Jumping off this article in the May issue of The Atlantic, I want to sketch out a few principles for what I think would be an enlightened, realistic approach to beating obesity. Here's where I'm coming from: I think the obesity crisis is real AND reversible; no one solution -- not banning high-fructose corn syrup, not soda taxes, not universal health care -- will be the panacea. Instead, a broad-based, metric-monitored national public health campaign, led by a strong political leader who has the authority and legitimacy to knock heads, can identify what works, what doesn't, and to persuade states, Congress, companies, and the culture at large to follow suit. I'm about additive solutions, not broad demonization, because additive solutions tend to work, and because selective demonization works much better.
This is nothing particularly new. Obesity is a major health concern, and it will take a multi-factorial approach to make any headway. But there was something in one of his points that hit home.
1. Recognize that what separates skinny people from fat people is luck, and not willpower. Either your genes or your unchosen social environment, will provide a shield against the pressures of the default obesogenic environment. If you're part of a chronically stressed population, have little or no access to quality public infastructure, find yourself growing up in a dysfunctional family, and have limited social mobility, the chances that you'll be able to summon some magical reserve of willpower is slim to none. If you're white, upper middle class, tend to be hopeful about improving your lot in life, and have the time and resources to diet and exercise, you might be able to find a weight loss regimen that works for you. Either way, don't give yourself credit, and don't blame other people who aren't as lucky. [emphasis mine]
Much of what Ambinder mentions as factors for success have already occurred to me. However, I honestly (and somewhat embarrassingly) never considered the psychological aspect of weight management in quite such clear terms. The impact of socioeconomic status is not limited to access health foods, exercise facilities and the ability to pay for them. If one has little hope for improvement in one's life circumstances as a whole, it makes perfect sense to have little investment in trying to lead a healthier lifestyle with regard to diet and exercise in particular.
I am one of those white, upper middle class types who probably gives himself more credit than is due. I've been raised to assume that investments I made in my well-being (whether academic, social or physiological) would yield dividends. After all, why wouldn't they? I've not had to face any institutional barriers to my success, at least not until I bumped into my first examples of rank homophobia amongst the surgeons in medical school, by which time my generally optimistic worldview was well-established.
Further, I was raised in a house where the snacks that were available were fresh fruit and yogurt. (Also, pretty much the only desserts available.) I lived in a nice, safe neighborhood with a mother that routinely booted me out of the house to go run around and play with the numerous other kids. I was established with healthy patterns early, and so now it's relatively easy for me to eat well and exercise because I have a good foundation. I have every expectation that good choices will pay off, because it has been ever thus. (Here is where I give my mother [who may or may not be a regular reader of my blog] props for the Good Parenting Choices.)
The reverse is obviously true, if unacknowledged. People who can reasonably expect to have limited success in life cannot be expected to throw themselves into a program of health improvement in defiance of their broader experience. Though this paints a very frustrating picture, at least it's a more realistic one.