Obesity in America (cont.)
In the presence of unhealthy but good tasting foods, introducing a few healthy options will probably make little difference. For example, putting water and juice into soft drink machines at schools is not likely to have an impact, because children already have those options and are selecting the soft drinks. More aggressive action is needed than to simply ask the food companies in a polite way to help solve the problem. The only way for the obesity problem to be solved is for people to eat less food and the food companies will make less money.
Moderator: Why is obesity such a problem in America?
Brownell: There are many factors that contribute to obesity. The most prominent is that people are exposed to what I call a toxic food environment. Calories are available as never before, unhealthy foods are pushed relentlessly by a powerful food industry, and even institutions that should protect citizens, like schools, contribute to the problem. Combine this with rapidly declining physical activity and we have a recipe for obesity. This is why I believe that the environment must be changed or else we will make no progress on the obesity problem.
Member: Don't you think that the government already has too much control on our personal lives? It's not so much what we eat that makes us obese, it's how we choose to overeat and not exercise that makes us that way. Do you really think that what is served in fast food places is really the government's business? The only thing they have the right to monitor in restaurants is the safe handling of food, nothing more as far as I am concerned. Fat is a good source of energy if you use it properly but it's the consumers who choose not to do that.
Brownell: You are absolutely right, except that the situation has spiraled out of control. As a nation, we rely on personal responsibility as the default solution to most problems. I favor this as the most attractive approach, but in some cases, personal responsibility is not solving the problem. Such is the case with tobacco, for example. We have decided as a nation that too many people die from tobacco-related diseases, hence we are not willing to simply rely on personal responsibility. Therefore, we protect our children from the tobacco companies, we impose high taxes on cigarettes, and we take other dramatic actions in order to address the problem.
You may believe differently than I do, but it seems to me we are approaching the point where obesity is having an impact on poor health, equivalent to that of smoking, and all signs are that the rates of the problem are increasing. So, we can sit by and hope for personal responsibility to resolve this problem. But my prediction is that this stance will leave us with the problem growing worse rather than better.
Member: Should we target the makers of fast food? It seems that calorie labeling on menu boards or something must be done!
Brownell: Fast foods are certainly part of the problem, but not the sole contributor to obesity. Snack foods, soft drinks, and even normal foods eaten in the home are a problem, because of high calorie levels and large portion sizes. That's why it does not make sense to target one food, one company, or one category of companies. Rather, large changes will be necessary in order to create an environment that makes it easy, rather than difficult, for people to eat a healthy diet, and for parents to raise healthy children. Right now, the environment makes it just about as difficult as possible for parents to encourage their children to eat a healthy diet. We owe our parents more, and we owe our children more.
Member: As a registered dietitian I have been looking at this issue a lot and a lot of research points to declining physical activity among kids as the primary issue related to childhood obesity. Calorie intake has remained relatively stable over recent years. So I hope we can focus more on physical activity as the solution.
Brownell: You are absolutely correct that physical activity is a major issue. The stable calorie values in the population get cited very often in the press and by people like the food companies who want the focus to be only on exercise. It is hard for me to believe, with the increasing amount of food available, and the large portion sizes, and the large increases in average body weight, that declining exercise is the only explanation for obesity. Therefore, I agree with you that physical activity must be considered and should be addressed aggressively, but I have very little confidence that addressing only activity and ignoring the food part will allow us to make much progress on the obesity problem. Thank you for pointing out the importance of activity. We need to work on both it and on food.
Moderator: What can parents do at this point to help their children become healthier eaters?
Brownell: Parents can do many things:
Member: Dr. Brownell, do you consider weight loss surgery as a ridiculous and very dangerous way of being a "tool for permanent weight loss"? I am a 39-year-old female and weigh 450 pounds, and was considering the surgery in the past, until I realized that it's nothing more than "controlled starvation." You still have to eat right and exercise, shouldn't we do that anyway without endangering our health? What are your thoughts/comments?