How can we really stop obesity?

I met a young man in my clinic recently, who came for treatment of obesity.

He was only 26, yet suffered from obesity throughout his life — now reaching a debilitating 420 pounds. His explanation for how he developed obesity was a reflection of the issues surrounding nutrition health policy in the U.S. He said that “it would have been easier to not put the weight on to begin with,” that he was “too poor to eat healthy,” and that he “wished there were programs that help with this.” Despite the perception that obesity is a personal failing, there are social and political reasons for the current obesity epidemic, which need to be treated from a health policy intervention.

The most effective way to treat obesity is through prevention. The most effective way to prevent obesity is through factors leading to unhealthy dietary intake. Changing the food environment — the physical, social, economic, cultural and political factors that make impact accessibility, availability and adequacy of food — is the way reverse the course of obesity.

It is well-known that obesity is seen more commonly in those with the highest poverty and the lowest education rates. Poverty leads to less food security: limited or uncertain availability of nutritionally adequate and safe foods. This has been linked to increased risk of obesity, irrespective of whether one experiences hunger. The source of the obesity epidemic is complex and involves genetic, psychological, environmental, social and economic factors. However, obesity’s rise is in-part driven by high-fat, high-salt and high-sugar foods available at low cost. This clearly afflicts those already in most need. Higher obesity rates are seen in areas with fast food restaurants and convenience stores, and I have heard stories from those who eat fast food or junk food attributed to limited financial means and the need to “be responsible and efficient” in their finances.

Policy interventions for obesity should play a role in combating obesity and would have dramatic public health direct and spillover effects, given the estimated 250 complications from obesity. This approach would represent an upstream-based intervention which potential for deeper and expansive effects as diseases are prevented, leading to societal improvement and reduced costs. Food access and security have been argued as a socioeconomic issue and, thus, a health policy issue. Making policy-based solutions to increase food security may modify the economic incentives to eat healthier, especially among low-income households. Poverty has undeniable harms effects on health and disproportionately affects ethnic minorities. There have been reports of a so-called “food insecurity-obesity paradox,” where there is an observed association between the food insecurity and higher obesity prevalence in the presence or absence of hunger. This irony results in two separate effects: the burden of food insecurity and limited nutritional choice discretion, as well as the adverse outcomes associated with excess weight and obesity.

Legislation can target both healthy food access and affordability given the potential cost of fresh foods, an oft-cited reason for fast-food consumption in lower-income regions. For example, food assistance program expansion through numerous programs — like Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), among others — may increase equity through improvement for a broad age group. However, although increasing individual means may play a role, further research in the effects and solutions for food deserts (areas without fresh fruit, vegetables, and other healthful whole foods) and interventions are essential to allow for affordable, healthy food options. Another consideration would be providing incentives for the opening of supermarkets, to increase food access. Obesity prevention through modification of the built environment and improved food access will likely benefit all members of a given household. Given the worrisome patterns of obesity in both the adult and pediatric populations, this intervention serves to potentially benefit members of all ages of a household in contrast to school-based or workplace-based interventions.

Although it may seem paradoxical to propose improving food access to combat obesity in the U.S., there is some truth to the idea that unhealthy foods are less expensive. Think about that fried chicken family dinner or the burger combo at the fast food drive-thru. We are currently living in a time of widespread nutrition access at low costs. In the U.S., we are in a time of “feast-rather-than-famine,” coupled with technological capability to create nutritionally-dense foods and our evolutionary biological skill in storing excess calories. These factors would naturally result in obesity.

As a society, we are in dire need to transition to a healthy lifestyle and diet. We must take healthy food access seriously if we are to effectively prevent and treat obesity as it continues to worsen. Despite the difficulty with measuring weight gain that was prevented, we must accept this challenge and the faith required in knowing that in the future. We can understand the policy measures set in place leading to reduction in weight gain in the industrialized world, only after we have set the laws in place to treat it. We know obesity burdens society through costs and immeasurable effects, and only swift action now will stop it.

Albert Do is a gastroenterologist.

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