Should obesity prevention be a personal matter?

Obesity is now increasingly recognized as the “natural” consequence of societal changes that have occurred over the past decades to foster an increasingly obesogenic environment.

Yet, rather than focus on the root causes of these societal drivers of obesity, governments apparently prefer to make obesity prevention a personal matter, with a strong emphasis on trying to get individuals to change their lifestyles.

It is clearly far easier to simply tell people to eat more fruits and vegetables and to walk 10,000 steps than it is to provide them with the means or the environment that would actually allow them to do so.

A paper by Celeste Alvaro and colleagues from Dalhousie University, Halifax, Nova Scotia, Canada, published in the latest issue of Health Promotion International, explores why Canadian government policies, particularly those related to obesity, appear to be ‘stuck’ at promoting individual lifestyle change.

The paper uses key concepts within complexity and critical theories as a basis for trying to understand the continued emphasis on attempting to change individual lifestyle factors despite strong evidence showing that a change in the environment and conditions of poverty is truly what is needed to tackle obesity at the population level.

As the authors note, not just in Canada have health promotion programs and policies had a “lopsided” emphasis on individual lifestyles, with limited attention given to addressing the broader social, economic and political factors that create and produce obesogenic environments in the first place.

As the authors point out, “Individuals are continuously blamed for unsuccessful modifications to their lifestyle, even though living in an obesogenic environment makes achieving a healthy lifestyle close to impossible.”

Despite some attempts to change ‘environments’ (such as schools and workplaces), as recently undertaken in programs such as ActNow BC, they often fail to comprehensively address key economic issues underlying obesity, but rather focus on encouraging individual behavioral change.

The paper calls on both complexity theory to conceptualize governments as ‘systems’ with a history that shapes their current decisions and actions as well as critical theory to draw attention to power struggles within the policy implementation process, and to the role of dominant interests and ideologies in maintaining particular policies.

The authors provide several illustrative policy examples that highlight key concepts explaining why governments prefer to perpetuate and appear to be ‘locked’ into a focus on these largely ineffective lifestyle policies.

Although the paper may help better understand why governments are so reluctant to address the true underlying drivers of obesity, the authors admit that the path to actually and substantially moving government policies in the direction of fundamentally altering the obesogenic environment is far from clear.

Whether or not their suggestion that health promoters and others inside and outside the health field must develop collective action to catalyse the required changes across government and political sectors, will in the end move government in the right direction remains to be seen and may well prove overly optimistic.

Given that many ministries have a say in the drivers of the obesogenic environment but have left it largely to the seemingly powerless Ministries of Health to deal with the issue of obesity, the authors suggest that it may be time for a critical debate about how to promote the active, sustained and collective involvement of multiple sectors and groups to address obesity.

Clearly, as long a governments continue ignoring the real factors at play in the obesity epidemic, and remain focused on ‘reactive’ solutions that target individuals rather than society as a whole, prevention efforts are unlikely to translate into a meaningful decrease in the incidence and prevalence of obesity anytime soon.

Arya M. Sharma is a Professor of Medicine at the University of Alberta who blogs at Dr. Sharma’s Obesity Notes.

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  • Cheryl Handy

    Ever since I had a high tibial osteotomy in December 2004, I could no longer walk, run. swim. With each movement, I felt like the bottom of my leg was going to break. The orthopedic surgeon was stumped.

    In 2007 I underwent chemotherapy for breast cancer. Now I take Tamoxifen.

    Five and one-half years later (July 2010), I had the metal removed and now I have osteomyelitis, dead tibia and an oozing sinus on my lower leg.

    The lack of mobility, illness/osteomyelitis combined with the chemically induced menopause caused significant edema and weight gain. People think I over eat. But I don’t. In fact, I eat very little.

    I cannot wait for a doctor to be willing/able to fix the osteomyelitis. So now I am taking charge and I work with a MD who specializes in nutrition and non surgical weight loss.

    Weight gain/obesity is not always as simple as a bad diet. Sometimes medical conditions create a change in life style or a change in body chemistry that warrants physicians have a different type of “straight talk” with the patient.

  • Anonymous

    Of course, as soon as there is any talk about trying to change the obesogenic environment, you will hear about “the government nanny state trying to take away your freedom to eat whatever you want”. Meanwhile, no one will mention farm subsidies that are mostly targeted to crops made into high calorie foods (including sweeteners and oils) or fed to livestock to fatten them up and change their meat’s nutrient profile away from what it would be if they ate a more vegetable-heavy diet.

  • Dorothy Green

    There is nothing “natural” about it even though it is a societal issue. It is called an epidemic – an overeating epidemic. It is the US eating culture. It is very difficult to avoid unhealthy food in this country. It probably takes more time to eat healthy than our ancestors did to find food when our DNA was formed.

    If we stop the dumb “drug wars’, wake up Americans and start a “war on overeating” with a strong message and RISK tax (reduction in sickness kitty on the substances now known to cause the overeating – sugar, fat and salt) and stop subsidies to the pushers (the agribusiness industry) we are on our way to resolving this problem. See how quickly smart small and medium size farms appear – communities become involved. Keep Michele Obama cutting red ribbons of new efforts to bring our food supply into the 21st century.

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