Obesity epidemic? Everyone knows the “facts,” right? Do the following seem so obvious as to be boring?
• Obesity is a personal problem that individuals should solve on their own.
• A calorie is a calorie.
• Fat people just need to exercise more and eat less.
• It’s all a matter of personal responsibility.
If you nodded your head as you read these, the recent documentary “Fed Up” will dissuade you of all of these notions.
Being overweight or obese is indeed a personal problem, which I see daily in my family medicine practice, as patients suffer from diabetes, aching joints, sleep apnea and, too often for overweight children, from teasing. But, with 2/3 of adult Americans overweight or obese, and with more than 9 million obese adolescents, this is a major public health issue, responsible for more than 100,000 deaths and costing us billions of dollars every year.
Through interviews with luminaries in the field, “Fed Up” explains why all calories are not created equal.
Consider 160 calories: If you eat them as almonds, you will also get fiber and protein which slow their absorption. But, if you eat 160 calories of sugar, you gain no beneficial nutrients, and the rapid absorption of calories causes an excessive production of insulin which leads to weight gain. Sugar also activates the same areas of the brain as cocaine and creates addiction.
While exercise is important and beneficial for other reasons, people generally can’t exercise their way to weight loss. For instance, a 110-pound child would have to ride a bike for 75 minutes to burn off the calories from a 20-ounce soda. And simply eating less is not the answer. The quality of what is eaten must be improved.
Years ago, fat was considered the villain, and the marketplace was flooded with low-fat foods. Because eliminating fat compromised taste, low-fat foods were loaded with sugar and salt. Of the 600,000 food items in the United States, 80 percent contain added sugar. Many now consider sugar to be the primary culprit in contributing to obesity and diabetes.
So where does personal responsibility come in? I’m a big proponent of personal responsibility. If you are one of my patients, you’re probably tired of my exhortations to be more active and eat better.
But personal responsibility has a context. It’s hard to eat well in a food environment where practically everything you pick up has added sugar. Patients are constantly misled by thinking they have selected a healthy food when they have not. The most egregious example is “fruit snacks” which parents think bear some relationship to fruit. In fact, they are candy.
Encouraging someone to lose weight in our society is like telling your favorite alcoholic uncle to be sober and then confining him to a liquor store.
We need a culture that facilitates good choices, instead of creating obstacle courses to reach them.
To do that, we can look at the successes with tobacco. Once upon a time, not so long ago, smoking was ubiquitous and the tobacco industry minimized the risks of smoking. Through changes in public policy with smoke-free workplaces and buildings, restrictions on cigarette advertising, controls on sales to minors, and increased cigarettes taxes, the proportion of smokers has declined by more than 50 percent since the 1970s.
Now obesity and diabetes are competing with smoking as public health problems. The analogy is not perfect: the goal with smoking is to eliminate it whereas we have to eat. But we can eat better.
So here are some suggestions:
On a personal level:
• Cook at home, which can be cheaper than eating fast food.
• Cut out – or at least cut down on – sugar, including the hidden sugar in foods such as yogurt, baked goods and spaghetti sauce. (Look at the labels in your pantry. Really.)
On a public level:
• Support controlling advertising to children. They see an average of 10 food ads a day, 98 percent of which are for foods high in sugar and fat. Young children can’t distinguish between advertising and fact.
• Support elimination of junk foods in schools. We don’t expect children to read comic books in school. Why should they eat the equivalent?
• Support a tax on sodas, which would decrease their consumption – and could provide funds to address the consequences of obesity.
And, look forward to reaping the rewards of feeling better. Envision a world with fewer aching joints, sleepless nights from snoring and heartburn, heart attacks, strokes, finger-sticks, insulin injections, and multiple doctor visits due to diabetes.
It’s a vision worth realizing.