercive measures that are unlikely to be politically acceptable. Thus, there is a risk that strategies that could potentially achieve a small decrease in obesity (or even a decrease in the rate of increase of obesity), and therefore benefit some people, might not be implemented by governments. An additional difficulty is that changes are likely to take many years to produce results because food and physical activity habits are deeply ingrained in social and individual patterns of behavior.

The notion of individual choice, responsibility and autonomy is especially difficult to apply in relation to obesity. There are barriers for people wishing to achieve behavior change.

To begin with, people’s personal behavior ‘choices’ are to a substantial degree shaped by their environment, which in turn is heavily influenced by local authorities and national government, industry and others. This may be because of constraints of affordability, accessibility, information, education and social or cultural background, or, as for children, because choices are made for them by others.

Secondly, many activities that appear to be voluntary are often an expression of rather unreflective habitual behavior, such as the types of food we buy or how we spend our leisure time. These deeply engrained habits are often difficult to change.

Thirdly, choices are frequently predetermined to some extent by the industries that manufacture the products people buy, the planners who design their built and work environments, and the advertisers who promote certain options over others. In this context the government has an important facilitatory role, for example through regulations on the types of product that may be marketed.

Fourthly, even for those with the means and knowledge to make choices, the abundance of options available means that making an optimal choice is difficult.

In many of these situations, people often adopt the ‘coping strategy’ of making a choice that is satisfactory to their taste rather than what is best for their health. Therefore, policies based on education, information and individual choice alone are not likely to succeed in reducing inequalities or reducing the prevalence of obesity in the population as a whole. With regard to implementing policies that aim at targetting interventions to treat or prevent obesity deliberately at specific groups, policy-makers would need to be sensitive to the risk of stigmatization, or of excluding those whose health is at risk, but who lie outside the target groups.

Numerous technological advancements in the 20th century have dramatically simplified our lives and have substituted high physical energy work with automation. This has lowered the price of food and lowered total daily expenditure of calories at home and at work.

In an agricultural or industrial society, work is strenuous; in effect, the worker is paid to exercise. The cost of not exercising through work can be dire. In a post-industrial and redistributive society, such as the US today, most work entails little exercise, and not working does not cause a reduction in weight, because food stamps and other welfare benefits are available.

As a result, people must pay to exercise, rather than be paid for it. The gym revolution and deliberate dieting efforts are compensations for the technological changes, but obesity is still on the rise due to those changes which caused a greater availability of calories and fewer calories to be expended through work.

Other technological changes, such as vacuum packing, improved preservatives, hydrogen-peroxide sterilization,stretch-wrap films, deep freezing and artificial flavors have enabled food to be cooked outside of the home and be stored for long periods of time. This has made such "fast" food more convenient and appealing to the consumer - contributing further to the problem of obesity.

The food industry is insisting that the problem doesn't lie with their foods, but with energy balance (ie. people need to expend more calories) and "informed choice". So who will actually beat obesity?

Government has traditionally been seen as the main promoter of health, but the intricacies of policy-making, regulation issues and engagement of the general public have pushed back government initiatives and made it an ineffective player.

The World Health Organization (WHO) has recently been putting forth a series of nonbinding actions that governments could undertake to address their own citizen's weight problems. However, the US, with backing from the powerful food lobby, so far is working to water down the proposals. These include restrictions on advertising, changes in labeling, increased taxes on junk food, and the elimination of sugar subsidies.

The situation in the field of health care and medicine is no better. A 2009 report shows that only 5-33% of physicians thought themselves competent in treating childhood obesity. In another survey of university-based residency programs, only 40% of these doctors knew the minimum BMI for diagnosing obesity, and 69% did not recognize waist circumference as a reasonable measure of obesity.

Children are caught in a particularly disadvantaged situation, as schools do not see themselves as responsible for defeating obesity. Though teachers acknowledge the seriousness of childhood obesity, both teachers and school principals oppose schools becoming "obesity treatment centers".

Leaving the anti-obesity effort to the family alone is not very effective, because most households in modern urban environment are exposed to numerous stress factors which increase the likelihood of obesity. A Swedish study demonstrated that the percentage of children with obesity rises with the number of domains in which psychological stress was experienced. Such stress is greatly increased with the death of marriage culture and an increase in divorce and illegitimacy.

The federal government will spend more than $1 billion this year on nutrition education. But an Associated Press review of scientific studies examining 57 of such program found mostly failure.

A recent evaluation of the 8-year, $7 million USDA program which reaches about 400,000 students in the LAUSD showed that the program simply didn't work. Kids who participated in the program ate no more fruits and vegetables than the kids who did not participate.

Doctors like Tom Robinson, who directs the Center for Health Weight at Lucile Packard Children's Hospital at Stanford University, say that studies of these programs are not needed. The research has already shown they don't work.

"I think the money could be better spent on programs that are more behaviorally oriented, as opposed to those that are educationally oriented, or studies that just describe the problem over and over again."

- Tom Robinson, MD.

Unfortunately, the US government has not been effective in setting realistic goals, or meeting them. A 2001 US. Surgeon General's report declared obesity a national health problem, and set a target for federal and state lawmakers and regulators to reduce children's obesity down to 5% by 2010. Children's obesity has instead grown to 18.4% today, among 4-year olds. This figure is much higher among adolescents.

Economic analytic reviews suggest that government intervention is necessary because the outcome of current market forces does not reflect true consumer preferences, due to information "blackout zones". Much of the public is unaware of healthy weight, and those who doubted weight as problem the most tended to score the lowest in diet and health knowledge.

Many researchers suggest that neither government regulations, public education nor revamped health insurance will fundamentally alter the technology-induced lower prices that may underlie the growth in overweight and obesity.

Obesity presents the nation with a wide array of health, economic, and productivity problems, but a lesser-known consequence of the epidemic is its effect on national security. In March of 2009, the Department of Defense reported that 1 in 5 military-age Americans is too fat to qualify for the armed services. Since 2005, the military has turned away 48,000 overweight recruits.

However, the problem is not limited to new recruits. According to a US military spokeswoman, 16% of active duty personnel are obese. The US. Navy reports that 62% of its members are overweight, and 17% are obese. The US Air Force reports that 55% of airmen are overweight, and nearly 12% are obese. Every year, between 3,000 and 5,000 enlisted members are forced to leave the military for being overweight.

A 2007 study estimated that the US military health care systems, TRICARE, spends $1.1 billion annually to treat overweight- and obesity-related diseases.

An increasing number of experts and authorities support aggressive measures directed against the fast-food industry similar to the campaign against tobacco. Due to lawmakers' efforts, the number of adults who smoke has fallen from 42.4% in 1965 to less than 20% in 2007. There are a number of effective methods that were used to fight smoking that could be easily adapted to the fight against obesity:

  • imposing excise or sales taxes on fattening food of little nutritional value
  • putting graphic, simple labels on the front of packaged foods showing their nutritional value in a form that consumers can easily understand and use
  • requiring restaurant chains to put simple nutrition information on the menu next to each listed item
  • banning advertising and limiting the marketing of fattening food

Obesity costs to society are an additional economic rationale for supporting the taxation of “junk foods.” Negative externalities (i.e., costs imposed from one set of parties onto another as a result of the former’s decisions) may occur from obese individuals onto individuals in the general populace in the form of increased premiums for health and disability insurance and Medicaid.

Twenty-four states have passed obesity liability laws. Proponents of these bills argue that the central issue is common sense and personal responsibility. Passage of the bills indicates a level of support for the view that obesity is an individual health issue. Supporters also endorse a 2004 Bush Administration statement that “food manufacturers and sellers should not be held liable for injury because of a person’s consumption of legal, unadulterated food and a person’s weight gain or obesity.”

According to the Yale Rudd Center for Food Policy and Obesity, 80% of consumers want easy to understand information on food such as calories, fat, saturated fat, trans fat and sodium content. However, only 4 states and 5 separate cities currently have laws that require the posting of nutritional information on menus and menu boards in restaurant chains. 14 other states and numerous local governments have followed suit and introduced legislation in 2009 require restaurants to post nutrition information.

However, some states pass anti-menu labeling legislation. On March 24, 2009 Gov. Jon Huntsman Jr. signed into law SB213, forbidding cities and counties in Utah from regulating the dissemination of nutritional information. The bill is supported by the Utah Restaurant Association, which claims that changing the menus could costs restaurants up to $18,000.

The 2006 School Health Policies and Programs Study (SHPPS) found that only 3.8% of elementary schools, 7.9% of middle schools, and 2.1% of high schools provided daily physical education or its equivalent (150 minutes per week in elementary schools; 225 minutes per week in middle schools and high schools) for the entire school year for students in all grades.

Many schools have eliminated or severely curtailed physical education (PE) in order to focus on academic subjects that students are tested on as part of the No Child Left Behind Act.

Not only are schools failing kids with their physical education policies, but child-care policies are also sub-par. Early childhood is an important period for developing dietary and physical activity behaviors, but no states provided specific nutrition standards or criteria for child-care facilities.

The National Association for Sport and Physical Education recommends that preschoolers accumulate at least 60 minutes daily of structured physical activity and at least 60 minutes per day of unstructured physical activity, and should not be sedentary for more than 60 minutes at a time except when sleeping. The American Academy of pediatrics recommends that TV time be limited to no more than 1-2 hours of quality programming per day for children over 2 years of age.

The majority of child and day-care centers to not meet these requirements.

In August of 2002, a group of overweight children in New York City filed a class action lawsuit against McDonald's Corporation seeking compensation for obesity related health problems, improved nutritional labeling of McDonald's products, and funding for a program to educate consumers about the dangers of fast-food. This litigation provoked an intense, mostly negative, response in the new media and the court of public opinion.

Yet, the case raises the important question of who ought to be held accountable for the economic and public health consequences of obesity. The courts have still maintained the philosophy of free choice; courts will not intervene to protect consumers from the ill consequences of their own decisions.

“The government should stay out of personal choices I make. . . my eating habits or yours don’t justify the government’s involvement in the kitchen,” writes Washington University economist Russell Roberts in 2002. Many others make the additional argument:

"From the nation’s Puritan start, Americans have considered health and wealth as marks of personal virtue. Many people work hard to maintain a healthy lifestyle, and they reap the benefits of their virtue: good health, better social lives, and additional happiness. The inevitable downside sees obesity (like smoking, heavy drinking, or poverty) as personal failures. Obese people have no one to blame but themselves."

Though obesity has many roots ranging from cultural phenomenons down to genetics, it is clear that a lasting solution to the epidemic must incorporate a cultural expectation of personal responsibility.