Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Sunday, April 20, 2008

Why our Nation’s Obesity Initiatives Fail in Producing a Healthy Population and Curbing the Epidemic - Megan Reeve

Obesity has been growing drastically in the United States over the last 20 years, among both children and adults. Childhood rates have actually tripled during this time (1). The government, along with the Center for Disease Control (CDC), has begun to label it as an illness or disease, rather than just poor eating habits (2). These higher rates are raising health concerns because of the consequences of heart disease, diabetes, hypertension, and several other health problems that are associated with obesity (1). The epidemic has only recently been identified as such, and focused initiatives to combat the problem have just begun to loosely be put into effect, such as changes in school lunches and more access to parks and bike paths (3), but they have yet to see much success. Since a large part of the epidemic is due to more than genetics and poor food choices, policies need to use tactics targeting behavior change and social constructs to see real transformations. Health practitioners and advocates also cannot expect change to occur overnight, this type of large-scale public overhaul will give very gradual results.

Currently, some states have enacted types of nutrition reform in schools, and others are promoting physical activity in communities to help alleviate the crisis (3). But so far there has been no solid federal involvement from the government, and some argue that is an important part of the battle against obesity that is missing (1,5). Clearly something still needs to be done, as obesity rates are still rising in all but a few states, mainly because it is not universally recognized as a large scale crisis, there is a lack of political will and funding to solve the problem, and throughout the country there is a lack of standardization among states to cooperatively get the nation to adopt healthy lifestyles.

Obesity is Not Accurately Recognized
Both the general public and public officials themselves have not correctly recognized and identified obesity for what it is: a disease and not simply poor eating habits or an unhealthy lifestyle. Many Americans believe in a culture of “quick fixes” and this terminology has begun to include diet and weight loss. Upon doing an internet search for weight loss or dieting, hundreds of different websites may appear offering pills or herbal remedies or new machinery promising a beautiful healthy body in very little time. Most Americans are not interested in long term approaches, nor do many of them think about the long-term effects their choices could have, as fast food establishments are as popular as ever, and young girls still suffer from eating disorders to keep their weight down. Both of these are examples of how busy daily lives can push the thought of a healthy diet and lifestyle to the bottom of the priority list, even though those choices can very well have a significant effect through old age. But since the importance of food choices and physical activity are mingled with ads about metabolism boosters, fat burning supplements, and cosmetic surgeries, the health consequences of high blood sugar and heart problems get lost as well.

The bias that exists among the public not only exacerbates the problem, but also means that many people are continuing to misidentify the obesity epidemic. Both the general public and healthcare workers judge people based on weight and/or appearance. This ignorant judgment can cause harm in all aspects of someone’s life, including home, work, school or their children’s school (4). In addition, it fosters blame and intolerance for those who are overweight, making them feel less and less adequate and more depressed (4). This often triggers binge eating, which is common among people suffering from feelings of inadequacy and depression, and continues their weight and health problems. Some people are predisposed to obesity because of genetics, some have metabolic disorders, and some may just have unhealthy lifestyles, or were raised only being exposed to the wrong types of foods, or perhaps are not sure what needs to be changed in their habits. By simply ignoring these people or being narrow-minded and cutting them off from society nothing is going to be solved. The crisis is simply going to continue and be perpetuated by those who think they are above the problem, and that those affected should take care of themselves.

Another problem in this facet of identification is the discrepancy that arises. As people are becoming more educated about the consequences obesity can have, nutritionists and dieticians are becoming more prevalent and available, but only to those who can afford them (6). Even the U.S. Surgeon General has said that 8 out of the top 10 leading causes of death, including coronary heart disease, stroke, some types of cancer, and diabetes mellitus, are all related to diet (6). Yet Medicaid and Medicare will only cover expenses due to nutrition and weight issues if it is absolutely necessary to the individual’s immediate health status. This limitation on coverage makes lifestyle changes very hard for those who cannot afford to pay out-of-pocket, and are not quite at the level where their lifestyle presents imminent danger to their health. But they may very well be at the point where revamping their way of life will take more than just a few thoughtful meal changes, and need assistance to achieve their goal. There are also discrepancies throughout the country, even though it is a widespread problem; the southern states are experiencing much higher rates than the rest of the U.S. (5). These kinds of issues need to be targeted without the ignorance that it is all individual choices and those in the south, or those too poor to pay for dieticians are not influenced by their environment. To be successful, the government and health officials need to understand the factors that contribute to these regional and socioeconomic disparities (1). By looking to make social changes instead of relying on personal changes, more success and less resistance will occur.

Lack of Political Will
There is a lack of politically driven initiatives to fight this dilemma. While looking at the whole picture, obesity may seem like a small challenge compared to war and the economy and universal health care, the problem has been gradually growing, and if it continues to grow at this rate, both American health care and the economy will be worse off because of it. Currently, there is a substantial lack of funding for obesity research and development, even though the impact it is having on the country (7). However, so many other diseases such as AIDS, Diabetes, and Heart Disease are considered higher priorities and are more well known, allowing for additional funding from smaller, private donors. Obesity is an underlying cause of both Diabetes Type II and many forms of Coronary Heart Disease. If additional funding were available for more research and education in these areas, it is likely that obesity rates would decrease, as would rates of adult onset diabetes and heart disease.

Funding also becomes an issue when it comes to children in this generation and future generations. Physical education classes in elementary schools and high schools are declining. Often schools are suffering financially and cannot afford gym teachers, or appropriate facilities that create an environment that promotes physical activity. The schools that do have classes are often too big with too many different age groups and skill levels with minimal supervision (8). There are loosely enforced requirements for both elementary and high school students to have a minimum amount of physical activity each week, but they are frequently not adhered to, and usually without consequence (9). Nationally less than 6 percent of high schools require physical education for juniors or seniors, according to the CDC (9). If funding is not the issue, schools have to deal with more demanding standardized test goals in fear of being closed if their students do not perform well. This added academic pressure often means that gym classes are the first to be deleted from the schedule when making space for a more demanding curriculum. Fitness advocates blame the state education departments for diminishing physical education’s importance by not enforcing the state’s minimum requirements for physical activity(9). Usually it is a combination of both of these situations, but simple federal funding to the schools that really need it, coupled with a more adamant insistence that physical education for children is necessary would easily assist in halting childhood obesity incidence.

There have been many state proposals to decrease obesity, but there needs to be a national commitment to fixing the problem. Researchers and scientists know all about nutrition and exercise, and how to live a healthy lifestyle, and normal standards of maintaining fitness. However, the problem lies in actually inspiring behavioral changes across the nation, and effectively empowering people to make those nutritious and fit choices by removal of barriers and complete access to what they need (1). Too much has been left to personal responsibility, which clearly is not the answer. People do not make decisions without input from others, and are constantly influenced by friends, school, work, and the media. In order to make changes at all of these levels, the government will have to at least engage at the macro level to help the changes and attitudes reach environments and communities on a more local level (1).

A few states are in the process of considering bills informally known as “fat taxes”, in an attempt to curb eating unhealthy and the purchasing of junk food. Controversies have arisen over the motives of this tax (10). Is it really about trying to help people to establish better eating habits, or is it just another way to squeeze more money out of the public and into the government’s pocket? It is similar to the tobacco tax, which forces people who smoke to pay more for their habit: Is a tax really the best way of addressing people’s eating habits? Often those who buy junk food do so because it is cheap and they do not have much money. To make junk food more expensive will not enable them to make healthier choices, but may force them to allocate more of their minimal funds to food (10). This idea also gives a different point of view regarding approach, as many opponents of these bills support the idea that personal responsibility is the best policy when fighting obesity (10).

Lack of Standardization Throughout the Country
Some states do a great job of building parks and walking paths and bike lanes, others have their schools revamping cafeteria food to offer only nutritious choices, while others do not even realize the magnitude of the obesity problem. Does this mean that those states with higher rates should be stricter about attacking the problem? Or that those already active states such as Colorado and Hawaii do not have much to worry about and can relax instead of rushing to form new bills and urging social change? The problem with tackling the epidemic on the state level like this arises when people move around the country, like many often do. Hypothetically, if children are conditioned in a school in New Mexico to drinking only milk and water and being exposed to only healthy food options, and their family moves to Mississippi, it is neither fair, nor helpful to allow them to revert back to soda machines and pizza rolls in their new school. If this issue is addressed state by state, the country will not see cohesive, positive results, and it will continue to be a disjointed balance of progress and failure. It is also difficult to convince national food and beverage corporations to make changes to their nutritional facts, or make national restaurant chains post nutrition facts unless the initiatives are unified throughout the nation (5). Without the federal government’s help, it is difficult to achieve consistency with new policies and effects that have the ability to change lifestyles.

The percentage of both the adult and child population that remains overweight or obese is still very high. If it is not addressed correctly in a short time, researchers suspect that it will be the first time children’s life expectancy will be shorter than adults (1,3). By properly addressing the epidemic as more than just personal choices for some states and cultures, and correcting stigmas that come out of the current weight bias, the problem can be corrected instead of just working to alleviate the symptoms for the fortunate few who can afford the treatment and nutritionists. Less focus should also be placed solely on weight loss. When thinking long term, it is more important to measure improved nutrition and physical activity than just pounds lost (5). The government will also need to admit that this is truly a public policy issue that they need to give attention to on the federal level if they want to see changes made on personal levels. Furthermore, the debate between government involvement and personal responsibility needs to be resolved. While personal responsibility is critical to adopting and sustaining healthy behaviors, many reports note that “individual change will not work in isolation” (5). Hopefully through this manner of thinking, American can turn the health of the nation around, instead of just lowering BMIs for statistics and losing weight for aesthetic purposes.


Trust for America’s Health. “F as in Fat – How Obesity Policies are Failing America, 2007”. Washington DC: TFAH.
Center for Disease Control and Prevention. Overweight and Obesity. Atlanta, GA: Department of Health and Human Services.
Boston Globe. “School Lunch Bill Targets Obesity”. 25 October 2004.
Friedman, Roberta R (2008). "Weight Bias: The Need for Public Policy." Rudd Report: Rudd Center for Food Policy & Obesity, Yale University.
Trust for America’s Health. “F as in Fat – How Obesity Policies are Failing America, 2006”. Washington DC: TFAH.
Testimony of Elizabeth Johnson, American Dietetic Association. National Bipartisan Commission on the Future of Medicare.
Obesity in America. Funding for Obesity Research.
Julia Sayles. Sports4Kids Program Coordinator. Personal Communication.
Schworm P. “Schools Let Phys Ed Slip Off Schedule”. The Boston Globe. 2004.
Heartland Institute. “Government Anti-Obesity Efforts Achieve Little Success”. Healthcare News.

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