Obesity pessimism

I posted before on the massive increase in obesity in the US over the last couple decades, trying to understand the why of the phenomenal change for the worse. Seriously, take another look at those maps.

A while back Matt Steinglass wrote a depressing piece in The Economist on the likelihood of the US turning this trend around:

I very much doubt America is going to do anything, as a matter of public health policy, that has any appreciable effect on obesity rates in the next couple of decades. It’s not that it’s impossible for governments to hold down obesity; France, which had rapidly rising childhood obesity early this century, instituted an aggressive set of public-health interventions including school-based food and exercise shifts, nurse assessments of overweight kids, visits to families where overweight kids were identified, and so forth. Their childhood obesity rates stabilised at a fraction of America’s. The problem isn’t that it’s not possible; rather, it’s that America is incapable of doing it.

America’s national governing ideology is based almost entirely on the assertion of negative rights, with a few exceptions for positive rights and public goods such as universal elementary education, national defence and highways. But it’s become increasingly clear over the past decade that the country simply doesn’t have the political vocabulary that would allow it to institute effective national programmes to improve eating and exercise habits or culture. A country that can’t think of a vision of public life beyond freedom of individual choice, including the individual choice to watch TV and eat a Big Mac, is not going to be able to craft public policies that encourage people to exercise and eat right. We’re the fattest country on earth because that’s what our political philosophy leads to. We ought to incorporate that into the way we see ourselves; it’s certainly the way other countries see us.

On the other hand, it’s notable that states where the public has a somewhat broader conception of the public interest, as in the north-east and west, tend to have lower obesity rates.

This reminds me that a classmate asked me a while back about my impression of Michelle Obama’s Let’s Move campaign. I responded that my impression is positive, and that every little bit helps… but that the scale of the problem is so vast that I find it hard seeing any real, measurable impact from a program like Let’s Move. To really turn obesity around we’d need a major rethinking of huge swathes of social and political reality: our massive subsidization of unhealthy foods over healthy ones (through a number of indirect mechanisms), our massive subsidization of unhealthy lifestyles by supporting cars and suburbanization rather than walking and urban density, and so on and so forth. And, as Steinglass notes, the places with the greatest obesity rates are the least likely to implement such change.


11 2012

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  1. Catherine V #

    I agree with your points on the inability to mobilize government efforts around positive rights/public goods (as well as the detrimental effects of subsidizing unhealthy foods, etc.) Have you seen the recent New Yorker article about antibiotics? (http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter) One of Specter’s interviewees asserts that changes in lifestyle and diet could not have accounted for the rise in obesity over the past several decades and looks at our overuse of antibiotics as a potential cause. With very limited knowledge of science and medicine, I have no idea how to assess the veracity of this claim. But, I wonder if even well-designed, scaled-up policies and programs focused on incenting healthy behavior could counter the biological causes of obesity. Just some food for thought (groan).

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