Obesity

Fat Americans Need To Be Poked and Prodded To Thinness

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My obesogenic environment made me do it!

When researchers condescend to an entire population, reaching out to pat the collective chubsters on their sweaty heads and coo, "there, there, it's not your fault you're a bunch of fat bastards," you know you're in for a rough ride. It should come as no surprise that, even though, the "problem" they intend to cure is on the wane, the researchers/activists have in mind an ambitious "system" of "large-scale transformative approaches" that will have Americans' soon-to-be-aerobicized rear ends slim and trim, whether they like it or not.

It's not our doing, you see. According to the authors of Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, published by the Institute of Medicine, we live in an "obesogenic" environment in which "Americans are now accustomed to the very societal influences that predispose the average person to gain excess weight." And since we're soaking in it — a sea of fat-inducing influences, that is — we can hardly be expected to make our own decisions about diet and exercise, or about the trade-offs between pleasure and health involved in driving (or running) past a doughnut shop.

Except that many of us already do. Anybody who has ever pulled out a bag of baby carrots for his kid to munch on at a public event where other tots are stuffing their pie holes with parent-supplied glow-in-the-dark treats knows that choices are possible, and can go one way or the other, as we prefer. Some folks just don't like the choices other people make. In fact, they protest that the argument for personal responsibility "has been used as the basis for resisting government efforts."

But, since a world of cheap and tasty food and easy transportation makes it too easy to choose the "wrong" way, we need an approach that "reestablishes the responsibility of the country—both the public and private sectors—to nurture and protect children, and to support the health priorities of the adults and families who influence them and make the decisions that determine the overall physical activity and food environments."

That is, "the context for the exercise of free choice must be improved."

Which is a nice lead-in for the grab-bag of social-engineering proposals the study offers in its stand-alone recommendations (PDF), including, piling child-care facilities with requirements for physical activity, taxes and outright bans on sugar-sweetened beverages, and screenings for soda-drinking during visits to the doctor's office.

In pages upon pages of recommendations that would, if fully implementd truly remake society, not all are, by any means, coercive. Some are a good idea, such as reconsidering farm subsidies — although the report cautions that "blunt approaches such as eliminating farm subsidies are unlikely to offer a quick fix to the obesity epidemic." Others are oddly vague, such as calling on employers to "create, or expand, healthy environments by establishing, implementing, and monitoring policy initiatives that support wellness." Ummm … OK. Honestly, some employers do interesting things like offering on-site gyms. And a call for "improving the physical environment of communities … in ways that encourage and support physical activity" might be just fine, so long as we acknowledge that building bike lanes doesn't mean that anybody is going to use them, and many of those gyms are magnets for the folks who would exercise at home, anyway.

Even some of the more instrusive approaches, such as medical screening for soda-drinkers, are unlikely to have much impact, since physicians routinely ignore the already long checklists of screening and interventions they're strongly urged to perform. If they didn't, over-nagged patients would flee in droves from hour-long appointments.

There's a wish list quality to much of this, interspersed with deep impatience with the lifestyle choices made by millions of Americans.

But why? Why do these researchers care about their neighbors' weight?

Well …  "Many of these health-related obesity costs are absorbed by Medicare and Medicaid, important programs already under attack because of their national price tag" and "U.S. military leaders report that obesity has reduced their pool of potential recruits to the armed forces."

Oh, and you thought they cared about you. Nope, having socialized costs, now we need to socialize choices that might raise those costs. And we might need to stick a uniform on your back and a rifle in your hand, so do some sit-ups, fatty.

Even if that sounds persuasive to you, it's hard to see why this is all so pressing. Just yesterday, the American Journal of Preventive Medicine published a forecast (PDF) that, while obesity among Americans is now expected to increase to 42% of the population by 2030, this represents a lower figure than earlier prediction of 51%. That is, people are still getting fatter, but the trend is leveling off (see Jacob Sullum on exactly that point).

Apparently though, we're just not making the right choices fast enough, and need some prodding in our doughy midsections.