Practical Steps to Fight Obesity, Part I

Issues of public health, no matter how dire, can be a hard sell. Unless there's a dramatic angle to the story, few will get fired up by a nation's well being. It's not uncommon for an individual to find the altruistic impulse to help a person in need--there's a bit of a thrill, for example, in the guilty gesture of giving to the homeless--but the overall public health doesn't stir up the same generosity of spirit. With individuals focused on their own extra pounds, the people charged with drumming up support for the obesity epidemic, which shortens lifespans and is very costly to the government, have a tough time building any interest.

The successful public health campaigns in recent decades have gotten creative to generate enough buzz to try to make a difference. The dramatic attempts to shock kids out of drug use (this is your brain; this is your brain on drugs) or to horrify smokers with the medical effects of cigarettes (the public display of emphysematous lungs) elicit most often derision or outright mockery, certainly not the intended effect. Meanwhile, business advertising counterparts, trained in the coercive arts, something not taught in an MPH program, are much more effective in targeting their audience.

Appealing to the national zeitgeist of health at any moment is a challenge. The most effective strategy looks for a dramatic edge, most often the age-old battle of good vs. evil. With a natural enemy or corporate entity to blame, it's a lot easier to frame the solution and rally supporters. It's not hard to understand when the goal is to eliminate the root of the problem.

A systemic change in the way we as a society choose to live, willingly or not, poses a much harder dilemma for the public health rabble rouser. Changes to our food supply, the relentless pressure to be thin and the growing ranks of sedentary media consumers have created a tectonic shift in the public perception and reality of food and weight. A systemic change doesn't present a simple, black-and-white, good vs. evil message to hang the proverbial public health hat on, not when food and weight is on everyone's mind, from industry to the individual. There hasn't been a way to find consensus to galvanize the movement against obesity, not when the solution remains either elusive or incomplete.

Responsibility for the obesity epidemic ranges from business to government to medicine. But pinpointing causes does little more than instigate outrage and blame. Moreover, only information and action can disempower the entities that thrive on the aimless attempts to fight obesity. For future generations to be protected from the endless supply of food and concomitant weight gain, the public health outreach needs to inform the adults responsible to teach children and to connect to kids in novel, memorable ways.

For adults to listen, the campaign needs to present the stark contrast between the assumptions of the food and diet industry and the facts about food and weight. It's patently clear that diets don't work, yet, shockingly, dieting is still the only advice given by professionals and industry alike. That advice tends to come with either disdain for the obese person or with the faulty promise of a swift, magical cure. In other words, a public health advocate needs to debunk the myth of a quick solution to both the common and individual obesity epidemic and present the facts about food and obesity to adults. The caveat, and only reasonable fact the experts agree upon, is that moderation of food intake will lead to weight stabilization and moderate loss, with moderate health improvement. The public won't be eager to hear about lowered expectations, but accepting that reality can be a relief when presented as a true alternative to the diet and weight-obsessed lives that plague most people with obesity. Accepting slow change is worth the liberation from cyclic failure.

Winning over kids to the campaign is a much harder challenge but is essential to avoid passing the crisis down generation after generation. The power children wield in first world culture spurred the formidable advertising and marketing minds to win over the impulsive id of youth. Kids may not plunk down the money for said product but instead must generate enough of a fuss for parents to grudgingly buy the item--be it food, content, toy or electronic gadget--for a moment of peace. Clearly, business has spent significantly more creative energy to attract children than any anti-obesity program thus far. We can ply them with carrots galore, but it's the wont of childhood in this day and age to fight full bore until that candy bar is safely in hand. Add to this scenario the limitless supply of child-friendly content, including television, video games or apps, and a typical child's fate becomes clear: a calorie-dense diet and sedentary lifestyle has become the norm.

Parents may very well want to shape their children's lives into healthy ones, but the information available to do so is confusing and often contradictory. Parents pull blindly from the nutrition cache and try unsuccessfully to replace white bread with veggies and dessert with fruit. They sign their voracious reader up for every sport. The specter of obesity haunts them enough to embrace any half-baked idea about a child's health. The decades of knowledge about child development and the wide and normal variability of a child's body type through childhood and adolescence remain ignored.

Parents need useful information to read and clear guidelines to follow. The basic dietary advice about healthy eating that has little effect on adults is even less effective for children. Given a child's limited, or more likely non-existent, desire to follow any food rules, the endeavor quickly feels hopeless. Just hand over a supersize bag of chips, turn on the TV and give up already. The next post will outline some of the key points to make the public education of children effective and and the important facts for parents to hold onto in order to save their kids from the obesity epidemic.


A New Public Health Approach to the Obesity Epidemic

The original public health problems pitted man against nature. Bacteria in unsanitary water causes chronic diarrhea. Iodine-fortified salt fixes goiters. These days first world public health issues are manmade. Without a common, uniting cause, human instinct leads the search for a villain to blame for the crisis and subsequently purge from society. It's the superhero approach to public health.

Sometimes that's easy. The big, bad tobacco industry played the villain well. It took a while to break down the marketing juggernaut, and the powerful nicotine addiction, but the end result was secure. Sometimes finding the villain is much harder. Who's the bad guy in the obesity problem? If you're an activist looking to stir the pot, who exactly are you fighting?

The obvious first culprit is the food industry and agribusiness. Taken broadly, these companies create processed food that's extremely tasty, inexpensive and minimally nutritious. It's been easy to target industry as the cause of the crisis and embrace the newest David vs. Goliath battle. There's no doubt these companies haven't done society a service, but they're only a cog in the machine. Maybe the diet industry, which encourages a generation to await the newest miracle weight loss plan, is the evil villain. Playing on our deepest desire, its promises are patently false and only worsen the problem. Chronic dieting slows down individual and collective metabolism to a crawl and only leads to more weight gain in the end. Perhaps the fashion industry is most at fault by instilling the impossible goal of near-emaciation in generations of girls.

Even the academics themselves may just make things worse by peddling their solutions to the obesity crisis as if weight loss and maintenance couldn't be easier. The experts' insights into the causes of obesity are eye-opening, but every book ends with the same tired rhetoric. Let's all learn how to have "healthy" diets and exercise, and the obesity epidemic will miraculously disappear.

People who've turned to doctors for help know that the medical field can be implicated too. Internists blindly watch patient after patient fall into the same obesity cycle and scornfully shame each one saying, "Well, if you just eat less ... " Pediatricians hide behind BMI thresholds and ply meaningless suggestions to parents about cutting out extra ice cream or white pasta, as if simple food choice is the issue. And Bariatric surgeons reap financial rewards by mangling perfectly healthy gastrointestinal systems without any sense of the long term success or risk of these procedures.

And then government, regulators, journalists and chefs who do want to help don't know where to turn. The bland advice to eat more vegetables and less fast food, to move more and sit less, to cook more and have family meals is all sound but wholly ineffective. The growing number of desperate people fall into the hands of the powerful industries ready to capitalize with false hopes and dreams.

So whom do you fight? Who's the bad guy? What's the obvious target for a budding idealist? When all the facts are clear and the activists gather around the table to develop a plan, there is no real answer. The problem is systemic. The entire society lost its way with eating. There's no villain to be found. It's a new type of public health problem grounded in how we have chosen to live.

As of now, activists focus on the periphery, the tiny nibbles that won't really matter. Transparent food labeling in supermarkets and restaurant chains helps people know what they're eating even if it doesn't affect food choice. Banning large sodas might help some people decrease sugar intake. Increasing availability and affordability of Farmer's markets looks nice on paper. The slow shift to slightly larger fashion models certainly leads many to breathe a sigh of relief. But when a society expects availability of any food at any time, when the farming industry runs on the subsidized price of corn, when everything a population does is sedentary, when competitive dieting has become television fodder and replaced softball as the national office sport, the writing is on the wall. And a few political gimmicks won't do a thing.

The success of activism lies in its target. Effective public health campaigns have to focus on the future. All eyes on the obesity crisis have addressed the current obese. The paltry ideas of the experts are as ineffective as every diet on the market. The only choice with the current generation is to debunk the myths of a magic cure and encourage steady, sustainable diets with reasonable expectations of, at best, moderate weight loss and improved health.

The only real place for activism is for future generations. That means proactive programs to teach children a different way to eat. Kids may need to learn what balanced meals look like and feel like in their stomachs. They also need to know that food means sustenance, health and pleasure. Kids need the basic facts about how eating is critical to body function and to the success of our species. And then they need a crash course to understand the wholesale changes in how we eat and how we want to look in recent decades. They need to be aware of the endless ways our world can hijack their minds and bodies into food obsession and the obesity epidemic. The world of food might change in years to come, but children have to cope now with the delectable treats on every corner, the endless pressure to diet and lose weight and the confused adults around them unable to find their way. Activists can take a stance to create a smart public health program that offers an alternative to this current world of food and supplies real ammunition to fight the daily pressures to succumb to the starve/overeat cycle which inevitably leads to obesity.