Most people believe weight gain and obesity are simply the result of individual choices. They're wrong. The choices we make depend on a variety of environmental cues, many of which we can't control.
It's not just a matter of education, or else no doctors, nurses or nutritionists would be overweight. It's not merely a matter of motivation or willpower, or else people who lose weight wouldn't gain it back.
The media, our schools, our workplaces and all types of stores we patronize simply have too many cues to eat and offer us too many calories to consume. Food and beverage companies are flooding our environment with these cues and products to boost sales, and in their eagerness to keep their profits growing they are making our waistlines grow at an alarming rate.
A record 65 percent of adults and 16 percent of youth today — more than 150 million people — are believed to be overweight or obese. As a result, many of these people suffer from illnesses such as diabetes and high blood pressure, and see their lives cut short.
Most people don't understand the strength and scope of the external influences that prompt them to eat more than they need to and can't keep track of the calories that keep them overweight or obese.
In fact, very small amounts of excess calories can lead to weight gain. An extra 20 calories per day can result in adding two pounds per year. Twenty calories is equivalent to a quarter-slice of wheat toast, less than a teaspoon of ranch salad dressing, two sticks of regular chewing gum or two breath mints.
Such small amounts of calories are difficult to notice unless we pay exceedingly close attention to what we consume.
Given the myriad number of things we do every day, eating is mostly an automatic behavior. It's unreasonable to expect people to devote the level of effort necessary to avoid weight gain when calories are in greater abundance than we need. Instead, society as a whole should make it easy for people to choose what to eat so they can maintain or lose weight.
We know that when people join a program where all the food is prepared and the calories are counted for them they can lose weight. But when the program is over, most people gain back the weight. What's missing are day-to-day cues that let them know when, what and how much to eat.
Cues to discourage smoking have helped millions of smokers to quit and many more not to start. The cues include "smoke-free" areas, posters warning of the dangers of tobacco and tough media campaigns that harshly criticize the tobacco industry. At the beginning, these campaigns were very difficult for smokers, but as time went on, most appreciated the benefits of an environment that supported quitting.
There are no comparable cues to help us avoid overeating. Instead of tackling the problem head-on with the critical messages of "eat less," "don't snack" and "stay away from sugar-sweetened beverages," obesity-prevention advocates are starting with mild messages. These include: "increase your intake of fruits and vegetables," and "substitute low-calorie snacks for high-calorie ones." Such efforts will not reverse the obesity epidemic, only slow the increase.
What can be done? We need bold campaigns and regulations to make it easy to control weight. Most people who are overweight or obese want help. At any given moment, one out of three Americans is on a diet. Yet, these people face an environment where it's difficult to obtain properly sized portions of food, and nearly impossible to avoid all the cues that prompt them to eat too much.
Outlets selling prepared foods should sell portion sizes consistent with weight loss because people usually can't determine the correct quantities on their own. We need complete meals with 400 to 500 calories or less. We need a six- or eight-ounce low-calorie beverage, a plate with two to three ounces of meat and one cup of vegetables.
We need to remove food from settings where eating is not necessary. Only food outlets should sell food and beverages — not other establishments such as hardware stores, bookstores, car washes or gas stations. Vending machines selling candy, chips, cookies and sugar-sweetened beverages cause problems for people in schools and office buildings and should be removed.
We need a massive media campaign against sugar-sweetened beverages. We've recognized that they don't belong in schools, but parents should not bring them into the home, either. Sugar-sweetened beverages don't belong in hospitals or in work site cafeterias — not when obesity is one of the leading causes of skyrocketing health-care costs.
We also need clear warnings and positive messages that help people resist unhealthy cues. Nutrition labels aren't sufficient. A universal traffic signal with a red light should be emblazoned on all products that the U.S. Department of Agriculture euphemistically calls "discretionary calories."
Food is more complicated than drugs and tobacco. We need to eat to survive, we like to eat, yet no one wants to be fat. But we need help to "Just Say No." Otherwise, the temptation of food that is not good for us can prove overpowering and impossible for most of us to resist.
Some ridicule government efforts to help Americans fight the battle of the bulge as the overbearing efforts of Big Brother to create a food police state. But aggressive marketing that puts too much food in front of us too often and in too many places has created an obesity epidemic that is literally a matter of life and death and cannot be ignored. Government help is needed to protect public health.
We have become fat in an environment with easy availability of calories and ubiquitous cues to eat. If we change the environment, we will adapt and lose weight. Limiting cues to eat and making appropriate portion sizes available won't prevent anyone from eating as much as they want, but it will help the majority of us who want to control our weight.
Deborah Cohen is a physician and a senior natural scientist at the RAND Corp., a nonprofit research organization. She is co-author of "Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World" (Beacon Press).
This commentary originally appeared in Pittsburgh Post-Gazette on January 7, 2007. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.