A Big Fat Crisis (34 page)

Frequently Asked Questions

1. What about personal responsibility? Shouldn’t people be able to control themselves better?

Personal responsibility requires insight into the factors that lead to obesity and the capacity to overcome barriers to a healthy diet. Unfortunately, too many people lack both insight and capacity. Our expectations of most people are unrealistic given the conditions of our modern food environment.

Imagine that the roads are poorly lit, full of deep potholes, and there are ditches on each side with no barriers to prevent people from falling in. Most people should be able to navigate these roads if they go slowly, travel in the daylight, and look carefully at what lies ahead. And some may have better vision or faster reflexes that place them at lower risk of a mishap. However, anyone in a hurry or who travels at night and doesn’t take the proper precautions will get a flat tire, crash, or both. With broken roads every journey becomes a risk. Wouldn’t it be better if the roads were smooth and in good repair, so people could traverse them quickly without having to make a special effort to be careful? By repairing the roads, everyone’s risk for a crash will be reduced.

The modern food environment is like a road filled with potholes and ditches. There are food hazards all around us, and only by being very careful, deliberate, or completely avoiding most restaurants and supermarkets are some of us able to protect ourselves. Yet there are plenty of people who don’t have the wherewithal to defend themselves from all the food hazards around us. If we had standards for the way food is marketed, fewer people would have problems choosing a healthy diet and most of us wouldn’t have to worry all the time about
what we are being served. People will have a greater capacity to be responsible in an environment that has fewer hazards and risk factors for diet-related chronic diseases.

2. If the environment is so overwhelming and personal responsibility doesn’t count for much, why isn’t everybody obese?

Although most people will eat more than they should when presented with more food than they need, that is not the case with everyone. Some people have early satiety, which makes them feel full when eating relatively small amounts. Some people are seldom exposed to the triggers that cause excess eating. Others are insensitive to such triggers because they are preoccupied or depressed or engaging in other unhealthy behaviors like smoking or using drugs, which can limit eating. Some have conditions like malabsorption or diseases that make them lose weight or lose their appetite. Some, as research has shown, can successfully resist temptation and routinely work very hard to carefully choose what and how much they eat, but this group is the minority, as most Americans are overweight or obese. I don’t think it is appropriate to think of two-thirds of the population as irresponsible. It doesn’t square with everything we know about the American people and their general ethic of hard work.

3. What about corporate responsibility? Why should businesses have to worry about consumer choices?

Responsible businesses should not encourage people to consume more food than their bodies need to stay healthy. Businesses should not be creating conditions that result in harm to individuals. In other sectors, businesses are not allowed to encourage people to take risks without proper warnings or without obtaining signed consent forms. Right now, if a restaurant serves somebody food with an amount of fat, salt, sugar, or calories that could increase his or her risk of chronic diseases, the customer is not usually warned. Nevertheless, rather than merely warning people, a better approach would be for businesses to promote foods that are healthy and don’t require caution. Food should be promoted in a manner that makes it less likely for people to increase their risk of chronic diseases. That way, if people do eat poorly, it would
be their own choice and not the result of an outside party overly influencing them.

4. Can’t you teach people not to eat mindlessly?

We often eat mindlessly because we can; humans have evolved to be able to do this. In fact, our capacity to eat without having to pay attention to the food and to do other things simultaneously should be considered a valuable and important asset. We can pay attention to our surroundings, socialize, and plan for the future while eating automatically. Not only does this save us a lot of time, but it helps us create bonds and positive relationships with others. Trying to teach “mindful” eating as a consistent practice would be an uphill battle and may also have negative unintended consequences, such as interfering with social relationships.

Many weight-loss interventions try to make people more aware of what they are eating, but usually after an initial period of success people fall back into the more natural routine of eating automatically. Besides being boring, being mindful of eating all the time precludes doing other things during meals. Most people do not want to “waste” time by concentrating on every bite and would rather use their brains to ponder other things.

5. How is the obesity epidemic related to global warming?

Too much carbon dioxide (CO
₂
) in the atmosphere traps heat and warms our planet. Our lifestyles are the direct cause of the release of excess CO
₂
, from our use of motor vehicles to our watching plasma televisions, which suck up lots of energy. But it isn’t obvious to most of us how our everyday actions are linked to global warming. For example, we can’t see the immediate impact on climate change of our use of air-conditioning, taking an airplane to go on vacation, or buying a steak dinner.

When we eat too much, our society has to produce more food and burn more fuel for harvesting and transport—all of which increase carbon emissions. An estimated 30–40 percent of all food is wasted, and 97 percent winds up in landfills. Food decomposes to methane, a potent global warming gas twenty-five times more powerful than CO
₂
.
Serving less would reduce waste, and eating less would reduce carbon emissions. Eating less meat and dairy in particular would have a huge impact because of the methane produced by cattle and dairy herds; meat and dairy products, account for about 18 percent of all greenhouse gases. Giving up meat and dairy one day a week is equivalent to driving 1,160 fewer miles per year.

Everything we do that consumes energy and/or produces waste contributes a little to the warming of the atmosphere. Multiply the energy use of a single person by a few billion people—that is the source of global warming. If we all reduced our behaviors that require energy consumption by just a small percentage, we could stem global warming. We could spend less time indoors (reducing air-conditioning and heating costs), travel more by walking or bicycle (driving our cars less), and eat less red meat and dairy products (reducing methane gas production). As a result, we would also get more exercise, burn more calories, and be less likely to gain weight and develop chronic diseases. Fortunately, taking steps to improve our health will also help protect our planet.

6. Shouldn’t people be free to make their own decisions?

People’s decisions are constrained by what is available, and people are vulnerable to a wide variety of framing effects, including prominence, position, and pricing. Change any one of these things and people’s decisions will change.

Who controls how food is presented? Right now corporate America manipulates all the factors that guide people toward making choices that increase their risks for chronic diseases. The elements that influence people’s choices should be made transparent so our decisions can be thoughtful and deliberate rather than the consequence of manipulation.

We accept a host of regulations that were created to protect people, including regulations about hygiene and safety that force restaurants to follow standard procedures in preparing, storing, and serving food. We accept regulations that force architects and contractors to build according to standards that govern construction and safety measures. We accept regulations that limit the sale of alcohol to licensed
outlets at certain hours and in standard portions. We accept and appreciate regulations that keep our air and water clean and safe. Many of us depend on regulations that protect workers and specify safe working conditions, minimum wages, and overtime. Regulations are generally intended to protect people from situations where they have a limited capacity to protect themselves. Regulations can also make the consequences of our choices transparent at the time we are making decisions.

While some regulations can go too far and make every task unnecessarily onerous, most regulations that have stood the test of time have made life more predictable and living conditions safer. If we can be confident that our air, water, and shelters are safe, we will have the time and ability to focus our energies on activities beyond the basics of survival. Today we lack sufficient regulations that would help people make safer food choices. Regulations that govern how food is sold and served could protect us from being manipulated and undermined and reduce our exposure to foods that increase the risks of chronic diseases.

Regulations don’t stop people from making their own decisions. Setting uniform standards makes it easier for people to make informed choices and protects us from relying on automatic, impulsive choices that compromise our health. People would still have the freedom to choose an unhealthy diet, but they would know that the choice was theirs rather than a consequence of an unregulated environment.

7. Why is regulation a reasonable approach to stop the epidemic?

Regulations have been effective in limiting alcohol-related harm and in reducing tobacco use. The regulations we have in place for alcohol are good models for potentially controlling obesity. Although the alcohol industry might like to see people drinking alcohol all day long in large quantities, most of us accept the legal limitations on alcohol availability and consumption as necessary to prevent too many people from becoming drunk and harming themselves and others. How many people think we should sell alcohol from vending machines, display it at every cash register from bookstores to hardware stores, serve it at meetings at work, allow people to routinely drink on the job, or sell it to children? Limiting the availability of alcohol, drinking on the job, and drinking in public
settings has helped reduce drunkenness and alcohol-related harm. By and large most Americans will agree that our restrictions on alcohol are reasonable. Restrictions on nonessential, low-nutrient processed foods and on serving sizes that increase the risk of chronic disease could eventually be considered as acceptable as alcohol regulations, especially if they help people moderate their consumption.

8. Can’t we educate people to make better choices?

Lack of education is not the main reason why people eat too much. Most people already know they need to eat less to lose weight, and that they should avoid foods like candy, cake, cookies, and chips. The problem is that people’s choices are highly influenced by the environment. Usually people fail to recognize how they are influenced by merely seeing tempting products or by viewing others’ behaviors. Lack of insight is a key barrier to making better choices. Unfortunately, because we often lack the capacity to recognize the triggers of our behaviors, it may not be possible to train everybody to overcome environmental barriers to a healthy diet.

9. Doesn’t the food industry just give people what they want?

What people “really” want depends on how goods are presented. If hamburgers were marketed as being disproportionately responsible for global warming and for increasing the risk of cancer and heart disease, rather than as mouth-watering, delicious, and satisfying, fewer people would “really” want them. Our tastes and preferences largely depend on culture, availability, and marketing. Our preferences change all the time. Take sushi, for example—it was practically unheard of thirty years ago, and now it is quite popular in the United States.

10. Are people too stupid to make their own choices?

People are not stupid, but they are also not robots that can make wonderful and optimal decisions twenty-four hours a day, especially when they are exhausted, work two jobs, are trying to raise a family and make ends meet. We are not perfect. Everyone has his or her limits. In addition, marketing methods influence people in ways they cannot
easily recognize. A society that allows food marketers to push at our limits and undermine us all the time is not helping most of us.

The kinds of regulations I am advocating do not remove individual choice. They increase transparency so that people will be able to make decisions deliberately, not automatically. Regulations can protect people from strategies that influence them without their awareness, like priming and conditioning.

11. Aren’t there effective solutions to the obesity epidemic other than creating more regulations?

So far, solutions that leave the problem to individuals to solve by themselves have not worked. Benign neglect is not benign, as the rates of obesity appear to be worsening for some groups. Although obesity rates are stable for others, we have not seen strong evidence that the prevalence is declining in any populations. As a society we have been reluctant to address the malleable forces that lead to obesity because of the common misperception that most individuals have the capacity to control their own consumption, regardless of the conditions of the food environment. Indeed, many groups prefer not to address the problem at all, and take the “You’re on your own” approach.