Obesity: Moving beyond willpower vs. the food-industrial complex

Marc Ambinder has written a terrific article on obesity for The Atlantic. It’s comprehensive and insightful, both objective and personal. Ambinder himself suffered from obesity until a year ago, when he went from 235 to 150 pounds following bariatric surgery. The operation immediately improved his severe diabetes, and within months it relieved years of suffering from sleep apnea.
The article includes explanations for the recent increase in obesity, observations on contempt for the obese (including “fat porn” TV shows), acknowledgement that weight loss is not simply a matter of will power, and an assessment of the political obstacles that make solving this important problem so difficult.

The article is quite long (over 7,500 words), as it needs to be to address such a complex issue. I’ve quoted below at length, hitting the high points, in hopes that a condensed account will motivate readers to consult the complete version.
First, a video that accompanies the article:

Obesity: Is it due to lack of willpower or environmental factors?

[T]he debate on how to deal with obesity remains frozen. On one side are the proponents of individual responsibility, who believe that fat people suffer from a surplus of self-indulgence and a shortage of willpower. On the other are people who believe that Americans are getting fatter because of powerful environmental factors like cheap corn, fast food, and unscrupulous advertising. Each side is held in political check by the other, and both have advocated unrealistic solutions: diets and exercise programs and miracle drugs that don’t work versus massive, and in many cases punitive, government interventions that are politically impossible.
If we are to solve the many problems that obesity is creating for American society, we must first move beyond the stale “willpower versus the food-industrial complex” debate. We need to understand what causes obesity, and what can really address it. And we need to try everything from rezoning fast-food restaurants and restricting food advertising to supporting new treatments and rewriting insurance policies. We won’t summon the collective will to take these steps until we recognize that our attitudes toward obesity are as unhealthy as the condition itself. We don’t want to look at fat people, much less pay for their medical care; we don’t want to be contaminated by them. But if we want fewer fat people in our midst, then we, as a nation, must start by treating them without condescension or contempt, and recognize the real obstacles that stand between them and better health.

The poor and their children are the most vulnerable

[M]ost fat people aren’t like me: as an upper-middle-class professional, I could draw on plenty of resources in my battle against weight. The people most vulnerable to obesity, however, do not have access to healthy food, to role models, to solid health-care and community infrastructures, to accurate information, to effective treatments, and even to the time necessary to change their relationship with food. And if that is true for fat adults, it is even more true for fat children, many of whose choices are made for them. Their vulnerability to obesity is much more the result of societal inequalities than of any character flaw. Indeed, for all the attention paid to fat’s economic costs, the epidemic’s toll on children is a stark reminder of its moral dimension. Without some form of intervention, researchers worry, large numbers of black and Hispanic children in the United States will grow up overweight or obese and lead shorter, less fulfilling lives. Is that a legacy we want to live with?

Why the recent increase in obesity?

Over the past two decades, as the U.S. economy shed manufacturing jobs, work has become more sedentary for many people; the decline in the real minimum wage and thus labor costs (which account for one-third of the cost of fast food) has made that Happy Meal even happier; and the pressures and distractions of modern life have driven us away from our hearths and off to T.G.I. Friday’s. The average American spends half of his or her food budget outside the home, and the concept of a “regular” mealtime–which correlates with healthful body weight–has been consigned to the dustbin of Nick at Nite sitcoms. … Portion sizes have increased at restaurants and at home. …
Food companies like to keep us happy, and they’ve figured out which molecular combinations make our mouths water. Cheaply manufactured, energy-dense, sugary and salty snacks now crowd our refrigerators and pantries. David Kessler, a former commissioner of the Food and Drug Administration, has written a book, The End of Overeating, that accuses the food industry of manipulating the levels of sugar, salt, and fats in food in order to create a neurochemical addiction. Over time, these “hyperpalatable” foods change our brain chemistry in ways that make us overeat. Other researchers have discovered that withholding sugar from rats seems to bring on symptoms similar to those produced by drug withdrawal. Food companies have also done their best to turn food into entertainment. … “It’s socially acceptable to eat at any time. That wasn’t the case four or five decades ago.” … over the past several decades, fresh-fruit and vegetable prices have risen significantly while prices for sugary processed foods have dropped. …
[J]ust being an American can naturally lead you to be obese: obesity is an almost inevitable consequence of living with our cultural norms, our history of agricultural production and subsidies, our long-standing socioeconomic inequalities, and the impact of technology on our behavior and bodies. Against this formidable dynamic, America has erected two lines of defense: name-calling, and hectoring about diet and exercise.

“Fat porn” and the ineffectiveness of diet and exercise

For the average fat person, life can be an endless chain of humiliating experiences. … The impact of “fat porn” [The Biggest Loser, More to Love, Dance Your Ass Off] on fat people is counterproductive. … [P]lenty of evidence shows that stigma makes fat people more likely to feel depressed, to experience stress, to receive poorer medical care, to experience discrimination in the workplace, to go on eating binges, and to duck exercise. …
A systematic review of weight-loss programs … found that the evidence that commercial and self-help weight-loss programs work is “suboptimal.” People who diet often regain more weight than they lose. … On The Biggest Loser, contestants are plucked out of their environment and social circle, sent to a weight-loss boot camp, and forced to radically change their calorie intake and output for several months. That’s one way to lose weight. But who, besides the very rich, or the very idle, can replicate the show’s setup?
[W]e need to recognize the limits of individual agency, especially in the new, “obesogenic” environment that’s been created over the past 30 years, and especially for those in the bottom third of the socioeconomic pyramid. Putting individual solutions and free will up against the increase in portion sizes, massive technological and societal changes, food-company taste-engineering, and the ubiquity of effective television advertisements is like asking Ecuador to conquer China. And yet, that is what public-health campaigns suggest we do.
The government can’t ask someone to pursue a healthier lifestyle–to attain a “normal” BMI, to become a non-stigmatized being–if it isn’t prepared to provide that person with the foundation for health granted to some of us purely by the accident of birth. “Increasing awareness” about healthy lifestyles is not simply gentle paternalism; in the absence of real support, it’s immoral. In that context, stigmatizing young children for being fat is unconscionable; stigmatizing poor adults is only marginally less so; and stigmatizing Mexican American boys and black women and American Indian children of both genders for their weight is both immoral and racist.

The political obstacles

The American political system makes it hard to displace entrenched interest groups. … “The committees with the most jurisdiction over food and nutrition policies are the agricultural committees,” [Robert] Raben says. “Who tend to want a seat on those committees? Not people who represent the consumers of goods. It’s the people whose constituents grow and refine the corn and the fructose. And the problem with advocacy groups is that they refuse to accept that the solution is not about replacing corn subsidies, it’s about adding tomato subsidies. But they’d rather demonize.”
The Department of Agriculture is charged with both promoting American agriculture and regulating it. The tendency of former USDA officials … to subsequently work on behalf of food giants like Archer Daniels Midland gives you some idea of the extent of what economists call “regulatory capture.”

Is there hope for the future?

Towards the end of the article Ambinder has some very positive words for Michelle Obama’s initiative on obesity. In speaking of her efforts, a senior administration official comments: “The goal is to use the threat of regulation to prevent us from having to make regulations, which would take more time anyway.”
Speaking of David Kessler, the former FDA commissioner:

Now, for the first time since he left government, he senses that the nation’s political leadership seems determined not only to take obesity seriously, but to do something meaningful. And food-industry firms, he believes, are starting to get nervous–a sure sign that they will offer concessions. Momentum, he told me, is finally building in the right direction. The Obama administration, he said, is “pitch-perfect. Everyone knows that this is the first lady’s priority. Everyone knows that it has the attention of the president’s senior staff. And she is the best spokesperson, and the best kind of spokesperson, to help change people’s minds.”

The political message on obesity

… has to come from the bulliest of pulpits: a hugely popular political figure who can help redirect the stigma that brutally accompanies obesity, away from those who don’t deserve it, and toward those who do–like food marketers who deploy psychological deception, or grocers who put sugary cereals where kids are most likely to see them. Those are the people who should feel ashamed.

UPDATE 6/11/2010:
Letters to the Editor (The Atlantic)
Letters is response to Marc Ambinder’s “Beating Obesity.”

What I would ask my fellow humans to think about is that the most painful aspect of obesity is not the life-risking diseases like diabetes, or the limits on life. For me, it is (I still have a lot of weight to lose) the judgment and scorn of other people. People who ridicule, or even try to harm, those of us who are overweight. People who see us as “less than” simply because of our size.

Related posts:
The So-Called Obesity “Epidemic”
Sin taxes: Financing health care with soda pop
Sanjay Gupta a victim of obesity myths?
Calories: What are we really counting?