Is your weight the result of your choices? Most people think it is. What if this belief was wrong?
In 1993, the new statistics on obesity in America sent one of my medical school professors into a rant that took up two weeks of class time. He felt we needed to hear the full story of why people gained weight. Ironically, once we got through the jargon, the top researchers' ideas he shared with us were a bit of a yawn. Here is a one line summary:
Obesity is increasing because of poor choices in diet and activity.
Not very surprising, but is it true? Our current public health messages still stem from this belief. Eat this not that. Move more. The way that we stigmatize and judge those who are heavy also come from this belief. Most of us feel that if people really wanted to change, they just need to try a little harder.
This belief is also the reason behind the social isolation and emotional pain known by many who feel too heavy. When you are in this you are left feeling that you must not be good enough to change themselves. I know because I've been there.
As worked up as my professor was back in 1993, I can only imagine how he would have been if he knew what was coming. Back in 1990, the first American State went above 15 percent adult obesity. Today, just a few decades later, there are no states below 20 percent obesity. 1
If it is about choices, why are more people than ever before apparently making bad ones? There are two common answers to this question. The first answer blames the food industry for making addictive foods and filling our 'food environments' with them. The second one places the blame on the individual without ever explaining why so many more are now affected. Is either view right?
To answer this, it is important to make a distinction between one individual's weight gain and a population's weight gain. To look at individual weight gain, let's take an imaginary person named John. Let's say John decided he wanted to get fat. If John added 1 gallon of ice cream on top of his current diet and never left the couch, he would gain weight. So far the choice theory of obesity seems to fit.
The population is where the theory falls apart. If weight gain started in the early 1990s, and if poor choices were to blame, we should expect the populations which could not choose their diets would not have gained weight. Imagine if a group of chimpanzees as they ultimate control group. Even if you believe chimps could make poor food choices, lets say their food was carefully measured each day and their activity levels were also monitored. Would you expect these chimps to gain weight in such a situation?
This actually was a real study. From 1990 to 2010 chimps in settings just like this gained over 30 percent per decade. During this time frame over 20,000 other animals have also had unprecedented weight gain.2 One of the researchers from this paper summed up the conclusions quite clearly:
"The claim that obesity is a disease of willpower is now completely unsupportable."
As a society, we need to really hear this message and we need to use it to update our beliefs about obesity. When I start to judge either myself for struggling to make the best choices or someone else for the choices they appear to be making, I try to remember the chimps.
As bad as this epidemic has been for the last few decades, unfortunately it looks like it is just getting started. By 2030 it is expected that most adults on the planet will be either overweight, obese or very obese.3
In these coming decades we are projected to lose 120,000,000 lives to obesity.4 This is more than 3 times as many soldiers killed in all wars worldwide since 1900 combined.5 We are also expecting to need over 47 trillion dollars to manage diseases related to obesity.6 This is over 10 times above the current global healthcare budget.7
We need to get this right. I wish the solution was as simple as eradicating processed foods or goading people into 'trying harder.' It is not.
To solve this crisis, we first let go of the lie that obesity is a matter of choice. That lie is wrong, it is hurtful, and it distracts us from real solutions.
1. Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. The American Journal of Preventive Medicine. 2012;42(6):563-570.
2. Klimentidis YC, Beasley TM, et al."Canaries in the coal mine: a cross-species analysis of the plurality of obesity epidemics." Proc Biol Sci 278(1712):1626-32. doi: 10.1098/rspb.2010.1890.
3. Finkelstein EA, Khavjou OA, et al. Obesity and Severe Obesity Forecasts Through 2030. American Journal of Preventive Medicine. 42:6. Pp 563-570. June 2012.
4. WHO Media Center Fact Sheet. Overweight and Obesity. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 10/26/14. Note: current death rate is 3.4 million/year projected to double by 2030.
5. Zbigniew Brzezinski, Out of Control: Global Turmoil on the Eve of the Twenty-first Century (1993).
6. Harvard School of Public Health. The Global Economic Burden of Non-communicable Diseases. Accessed 10/26/14.
7. WHO Media Center Fact Sheet. Spending on Health: a Global Overview. http://www.who.int/mediacentre/factsheets/fs319/en/. Accessed 10/26/14.