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.

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