Why are we not doing more to prevent obesity?

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In many ways, obesity is a very complex disease, and it’s likely to remain so for many years. You can always go deeper down the rabbit hole, regardless of whether you are researching fat cells, metabolism, eating psychology or socioeconomics. Researchers are usually very happy to do this, it’s what we trained for.

There comes a point, however, when new studies do not add very much to what is needed in order to bring about a certain outcome, such as prevention of obesity. It’s true that we need much more research, for example on obesity etiology, but do we really need more evidence to tell us that junk food and inequality/poverty (this latter risk factor only applies to countries that have already made the nutrition transition from natural food to junk food, such as Europe and North America) are major causal factors? I think not.

Indeed, we can and should act now to reduce both, and in so doing, we would very likely help to prevent new cases of obesity and probably many other diseases that are also linked to both risk factors, such as depression, arthritis, diabetes and heart disease.

Apart from getting rid of junk food and lowering rates of poverty, we should also be promoting healthy nutrition across the lifespan, where the food contains minimal quantities of pesticides, preservatives, sugar, salt, unhealthy fats, steroids, and antibiotics – just plain natural food, it’s simple. We should also be doing things like promoting physically active transport, and reducing sitting time at work and at home. Healthy eating and regular physical activity will not get rid of obesity, but they can probably go some way in lowering the obesity incidence rates at the very least.

And while messages to promote healthy eating and physical activity can be helpful, we have to be much more comprehensive in how we change the environment. Indeed, the food environment has become so toxic that it feels like we almost have to completely rethink how we produce food. Junk food simply has no place in a society where we value and place emphasis on prevention on chronic disease. Reducing poverty will also require much more than pretty messages, it requires major political decisions and pressure from voters. Bear in mind that the difference between the rich and the poor is at its widest in over 7 decades.

There will always be times when we have to do more research in order to understand more about a particular disease or problem, but if we are talking about obesity prevention, this is probably not that time. This is the time for action, like what is happening in Mexico (see my previous post), where they are successfully working to reduce their more or less catastrophic childhood obesity rates, for example by taxing soda, during very challenging conditions.

Actually, if there is one thing that we should do more research on, it would be to find out why we are not implementing much more serious obesity prevention programs and why we have let mega food corporations take over close to our entire food supply. And while we try to find answers to those two question, there is nothing stopping us from implementing healthy nutrition and physical activity habits for everyone, especially for children in socioeconomically challenged areas.

If you have an answer as to why we are not doing more to prevent obesity, I would love to hear from you. Please share.

Erik Hemmingsson

Some success with obesity prevention in Mexico

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This was a very interesting seminar on obesity prevention in Mexico. Mexico has once of the highest rates of obesity in both adults and children, and a very potent diabetes epidemic, including huge diabetes mortality. Prevention efforts are clearly a huge priority.

Simon Barquera: There is a very high obesity mortality in Mexico, much higher than in the US. The rates of obesity in children is also very high, almost 10%, and growing. In total, there is a 71% prevalence of overweight and obesity, probably getting close to saturation, but still growing. There is also a changing of phenotype with much more abdominal obesity, similar to elsewhere in the world. There has been a reduction in physical activity, but even greater changes in ultra-processed junk food, mainly soda (up 30% since 1997) and refined carbohydrates.

Juan Rivera: Mexico are exploring options to use taxes to combat obesity, including higher tax for junk food and sodas. Revenues can then be used for obesity prevention programs. Recommendations were to limit junk food and sodas in schools. Civil society proposed a 10% tax on sodas and 8% on junk food, and to mobilize public opinion in favour of the proposal. Preliminary data show a reduction in soda consumption and people buying more water instead. Food labelling has also changed to clearly show calorie content and sugars. More taxation may be needed to reduce junk food and soda intake further.

Alejandro Calvillo: Childhood obesity increased 40% between 1999-2006, more than any other country in the world. Initiatives to halt this trend concern marketing of junk food to children, including legal action against mega food corporations for misleading marketing, and improvement of the school food environment. There is a strong network of organizations that have worked with obesity prevention, including Greenpeace and Oxfam. Soda consumption is currently 50% higher than in the US and among the highest in the world, but has now dropped by 13%. There has been very strong resistance from industry along the way, but new policies and taxations are now in place.

We have been divided and conquered by Big Food

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Let’s face it: we have been divided and conquered by the food and beverage industry. It’s not pretty. In fact, they have been running circles around us, more or less unopposed on their way to almost gaining 100% control of what we eat and obviously making mega profits along the way. Most people probably never realized there was a match on. Sometime in the future, I am sure we will ask ourselves how we could let them get away with so much, just like we today are asking ourselves how we failed to control Big Tobacco.

http://authoritynutrition.com/big-food-is-much-worse-than-big-tobacco/

Here are some of the things they have been getting away with:

– loading our food with toxins, chemicals, preservatives, pesticides, antibiotics and steroids

– adding sugar, salt and fat to pretty much everything to make it more palatable and cover up any bad tastes

– specifically targeting children in their advertising

– increasingly producing “food” in factories without any natural ingredients or nutrients

– saying they want to be part of the solution, for example by reducing calories, but then doing the complete opposite

All of these changes have been very gradual so that no one would notice. Historically, we have been suckers for these slow changes. As an example of just how toxic our food environment has become, picture yourself time-travelling from the 1950:s, just before the rise of the junk/fast food industry, to today. You would be stunned at the amount of junk food on offer, and the brash and cynical marketing that accompanies it (think toys to children from the latest children’s movie, for example).

Now, thankfully, the tide appears to be turning. More and more people are waking up and not liking what they are being served or how mega food companies operate, and are starting to find more healthy and sustainable food sources or even growing their own. Crucially, consumers are also getting more and more connected and organized in fighting back, particularly in the US. This is where the fighting appears to be at its most fierce, since this is also where the food environment is worst.

We have to be mindful, however, of not falling for more of their classic divide and conquer tactics. One such example is when we as researchers try to link a particular junk food or beverage to a particular health outcome, such as obesity or depression. By just focusing on one adverse health outcome, and endlessly debating this, we are shooting ourselves in the foot and not getting anywhere. What we have to do is to analyze the total cost of junk food, including all known health problems and the negative effects on the environment (which are massive).

I doubt that we can count on politicians to solve this for us, this needs to come from the bottom up, i.e. consumer power. And once enough people get fired up and organized, then we will start to see real change happening, i.e. real food, packed with nutrition and grown in a truly sustainable way, available to everyone.

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How can we possibly prevent obesity when there is so much inequality?

Make no mistake about it: wealth inequality is one of the main drivers of health and disease generally. Inequality is strongly associated with outcomes such as obesity, depression, diabetes, cancer, heart disease, arthritis, etc. The list is very long.

Given that inequality is reaching new heights every day it seems, we have to ask ourselves how we can possibly hope to prevent obesity, and other major diseases, in the face of this massive inequality? Please watch this short and very informative video of how skew the distribution of wealth really is.

http://consciouslifenews.com/viral-video-us-wealth-inequality/#

If you have the time, you can also listen to self-confessed plutocrat Nick Hanauer talk about how the pitchforks will come out soon if this situation is not remedied.

Indeed, the situation in the US, the UK and elsewhere is not unlike the pre-revolution situation in France some 225-230 years ago. The good thing is that a financial crisis like we have today can act as a very powerful catalyst for replacing the current dysfunctional economy, that only works for the wealthy few, with something that allows everyone to thrive.

Because obesity mostly affects the poor, it is not surprising that the epidemic is doing so well, since more and more people are crossing the poverty line and the middle class is being squeezed. How would you react if you were below that poverty line, and you were being told to buy more vegetables and exercise more, when you are working 2-3 jobs just to stay alive and put food on the table, and not knowing if you are going to have any job next month or even next week?

If governments were really serious about preventing disease, they should first do their utmost to reduce wealth inequality. Only then will it be realistic to expect our prevention programs to have any kind of positive effect on the obesity epidemic.

Erik Hemmingsson

Bullying and obesity go hand in hand in so many ways

If you have any working experience in an obesity treatment facility you would be very familiar with the many gut-wrenching stories of bullying that the patients have experienced. A routine question to ask the patients is if they have any clue as to why they gained the extra weight to begin with. It’s not unusual to hear that it all started with the bullying, usually from a young age.

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You may think that this is mainly peer-to-peer, but it can definitely be from parents as well. Usually this would be related to something they perceive to be not quite right with the child, perhaps carrying a tiny, tiny amount of extra weight. The child will then be told that there is something wrong with them. Obviously this is not the case, it’s the parent who is wrong for instilling the child with an erroneous negative self-belief (there is something wrong with me).

And how many stories have we not heard about  the completely insensitive bullying athletics coach/PE teacher who thinks that the child is overweight and needs to lose weight ASAP, and who always picks these children last for the teams, et cetera, et cetera.

The message for these bullied children is unbelievably negative: you are not good enough, there is something wrong with you, nobody wants to be with you. It’s not exactly strange that the obese in general have lower self-esteem and confidence than normal weight individuals, both as children and as adults.

Then there is the more classic case of bullying among children, sometimes from pre-school, because of a lack of tolerance and respect for what looks slightly out of the norm, particularly give our completely unrealistic body shape ideals. More and more studies are now confirming all those anecdotes about the toxic effects of bullying:

http://www.ncbi.nlm.nih.gov/pubmed/25157018

Indeed, obese children are much more likely to suffer bullying than normal weight children, which is confirmed by both the children themselves and also the teachers. But this does not mean that the bullying only happens during the childhood years. Studies on obesity bias and discrimination are becoming much more common, for example by Rebecca Puhl and colleagues at Yale. Please take the time to watch some if not all of this excellent talk, for example on how stigmatization has a profoundly negative effect on our physical, social, psychological and emotional health and well-being:

If we are serious about preventing obesity, we cannot emphasize enough the importance of zero tolerance towards bullying, in whatever form it comes in, and regardless of where it comes from. We also need to address all those negative self-beliefs and fears that arise as a result of bullying. This include things like body dissatisfaction because we perceived our body as the reason the bullying started in the first place.

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I also firmly believe that anyone who wants to lose weight long-term needs to overcome their more or less inevitable body dissatisfaction, and connect in a more positive way with their bodies, as opposed to rejecting them and seeing them as the source of shame and discomfort. The more you have of negative thoughts and emotions in relation to your body, the more weight you are likely to trap. It’s not exactly a surprise that more and more studies are now confirming that bullying leads to weight gain, which leads to more bulling, which leads to more weight gain, which leads to more bullying…

Erik Hemmingsson

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