White House at Sunset

Stuck on a Partial Understanding of Obesity

The news is full of sound bites about obesity today. The White House Conference on Hunger, Nutrition, and Health is front and center. And the 44-page report that will guide today’s meeting has plenty of good stuff in it. Most notably, it reflects a better, albeit only partial, understanding that obesity is a complex chronic disease. It calls for better access to healthful nutrition and physical activity, as well as stronger research programs for nutrition and food security. These are all good things.

But, unfortunately, embedded in the framework is an old presumption that teaching and prodding people to “eat healthy” will cure our problem with obesity. That presumption is flawed because our challenge of excess obesity arises from environmental and physiological factors interacting. Not from people suddenly making bad choices.

No matter how much we bang people over the head – or “educate” them – to make better choices, healthy eating does not cure obesity for most of the growing numbers of people who live with it.

Good Signs of Progress

The going in assumption is indeed that obesity is a chronic disease like hypertension, diabetes, and cancer. This is a helpful because it takes us past old assumptions that obesity – “being overweight” – is merely a bad behavior. The report also calls quite clearly for better access to clinical counseling support for coping with obesity. These are good signs of progress.

At the same time, CDC released its 2021 obesity prevalence maps, calling for equitable access to obesity prevention and treatment. CDC’s acting principal deputy director Debra Houry explained:

“When we provide stigma-free support to adults living with obesity, we can help save lives and reduce severe outcomes of disease.”

Relying heavily on this new data from CDC, the Trust for America’s Health released its annual report, the State of Obesity 2022. While this report still carries some of the moral panic and bad behavior narrative that dominated prior editions, the Trust is quite forthright this year in saying “obesity is multifactored and involves more than individual behavior.”

All of this signals progress and we welcome it.

Turning Food into Joyless Medicine

Perhaps nothing else illustrates the desire to cure obesity with healthy eating than the concept of prescribing food as medicine. The paternalism in this concept repels people.

But even more important is the neglect of the cultural, social, and joyful significance of the meals we share. Food is much more than medicine. Treating it like a pill, potion, or admixture we must swallow thus diminishes it.

Progress to Celebrate but More Is Needed

So in the news of today, we find progress to celebrate. There’s a better understanding that obesity is a chronic disease like hypertension. There’s advocacy for better access to care. The advocacy for better access to good nutrition and physical activity is outstanding.

Maybe next, we can move on to a more complete understanding of obesity.

Click here and here for more on the White House conference today. For the new CDC report, click here, and for the Trust’s report on obesity, click here.

White House at Sunset, photograph by Tarun Sinhat, licensed under CC BY-SA 4.0

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September 28, 2022

One Response to “Stuck on a Partial Understanding of Obesity”

  1. September 28, 2022 at 3:21 pm, David Brown said:

    Ah assumptions. One can never tell if an assumption is correct if there are gaps in the data set. A case in point is the conclusion in a 1997 study that high arachidonic acid intake is harmless. What the researchers did not determine is whether very low levels of arachidonic acid intake might be beneficial. https://aocs.onlinelibrary.wiley.com/doi/abs/10.1007/s11745-997-0056-6

    In a 2021 study the authors wrote, The main risk factor for CVD is metabolic disorder including obesity and diabetes….The intake of pre-formed AA in food is an important cause of circulating AA. However, previous studies mainly show the dietary content and human intake of AA in America and South Korea. Data on dietary AA from other countries are lacking, and further studies are needed to explore and provide new insights into the relationship between dietary AA with cardiovascular health.” https://pubmed.ncbi.nlm.nih.gov/34769460/

    To elucidate the causes of obesity and the chronic inflammatory diseases, researchers are going to have to be more thorough.