Bioethics Forum Essay

Why Shame Won’t Stop Obesity

I am still in medical school, but today I sigh the frustrated, disapproving sigh of a fully trained doctor. “You know,” I scold the middle-aged man in front of me, “you really should start eating better.”

Like many patients I saw in clinic that morning, this man is obese. His diabetes is poorly controlled. His blood pressure is through the roof. And he hasn’t lost a single pound in months.

Oh well, it’s lunchtime and I’m hungry. I slip off to the hospital cafeteria and begin to ponder why these patients can’t seem to lead a healthier lifestyle. As I wait in line, I consider a more pressing problem: should I get the fried chicken or the four-cheese pizza? I settle on popcorn shrimp and some curly fries. Only then do I ask myself what exactly I would have recommended my patients eat – besides maybe a side of cheesy broccoli and some bruised bananas – had they joined me for lunch.

This, sadly, is the case in the cafeteria of a major hospital, an institution devoted to preserving and promoting health. It is a stark and telling microcosm of a much broader issue – one in large part responsible for the skyrocketing rates of obesity and associated disease in this country.

Americans today are exposed to an unprecedented amount of readily available high-fat, high-calorie, and low-nutrient foods. We are saturated with junk food advertising. We are eating more and more meals outside the home, and portion sizes are bigger than ever. Healthy options are more frequently the exception than the rule.

It is hardly surprising, then, that we find ourselves in the midst of an obesity epidemic. Nearly three-quarters of Americans are overweight or obese, and a report by United Healthcare predicts that half of all American adults will develop diabetes or prediabetes by the end of the decade. The report further estimates that diabetes – which increases one’s risk of stroke, cardiovascular disease, kidney failure, blindness, and amputations – will cost our society $500 billion a year  by 2020.

In an effort to combat this disturbing trend, Georgia – the state with the nation’s second highest obesity rates – recently launched a provocative and controversial ad campaign. It emphasizes the role of parents in failing to recognize and address childhood obesity. In the commercials, obese children sullenly ask questions like, “Mom, why am I fat” and drive home poignant messages like, “It’s hard to be a little girl, when you’re not,” or “Being fat takes the fun out of being a kid.”

One might argue that Georgia’s campaign is a bold and necessary step in the right direction, and to the extent that it raises awareness and sparks constructive conversation, it may be. However, these commercials miss the point. Shaming children and parents into losing weight is unlikely to be an effective strategy. It increases stigma on those already struggling with the psychosocial consequences of being overweight, and shifts the focus of obesity control efforts to personal responsibility at a time when, for many individuals, options for improving eating habits may be limited.

While taking responsibility for one’s health is certainly part of the solution, we must also recognize that we have created a food environment so ripe for obesity that to expect anything else would be irrational. Even for the most knowledgeable and resourceful among us, consistently eating well is a challenge. It is difficult to distinguish healthy options from unhealthy ones, and purchasing the right foods once they are identified is no cakewalk. Furthermore, people living in low-income areas have limited access to healthy food options for a variety of reasons, a barrier that contributes to their particularly high risk for being obese.

There is much we can and should do to reverse the current trend. An important step would be to provide monetary incentives to promote the production of and access to fresh, healthy food. By subsidizing fresh fruits and vegetables and supporting restaurants and vendors that offer healthy alternatives, we might create an economic environment more conducive to healthy eating. Making healthy options more accessible and affordable, especially for those living in low-income areas of the country, is a vital component of reducing the burden of obesity. When you can buy 2000 calories for under $10 at your neighborhood McDonalds, but have trouble getting your hands on an apple, it’s difficult to justify trying to shame anyone into skinniness.

Another important measure would be to minimize junk food advertising, especially to children. Each year, the food industry spends nearly $2 billion marketing its products to children, and evidence suggests that children exposed to junk food advertising express greater preference for these types of foods. Asking the industry to refrain from advertising foods that contain unhealthful amounts of sugar, salts, and fats to youth could also encourage the production of healthier options.  I think that initially the guidelines should be voluntary, but significant public and political pressure should be placed on the food industry to adopt them. If it becomes clear over time that they are unwilling to do so, then federal regulations may be needed.

A third initiative might center on education and empowering youth to make informed decisions. Instituting nutrition and health curriculums into public schools would help children learn how to read nutrition labels and identify healthy foods, as well as understand the negative long-term consequences of obesity. Today’s youth may be the first generation of Americans to live shorter, more disease-riddled lives than their parents – a staggering prediction based largely on the rapid rise in childhood obesity. Let this not be our legacy.

Dhruv Khullar is a student at Yale School of Medicine and Harvard Kennedy School.

Posted by Susan Gilbert at 03/28/2012 12:04:52 PM |

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