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Personal willpower not to blame for obesity
This is partly what I was trying to get at in The Epic Thread. So much of how our society is structured deserves some blame.
And of course the restaurant and food lobbies have already weighed in on this report siding with the "food nannies".
(Reuters) - America's obesity epidemic is so deeply rooted that it will take dramatic and systemic measures - from overhauling farm policies and zoning laws to, possibly, introducing a soda tax - to fix it, the influential Institute of Medicine said on Tuesday.
In an ambitious 478-page report, the IOM refutes the idea that obesity is largely the result of a lack of willpower on the part of individuals. Instead, it embraces policy proposals that have met with stiff resistance from the food industry and lawmakers, arguing that multiple strategies will be needed to make the U.S. environment less "obesogenic."
The IOM, part of the Washington-based National Academies, offers advice to the government and others on health issues. Its report was released at the Weight of the Nation conference, a three-day meeting hosted by the U.S. Centers for Disease Control and Prevention. Cable channel HBO will air a documentary of the same name next week.
"People have heard the advice to eat less and move more for years, and during that time a large number of Americans have become obese," IOM committee member Shiriki Kumanyika of the University of Pennsylvania School of Medicine told Reuters. "That advice will never be out of date. But when you see the increase in obesity you ask, what changed? And the answer is, the environment. The average person cannot maintain a healthy weight in this obesity-promoting environment."
Shortly after the report was released, the Center for Consumer Freedom, which is funded by restaurant, food and other industries, condemned the IOM as joining forces with the nation's "food nannies." The Center said the IOM recommendations would "actively reduce the number of choices Americans have when they sit down to eat" and emphasized that "personal responsibility" alone was to blame for the obesity epidemic.
A study funded by the CDC and released on Monday projected that by 2030, 42 percent of American adults will be obese, compared to 34 percent now, and 11 percent will be severely obese, compared to the current 6 percent.
Another one-third of American adults are overweight, and one-third of children aged 2 to 19 are overweight or obese. Obesity is defined as having a body mass index - a measure of height to weight - of 30 or greater. Overweight means a BMI of 25 to 29.9.
Officials at the IOM and CDC are trying to address the societal factors that led the percentage of obese adults to more than double since 1980, when 15 percent were in that category. Among children, it has soared to 17 percent from 5 percent in the past 30 years. One reason: in 1977, children 2 to 18 consumed an average of 1,842 calories per day. By 2006, that had climbed to 2,022.
Obesity is responsible for an additional $190 billion a year in healthcare costs, or one-fifth of all healthcare spending, Reuters reported last month, plus billions more in higher health insurance premiums, lost productivity and absenteeism.
NO MAGIC BULLET
The IOM panel included members from academia, government, and the private sector. It scrutinized some 800 programs and interventions to identify those that can significantly reduce the incidence of obesity within 10 years.
"There has been a tendency to look for a single solution, like putting a big tax on soda or banning marketing (of unhealthy food) to children," panel chairman Dan Glickman, a senior fellow of the Bipartisan Policy Center and a former secretary of the Department of Agriculture, told Reuters. "What this report says is this is not a one-solution problem."
The panel identifies taxing sugar-sweetened beverages as a "potential action," noting that "their link to obesity is stronger than that observed for any other food or beverage."
A 2011 study estimated that a penny-per-ounce tax could reduce per capita consumption by 24 percent. As a Reuters report described last month, vigorous lobbying by the soda industry crushed recent efforts to impose such a tax in several states, including New York.
"I do not think in any way, shape or form that such punitive measures will change behaviors," said Rhona Applebaum, Coca-Cola Co.'s chief scientific and regulatory officer, in advance of the report. Anyone deterred by the tax from buying sweetened soda, she said, will replace those calories with something else.
The IOM committee also grappled with one of the third rails of American politics: farm policy. Price-support programs for wheat, cotton and other commodity crops prohibit participating farmers from planting fruits and vegetables on land enrolled in those programs. Partly as a result, U.S. farms do not produce enough fresh produce for all Americans to eat the recommended amounts, and the IOM panel calls for removing that ban.
The committee did not endorse the call by food activist Michael Pollan and others to eliminate farm subsidies that make high-fructose corn syrup, partially hydrogenated vegetable oils and other obesity-promoting foods very cheap. "There is no evidence subsidies contribute to obesity," said Glickman.
THE TRUE LACK OF CHOICE
The traditional view that blames obesity on a failure of personal responsibility and individual willpower "has been used as the basis for resisting government efforts - legislative and regulatory - to address the problem," says the report. But the IOM panel argues that people cannot truly exercise "personal choice" because their options are severely limited, and "biased toward the unhealthy end of the continuum."
For instance, a lack of sidewalks makes it impossible to safely walk to work, school or even neighbors' homes in many communities. So while 20 percent of trips between school and home among kids 5 to 15 were on foot in 1977, that figure had dropped to 12.5 percent by 2001.
The panel recommended tax incentives for developers to build sidewalks and trails in new housing developments, zoning changes to require pedestrian access and policies to promote bicycle commuting. Flexible financing, and streamlined permitting or tax credits could be used as encouragement.
The IOM report also calls for making schools the focus of anti-obesity efforts, since preventing obesity at a young age is easier than reversing it. According to the most recent data, only 4 percent of elementary schools, 8 percent of middle schools and 2 percent of high schools provided daily physical education for all students.
The IOM report recommends requiring primary and secondary schools to have at least 60 minutes of physical education and activity each day. It calls for banning sugar-sweetened drinks in schools and making drinking water freely available.
The report also urges that healthy food and drinks be easily available everywhere Americans eat, from shopping centers to sports facilities and chain restaurants. The idea is that more people will eat healthier if little active choice is needed.
"We've taken fat and sugar, put it in everything everywhere, and made it socially acceptable to eat all the time," David Kessler, former head of the U.S. Food and Drug Administration, told Reuters. He was not part of the IOM panel.
"We're living in a food carnival, constantly bombarded by food cues, almost all of them unhealthy," Kessler said.
Experience has shown that when businesses offer consumers a full range of choices - and especially when the healthy option is the default - many customers will opt for salads over deep-fried everything.
Walt Disney Co., for instance, found more than 50 percent of customers accepted a healthier choice of foods introduced at its theme parks. And last summer, fast-food giant McDonald's Corp said it would include apples, fewer fries, and 20 percent fewer calories in the most popular Happy Meals for kids.
The IOM report urges employers and insurers to do more to combat obesity. UnitedHealth Group offers a health insurance plan in which a $5,000 yearly deductible can be reduced to $1,000 if a person is not obese and does not smoke. Some employers provide discounts on premiums for completing weight-loss programs.
Such inducements are far from universal, however. The government-run Medicaid healthcare program for the poor and disabled does not cover weight-loss programs in many states. And as of 2008, only 28 percent of full-time workers in the private sector and 54 percent in government had access to wellness programs.
Re: Personal willpower not to blame for obesity
I have hope for this thread. That is all for now.
ETA: I actually read the article, and I fully agree with a soda tax. One of the reasons smoking rates have declined so sharply in the last thirty years is because smoking is super expensive. Interestingly, one of the reasons we are fatter today is because we're not smoking anymore...
I guess we replaced smoking with snacking. Instead of smoking in cars, elevators, work, parties, sitting in front of the tv, etc. we're now using those occasions to eat and kids can participate in this snacking round the clock behavior as well.
I wonder how much weight this IOM report carries. They're right on but how much more power do the food/agriculture industries have? That's what it comes down to every time.
For a while I've been thinking that big Ag/food should just battle it out directly with health insurance companies.The gov't bows down to them at the end of the day so just take them out of the equation. The only thing we need gov't to do is to make sure either Ag/food or the health insurance companies are going to foot the bill for the mess.
Since I've been checked out for a semester or more, I must have missed a lot of Fat Tuesday posts! I'm not surprised by the findings of this report at all. I'm lukewarm on a soda tax, although it would be nice if it were earmarked to support healthy eating initiatives if it were put in place. Working in an emergency room over the last year, I have seen that the lowest income people often are the heaviest, though, so I'm not sure how much the tax would discourage consumption. Anecdotally (and I believe it is confirmed by statistical evidence), they are also far and away the largest group of smokers, despite the horrendous cost of cigarettes nowadays.
Just one personal point that I have learned over the last year: during nursing school I worked some shifts on a bariatric post-op floor to get some experience. Some patients there told me that their experience being obese is that they have gotten less respect than drug addicts or alcoholics. That's sad and wrong, and until we as a society take a more respectful tone about the discussion, I don't think we'll get anywhere.
I skimmed the article again, and while I agree with the points it makes, there are several things standing in the way of some of it's recommendations.
My community is launching an initiative this summer to look at all the pedestrian infrastructure in the city. This includes identifying missing sidewalks, and repairing sidewalks that are in disrepair/unpassable. The *only* reason this initiative is happening is because the community as a whole decided to raise taxes for special projects such as this. Developers contributing to the reconstruction is part of it, but in no way does it cover all that needs to be constructed.
The same goes to schools requiring 60 min of PE. Many of those programs were cut due to lack of budget. If you require schools to implement them again without raises taxes/providing more funds, something else equally important has to be slashed.
Even though the economy is improving slightly, there's no way that communities will be able to implement the changes for at least another decade. Maybe even longer if the trend continues where people don't want to contribute money towards taxes. So again, we're left with a lot of talk and handwringing about what can be done, with the insistence that we're not going to pay more to actually help fix the problem.
Exactly. Infrastructure takes time and we don't necessarily have the luxury of time on our side here. An immediate first step would be to end the ban on produce growth on the farmlands where the ban is in effect. Will our collective weight be shed through this one move? No, but it's a step in the right direction and really, more produce for all of us can't possibly be a bad thing.
<a href="http://www.thenest.com/?utm_source=ticker&utm_medium=HTML&utm_campaign=tickers" title="Home DThe one thing I disagree with is physical education in schools. I think this is a waste of time and money. First of all, exercise isn't really going to help these kids lose weight - how many calories can you possibly burn in gym class? Second, PE classes are generally 10 minutes of activity and 40 minutes of getting changed, calling roll, setting things up, etc. Thirdly, PE generally sucks. It doesn't exactly instill a lifelong lesson of enjoying physical activity. I know few people who look back fondly on PE class, let alone people who credit it with setting them up for a healthy lifestyle.
I do think that it is crucial to have recess in elementary schools, though, and let kids be active in a free, fun way. Children are not meant to sit at desks for 8 hours a day. Neither are adults, for that matter. Sitting still for hours at a time is terrible for your health, no matter how much exercise you do the rest of the day.
And none of this matters if we aren't changing our society so that children and adults can be active outside of school.
Oh, crap. I have a mysterious subscription to Martha Stewart Living (seriously, I don't remember signing up for it) and if the strawberry shortcake on this month's cover had been real and on my table last night, I would have eaten most of it. Om nom nom.
Nope, it's absolutely your fault that you ate all the cake. It's not your fault that eating the damn thing has become a socially acceptable, often encouraged and sometimes presented as a cute brag-plaint worthy activity that only encourages a pattern of extream over eating, an overtly sedentary lifestyle, and addiction to overly refined foods and chemicals.
Its still on you to stop eating all the cake and to go for a walk. But it would be a whole hell of a lot easier to do so with some help from the rest of the country.
Thank you. I can get behind this sentiment.
And I'm all about respecting people who struggle with weight and/or obesity. But I think one aspect of respecting someone is empowering them - not shaming them, but rather ingraining in them their own power and onus to do whatever they can to better their situation, even in spite of societal influences which would make that more difficult.
I have mixed feelings on some of this. I think the trends toward unhealthy eating and lifestyle are based in large part on demand. A couple of years ago we moved to a new town, and live within walking distance of restaurants, banks, the post office, grocery story, etc. The neighborhood is extremely pedestrian friendly. Our neighbors have started light-heartedly joking about us because they see us walking so much...because virtually none of them go anywhere without driving. We've asked a few why: sure, it's only a 15 minute walk, but it's a 2 minute drive. Some of these folks are avid runners, so it's not like they are lazy, they just have compartmentalized where they have to do their errands as fast as possible in order to have time for other things (including, which blows my mind, exercise).
I think the issue of time plays into food choices, also. (Anecdote alert!) I don't know a ton of people who cook entire meals without some use of processed convenience food anymore, and it's not because they don't want to be healthy, it's because they just don't feel it's worth the time or they just don't have the time.
I agree that subsidies can and should be adjusted to give an advantage to healthier options, but other than that I've been starting to think lately that this issue is part of an overall cultural phenomena where convenience and time are highly prioritized, and I'm not sure how that can be addressed.
I def. support the soda tax and maybe an additional tax on additive sugar and HFCS in products. Neighborhoods need sidewalks but I'm not sure how much their existence alone will change people's behavior now that they're used to living without them.
I still maintain that the biggest obstacle to lowering obesity rates has to do with the increasing number of hours that many (maybe even most?) Americans work at sedentary jobs. People need more time to exercise/be active and cook healthy meals. Yes, many people find the time now even while working 50+ hours a week but sometimes the effort to do so can seem heraclean. I don't know how on earth you could encourage such a thing though, esp. in our troubled economy.
I think this sums up the issue really well. Yes, we all need to take responsibility for ourselves, but certain environments are more conducive to that.
I did have trouble with this part of the article:
Why should we be subsidizing corn syrup and then taxing consumers for purchasing it? I want to know more about where they got their numbers. If taxing soda would decrease consumption, then why would we not get a similar result from simply ending the subsidies that make corn syrup so cheap in the first place? I have no doubt that cheap, widely available soda has contributed to obesity in this country; I know for sure that it contributed to mine. But doesn't a soda tax without a repeal of corn subsidies just result in a transfer of wealth from the consumers to Big Ag? That seems like a backwards, punitive approach, not a preventive one.
I think this sums up the issue really well. Yes, we all need to take responsibility for ourselves, but certain environments are more conducive to that.
I did have trouble with this part of the article:
Why should we be subsidizing corn syrup and then taxing consumers for purchasing it? I want to know more about where they got their numbers. If taxing soda would decrease consumption, then why would we not get a similar result from simply ending the subsidies that make corn syrup so cheap in the first place? I have no doubt that cheap, widely available soda has contributed to obesity in this country; I know for sure that it contributed to mine. But doesn't a soda tax without a repeal of corn subsidies just result in a transfer of wealth from the consumers to Big Ag? That seems like a backwards, punitive approach, not a preventive one.
I do agree to a point however I truly still feel that a good % of the people this article is referencing know better and just choose to use numbers like these as an excuse.
Maybe that is what you are both saying above.
In my opinion, I do feel lack of education and finances definitely play a role but that is not the case for the sector I'm referencing. They are educated, wealthy, and fat.
In those cases, it is 100% lack of good choices in regards to food and lack of exercise completely.
Lazy. This may be where it goes back to fat now being socially acceptable to a degree as was mentioned above.
They can be lazy and fat (as a result of lazy) because no one is going to say anything to them.
It is disheartening especially watching it flow down to the younger generations. The other night I watched a 3 year old drink soda and almost bit my tongue in half trying not to educate about good choices.
I agree with you. While I recognize societal impact on obesity rates, you still have to include the onus that is on each individual person to make their own efforts to not jeopardize their own health by becoming overweight. That's why I referenced empowering vs. shaming... it is a personal issue for those who struggle with it, so the second you bring it up they feel like a big judgy finger is pointing at them while someone yells, "FATTY!" And it's HARD as hell to lose that much weight. But it does in fact come back to basic choice as much as you have power over your food purchases/intake and activity levels.
ETA: Obvious exception is if a person has a medical condition that severely hampers or altogether bars their ability to control their weight.
What would be a better work day alternative?
I would like to know how/why some of you think it's now socially acceptable to be fat/overweight/obese?
Is it because we have trendy clothes to wear? Because I'm just not following.
And because a valid discussion is going over on MM right this second, I'll add that the 8+ hour workday issue mentioned above contributes beyond just being chained to your desk.
Negotiating workout time with your spouse, partner (just not in NC), significant other etc. can be a challenge as well.
At the end of the day though, I still feel we are all responsible for making it happen.
10am - 3pm
No joke. I guarantee you more work would get done and people would be a LOT happier.
Like with the battle over Obamacare which actually funnels a whole bunch of money to insurance co's and makes instant customers for them, the ins. co's still had to pretend to have their panties in a wad like a bunch of spoiled brats. I think that's the same thing going on here. They know people are addicted to soda and other junk and they'll make up their 24% loss elsewhere so long as they don't lose their raw material subsidies. They're used to getting away with large scale theft like the banks so they have to complain a li'l bit I guess.
As long as the foundation of the American diet rests on these subsidized materials (rather than produce and/or responsibly farmed animal products), then we'll stay placated by all of our easy, cheap food. Politicians know we'd be pretty pissed if the cost of squishy bread, potato chips, frosted flakes, ground hamburger and boston creme pie yogurt shot up suddenly and they would without subsidies to Big Ag. That sort of thing leads to serious unrest. They want us fat, slow and apathetic.
All this right here.
Except that when you eat all the cake and someone says, "G*d damn, you ate all that cake? That's not good for you and will make you fat," everyone gets all up in arms and clamors for it to be more socially acceptable because sometimes you have a metabolic disorder that causes you to need the cake or a genetic predisposition to eating cake, so why is it NOT socially acceptable, because fat people are people too, damn it.
You can't have it both ways.
Updated September 2012.
One thing that was nice about my mom being a teacher and getting home earlier was that dinner was served at 6 p.m. every day and we ate it at the table as a family. No TVs and all that.
On Saturdays things were played by ear, but on Sundays we ate breakfast and dinner at the table as a family.
I miss that.
ETA: This also meant that we got to play outside until it was time for dinner, we weren't up in the house watching TV etc.