Whose fat is it, anyway?

by Tom Farley M. D., M. P H.

The author is chair of the Department of Community Health Sciences at the Tulane University School of Public Health and Tropical Medicine in New Orleans. This opinion piece was first published by the New Orleans Times-Picayune newspaper.

Do you know anyone who wants to be fat? I don't. Then why are Americans the fattest people on earth?

In 1999, three of five Americans were overweight and 27% were classified as obese. This isn't a cosmetic problem, it's a full-blown public health epidemic. Rates of obesity, which increases the risk of heart disease, breast cancer, stroke, and diabetes, have doubled in the last 25 years. Now one in eight children is seriously overweight, leading to a new phenomenon: "adult-onset" diabetes in kids. Researchers have estimated that the obesity epidemic kills 325,000 people per year in America, more than the deaths from alcohol, drugs, guns, and car crashes combined.

A lawyer in New York is taking the problem to court, arguing that Burger King and fast-food look-alikes are responsible for his clients' obesity. Most people I know think the lawsuit is outrageous. Obviously, everyone knows that fries make you fat, and no one makes you eat them. Obesity, it follows, is a matter of personal responsibility.

But is it entirely? If no one wants to be fat, but the majority of Americans are, then that would mean we are a nation of mostly lazy, stupid, irresponsible people. I find that hard to buy. If that were true, how did we get to be the number one economy in the world? I also find it hard to believe that we are much more irresponsible than our parents were 25 years ago.

People haven't changed in the last quarter century, but the world around us has. High-fat, "calorie-dense" food is now everywhere in our environment: in fast food joints, grocery stores, convenience stores, snack bars, and vending machines. Junk food has even invaded our schools; to boost revenue, many school systems are signing contracts to sell soft drinks, and 20% of school cafeterias now sell food from Taco Bell.

Throughout evolution, we humans have been genetically programmed to pack away any available calories for the next famine, so few of us have the willpower to consistently refuse calorie-dense food that we trip over. But just to be sure, the food industry floods the country with $10 billion in advertising. McDonald's alone spends over $1 billion a year. The businessmen buying the ads aren't stupid, they are spending the money because the advertising makes us eat more, and it works. One quarter of teenagers' calories now come from snacks. Americans now drink on average 44 gallons of soft drinks per year, enough calories to add 5-10 pounds.

But then eating is only part of the calorie-balance equation in obesity. We Americans have virtually stopped doing what used to be the most common form of physical activity walking to work, school, or the store because we've built sprawling communities without sidewalks in which it is virtually impossible to travel except by car. And our schools have scaled back physical education to beef up their academics. Now 80% of adolescents don't participate in PE in school at all.

Because our modern environment bears much of the blame for the obesity epidemic, we should take steps as a society to fix that environment. We can get PE back into schools and get soft drinks and other junk food out. We can build more sidewalks and bike paths, and design mixed-use neighborhoods so people can travel to school, work, or shops on foot or by bike. And we can think seriously about restricting the number and location of fast food joints, convenience stores, and vending machines that sell high-fat, calorie-dense food.

For decades, health experts have been telling people to eat less and exercise more to be responsible and during that time the obesity epidemic has ballooned. It is about time we as a society took some responsibility. After all, as a society we pay tens of billions for obesity-related illnesses through taxes for government insurance programs like Medicare and Medicaid. So why not be smarter and as a society help prevent the problem?

Lawsuits against Burger King are just about the worst way of dealing with this killer epidemic. If they succeed they just make a few lawyers and plaintiffs rich without making anyone healthier. If we want to really tackle the obesity epidemic, though, we must recognize that our environment bears much of the blame, and we must make changes in our schools, workplaces, neighborhoods, and communities that will help us bring our calories back in balance.