commentary

(Girl with Pen)

July 26, 2012

Bedside Manners: Obesity Is Not All Your Fault

by Chloe E. Bird and Tamara Dubowitz

If you had good options about what to eat but made bad choices and became obese, then the fault would be yours. But, what happens when you don't have good options?

That's the problem in America today—being overweight is not all your fault. You don't make the decisions to put transfats, high-fructose corn syrup and excess salt in your food, or unhealthy snacks in the vending machine at work. You don't dictate that the equivalent of 54 sugar cubes get put into an extra-large soda. These are so-called constrained choices—ones you don't get to make. Yet, you live with the consequences.

We believe it is time to consider who determines the options for us and what can be done to put better ones on the table. We can't all afford to buy only organic foods or even have access to them. And, we probably don't make it a pastime to follow the latest research on nutrition. But, we can take a moment to think before we order a second soda.

And, we can choose to call on those who determine the options to shoulder part of the responsibility for America's obesity epidemic and to stop the name-calling—like labeling medical researchers "food nannies" when they ask restaurants to deliver sensible portions, priced right. We need to hold vending-machine companies and managers to account if they stock only junk food in those little compartments.

Consider a few statistics. The latest figures indicate that two of three adults and one of three children and adolescents in the United States are overweight or obese. The impending health and economic consequences are staggering. According to the Institute of Medicine, the medical costs alone of obesity-related diseases and disabilities exceed $190 billion a year. These costs comprise more than 20 percent of national health care spending. The number keeps rising. Want your health care costs to spike further? Then, keep eating the constrained choices that are not healthy.

RAND research, using data from the Women's Health Initiative study, found that living where there is a higher density of fast food outlets is associated with higher blood pressure and risk of obesity; while, a greater density of grocery stores is associated with lower blood pressure and lower risk of obesity. These relationships hold even after taking into account women's characteristics and socioeconomic status of their residential neighborhoods. In other words, where you live can affect your weight and your health.

Moreover, another recent RAND study found that 96% of main entrées at all restaurants studied—including delivery, family style, upscale, fast food, buffet, and fast casual—exceed the daily limits for calories, fat, saturated fat, and sodium recommended by the U.S. Department of Agriculture.

Policy approaches to reduce obesity are not magic bullets. If we want to reverse the obesity epidemic, then we need environments which assure that we have good food options and the opportunity to choose them.

We will be more successful at stemming the growing tide of obesity and improving our own health if everyone accepts their share of responsibility for the obesity epidemic. We need to ask our favorite restaurants, the food vendors near where we work, even grocery stores to give us better options. We can always ignore them if we wish, but then that's our choice. Right now, too many bad choices are being made for us.

This commentary was cross-posted on Girl with Pen.


Chloe E. Bird is a senior sociologist and co-author of Gender and Health: The Effects of Constrained Choices and Social Policies (Cambridge University Press, 2008), and Tamara Dubowitz is a policy researcher at the RAND Corporation, a nonprofit, nonpartisan research institution.

This commentary appeared on Girl with Pen on July 26, 2012