The least obese state in the U.S. today would have ranked as the most obese 15 years ago, according to the new “F is For Fat 2011” report released by the Trust for America’s Health and the Robert Wood Johnson Foundation. The stats in the report are shocking, but not surprising if you spend much time out in the world. People are getting bigger. Portion sizes at restaurants are ridiculously large. Screen time is increasing, outdoor time is decreasing and the expectations of what “fit” shape is are being reshaped by sheer numbers. As a guy who’s wrestled with being overweight since childhood and finally managed to win (mostly) in my 30s and 40s, and more importantly, as a father who wants to arm his kids with the best tools possible to stay healthy as they grow up, I’m deeply concerned by the report’s findings as well as with some of the proposed solutions.
Here’s a link to the full study (http://www.rwjf.org/files/research/tfahfasinfat2011a.pdf), which I recommend you read. And here’s a quick look at some of the most amazing of the study results:
- Adult obesity rates rose in 16 states over the past year. No state decreased.
- Obesity rates exceed 25 percent in more than two-thirds of states (38 states).
- More than one-third of children ages 10–17 are obese (16.4 percent) or overweight (18.2 percent).
- Twenty years ago, no state had an obesity rate above 15 percent. Fifteen years ago, Mississippi had the highest obesity rate, at 19.4 percent, which is lower than the lowest ranking state today, (Colorado at 19.8 percent).
- Twenty years ago, the state with the highest combined obesity and overweight rate was 49 percent. Ten years ago, only two states had a combined rate above 60 percent. Now, the lowest rate is 54.8 percent, and 44 states are above 60 percent.
What these results illustrate is not simply that a lot of Americans are heavy. If they were, and had always been so in that percentage, then one would presume some people are designed differently than others (they indeed are), and some are meant to be far, far heavier than others and that perhaps we shouldn’t worry so much about how obese folks are so long as they are happy and healthy. The problem is, people weren’t designed to be obese in such a large proportion – they were by and large once one way and are now another. And the trend toward obesity is happening terribly quickly. And it’s bringing with it a host of health problems that to preclude happiness for their sufferers.
What has changed in the past 20 years? Past 40 years? Past 100 years? One of the things I wish this study did better (or did at all, for that matter) is put the data into a longer term perspective. How heavy were people in 1940, 1880, 1600? When did the changes we have to worry about most occur, and how can they be counteracted?
In the longer term, 100s-of-years view, I see some obvious changes:
- access to practically unlimited, though often nutrient-poor calories, even for the poor, in wealthy nations
- fewer physically demanding jobs
- a less physically demanding lifestyle overall – less walking to get around, chopping wood, hauling water, etc.
- a massive increase in sugar intake with advent of refined sugar
- processed foods
- a move away from traditional foodways
But what about the period the study covers? What has happened to accelerate this process so rapidly? And how do we fix the problem? The report concludes (with my comments in parentheses):
1. Ensuring that all foods and beverages served and sold in schools meet or exceed the most recent Dietary Guidelines for Americans.
(Makes sense. Though it seems to me that the food we had in school when I was a kid, at least when I wasn’t brown-bagging it, was the worst, unhealthiest slop imaginable – and obesity rates were much lower. Why?)
2. Increasing access to high quality, affordable foods through new or improved grocery stores and healthier corner stores and bodegas.
(Sure, maybe in some places, but I’m convinced that there are plenty of affordable, healthy foods in most grocery stores now and people are still getting fatter in those places. I’ll demonstrate in a future blog post. We just need to teach people how to cook again.)
3. Increasing the time, intensity, and duration of physical activity during the school day and in out-of-school programs.
(Yes, this is important, let’s do it! But I don’t see how this can make up entirely for the lack of physical activity kids have compared to decades ago, when their home recreation time was spent outdoors, not in front of a video game screen. Seems to me this change needs to happen at home as well as in school to really be effective. And it’s worth noting how ubiquitous structured youth sports programs for kids now are, and yet kids are getting fatter. Why? Maybe, counter-intuitively, free play is better than structure for developing lifelong fitness habits?)
4. Increasing physical activity by improving the built environment in communities.
(Yes! Bike paths, safe sidewalks, rail trails, recreation fields, parks, etc. Keep building.)
5. Using pricing strategies — both incentives and disincentives — to promote the purchase of healthier foods.
(Skeptical. This seems like a bad idea, especially since in terms of dealing with obesity I don’t think the government is always sure what healthy is. Remember the food pyramid? Low fat eating craze? A pat of butter is unhealthy, but a massive glob of margarine or a full bag of “low-fat” chips is healthy? Blech. This is part of the problem, not the solution. We need to move back toward traditional foodways through education, and that will create demand for healthier foods and naturally affect commerce.)
6. Reducing youths’ exposure to the marketing of unhealthy foods through regulation, policy, and effective industry self-regulation
(Skeptical again. Rather than worry about their exposure to marketing and meddling, we need to use education to provide children with the tools to understand marketing and make good decisions. Just because a clown tells a kid to eat a hamburger doesn’t mean he has to do it. Or that you, his parents, have to buy it for him.)
While some of these suggestions are good ones, I worry that some are related to the sorts of things that may have helped get us into this in the first place: an over reliance on government to set the standard for what a healthy diet is: think the food pyramid and its underpinning of the low-fat, highly processed food craze. Or the once-widely supported idea that formula is better for babies than breast milk, when now data shows that exclusively breastfed babies have lower obesity rates as they grow up. Add to that the implication that the public health officials should somehow be responsible for getting your kids all the exercise they need during the school day or as part of formal government programs, perhaps the other side of the coin of a culture of fear-mongering that’s led to helicopter parenting and the unwillingness to push kids out the back door and say, “play, already, we’ll call you when it’s time to come in.” Then there’s the hesitancy to treat individuals like the powerful creatures they are and give them credit enough to demand from them the discipline they need to ante up in order to lose weight.
Former Surgeon General David Satcher, MD, PhD, remarked in a personal commentary in the report: “In the  Surgeon General’s report, I wrote that the obesity crisis would not be solved by treating it as a personal failing on the part of those who weigh too much. This is still true. We must realize that our predicament cannot be solved through individual action alone. Both the public and private sector must pitch in to ensure that we live in a society where gaining weight becomes more difficult and maintaining a healthy weight becomes easier.”
But individual action, at end of the day, must solve this problem. The message public health officials risk conveying is, “Are you obese? Are your kids obese? It’s not your responsibility; we’ll take care of it. We’ll pass laws to outlaw foods that could make you fat, outlaw commercials that could tempt your kids to eat the wrong food, and create government gym programs that will obviate the need for you to make exercise a natural and intrinsic part of your lifestyle.”
This attitude on the part of public health officials, while generous and compassionate, will contribute to the problem. Because it continues to suggest, as do some of the policy solutions proposed by study, that this is not a problem ultimately solved at an individual level. It is. Yes, the government absolutely can and should provide resources that support and reinforce that individual effort, but it should not suggest that any change in an individual’s weight can be accomplished without relying on the strength and discipline of each individual American to deal with the fundamental calories in calories out equation at the heart of weight management.