Obesity Is Not a Diet-Related Disease
“Poor diet is the leading cause of mortality in the U.S. due to the direct relationship with diet-related chronic diseases,” write Emily Matthews and Emma Kurnat-Thoma for Frontiers in Public Health. At the top of the list of “diet-related chronic diseases” is obesity, because it leads to so many other chronic health problems, disability, and death. With the confirmation of RFK as the new secretary of HHS, the government may soon be embarking on a quest to conquer obesity by applying this framework.
But there is one little problem that may trip up this valiant crusade. Obesity is not simply a diet-related disease. Rather, it is an environmental disease. Our diet is a product of the environment in which we live and multiple dimensions of the environment in which we live play a role.
Four Environmental Dimensions
Diet is shaped most directly by our food environment. Typically, people like to think about the problems with our food environment strictly in terms of bad food. The definition of “bad food” is a moving target. Back in the 1980s, the good vs bad food discourse was all about low-fat vs high-fat foods. Then attention shifted to added sugars. Now the target is quite clearly ultra-processed foods.
But in fact, much more than the food itself defines our food environment. Every dimension of food marketing plays a role – product development, pricing, placement, and promotion. Prevailing culture plays a big, but often neglected role – it defines how food fits into our lives. Can we have a meeting without a generous supply of food at hand? Do we get our food from drive-throughs in our large vehicles with ample cupholders and trays for it?
Beyond our food environment is the physical and tech environment that defines our routine movements. That environment is making our daily lives more sedentary, which has profound effects on metabolic health.
Then there are drug and chemical exposures that are most often involuntary and inescapable. Endocrine disrupting chemicals alter our metabolism in many ways, including our appetites. Many people are taking drugs that cause weight gain.
Finally, but not least in importance is ubiquitous stress and distress. This comes in many forms – financial stress, social stress, altered sleep patterns, and time poverty are but a few of these sources of stress. They often carry the label of social determinants of health.
Interacting Dimensions of Obesity
These four dimensions do not each exist in a vacuum. They interact with each other and most especially with our diets. So to simply nudge, exhort, and mandate that people move toward healthier diets is an inadequate strategy. Without a more complete effort to address all four dimensions of our environment that are driving obesity, this new effort will fail – as have other crusades that came before.
Because obesity is not simply a diet-related disease. It is an environmental disease. Diet is just one dimension of it.
Click here for the article by Matthews and Emma Kurnat-Thoma and here for more on social determinants of health and obesity.
Still Life with Currency, Wine Glass, and Peach; painting by Charles Meurer, 1904. For a larger view, click here.
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
February 17, 2025
February 17, 2025 at 6:59 am, Michael Jones said:
Indeed, diet is but one dimension of the problem, but it IS a dimension, and one that sorely needs to be addressed. In this battle we must be able to walk and chew gum at the same time.
February 18, 2025 at 4:16 am, Ted said:
Perhaps walking and chewing gum would be more feasible if we left our phones in our pockets.
February 17, 2025 at 7:50 am, John DiTraglia said:
Obesity Is Not a Diet-Related Disease period it’s not caused by food
It’s also not caused by food environment – lack of exercise – stress or combinations of those
those are also classic dead ends
we don’t know what causes obesity
February 17, 2025 at 8:35 am, David Brown said:
Excerpt from the Matthews and Emma Kurnat-Thoma article. “SNAP participants struggle more than higher income groups to meet the U.S. Department of Agriculture (USDA) Dietary Guidelines and achieve a nutritious diet.” https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1339859/full
Unfortunately, the bureaucrats who write the UDSA Dietary Guidelines have never been able to figure out what constitutes a healthy diet. These “career federal nutrition scientists’, as they characterize themselves, consistently reference American Heart Association (AHA) dietary advice. https://pubmed.ncbi.nlm.nih.gov/38522617/
Likewise, AHA-affiliated scientists justify their dietary recommendations by citing the USDA Dietary Guidelines. https://pmc.ncbi.nlm.nih.gov/articles/PMC11391774/
Neither entity has seriously attempted to resolve this controversy. https://www.asbmb.org/asbmb-today/science/110212/an-essential-debate
February 17, 2025 at 11:18 am, Katherine said:
Below are the reasons a licensed and registered dietitian would be paid to assist someone with their obesity and foos challenges. Other health professionals will give a pill and walk away. So there is merit, JFK Jr, in
employing RDNs and having government advocate for their involvement in decision-making.
‘But in fact, much more than the food itself defines our food environment. Every dimension of food marketing plays a role – product development, pricing, placement, and promotion. Prevailing culture plays a big, but often neglected role – it defines how food fits into our lives. Can we have a meeting without a generous supply of food at hand? Do we get our food from drive-throughs in our large vehicles with ample cupholders and trays for it?’
Great post!
Beyond our food environment is the physical and tech environment that defines our routine movements. That environment is making our daily lives more sedentary, which has profound effects on metabolic health.
Then there are drug and chemical exposures that are most often involuntary and inescapable. Endocrine disrupting chemicals alter our metabolism in many ways, including our appetites. Many people are taking drugs that cause weight gain.
Finally, but not least in importance is ubiquitous stress and distress. This comes in many forms – financial stress, social stress, altered sleep patterns, and time poverty are but a few of these sources of stress. They often carry the label of social determinants of health.
February 17, 2025 at 11:53 am, Richard Atkinson said:
Good column, but doesn’t describe the whole picture. Environment clearly plays a role in obesity in America. The fattest person in the USA can starve to death, but food is not medicine (as the Frontiers article states) and definitely isn’t the solution to obesity. There are over 14,000 hits on PubMed using the search terms, “diet and physical activity and obesity and treatment,” none of which show a long term success rate in more than a modest minority of patients. Look up Einstein and insanity. Genetics plays a major role and very likely environmental chemicals. At the onset of the obesity pandemic, adenovirus 36 infected ~30% of patients with obesity vs 11% of leans, but as the Adv36 positivity spread, the correlation with obesity diminished, probably due to previously positive people losing their antibodies and now being “negative”, but the obesity persisted. The Frontiers article is rift with government solutions, likely none of which will actually reduce obesity, but will make food, and life, more expensive for the whole country. This paper deserves all the criticism the column gives it and should not be taken seriously by objective observers.
February 18, 2025 at 10:12 am, John DiTraglia said:
Wow. Some raw nerves going on guys. Provocative one here Ted.