People like tasty food in large quantities. Sugar, salt, fat - all taste good. They like it because it tastes good. Badness is an unfortunate side effect.
And the large quantities? Thanks to our technological advances in the last century, food is now so cheap we can afford as much as we want - and people want a lot. As a result, we (in the developed Western world) now have a food industry that produces probably 200% of the actual food we need to survive and be healthy.
If we suddenly go all healthy, we are going to put a lot of people out of work.
Living in China, I was impressed by what they are doing to combat obesity. This includes:
Space for public recreations for people of all ages. Every apartment building or housing complex has a playground, as well as outdoor gym equipment (much of which is useful to the elderly) and nearby access to a track. There is a cultural norm to take a stroll or do some other physical activity in the evening as a family.
Subsidized space for produce vendors on every corner. It’s quicker and easier to grab an apple than just about any other snack.
Schools and workplaces are encouraged to support two physical activities a day.
Schools serve cheap, healthy, delicious food that is mostly vegetables.
For some reason, discussions like this remind me of the warm, patient-centered ER physician who I worked briefly with as a med student.
During one encounter with a morbidly obese patient (who was in the ER for a minor complaint) he told her “You need to eat less.”
I suspect that is still good advice (especially in the realm of portion control), along with not allowing kids* unlimited access to electronic devices and encouraging physical activity instead.
The temptation to graft the diets/“miracle foods”/microflora of primitive/Third World people onto “Western” populations to cure obesity/disease is widespread. It ignores genetic, cultural and lifestyle factors in the search for a quickie fix.
*tougher to restrict adult access, but not impossible.
But China isn’t some bizarre third world country. They are a country that rapidly went from “people are starving” to “full blown obesity epidemic”. Rather than sit on their hands saying “what are you going to do?” (Or better yet, throwing subsidies at junk food manufacturers) they decided to take some simple, commonplace steps to try to stem the tide.
Public health works. We have countless success stories of health problems that have been addressed on a population level.
Obesity is a sticky problem and there isn’t a magic bullet, but the fact is that some places are fatter than others, and that points to population level effects we can take advantage of.
I live in DC, one of the least overweight cities in the nation. We actually have pretty high genetic risk factors. But somehow, we aren’t getting fat at the same rate as everyone else. Why wouldn’t you want to look on to why that is, and if it can be replicated elsewhere?
Umm… I own farmland and those prices are my income thank you.
Actually corn prices are at rock bottom right now, down to about $3.61 a bushel.
They were over $6 a few years ago.
The problem with the third world is now they are suddenly first world.
Think of this. You live in a place where starvation due to famine is common. Who survives a famine? Its the person who’s body learns to burn less calories and store fat. Now suddenly they have plenty of food and see what happens.
They also tend to live in a place where physical labor is common as is walking.
Imagine, for example having to stop walking 2 miles a day with a 5 gallon bucket of water on your head!
Now imagine your that person who for years was working to help alleviate all that backbreaking labor and toil. Now your suddenly told you MUST go back to physical labor!
Bear in mind that exercise has health benefits, but it won’t work for weight loss. Playing basketball works for weight loss better than NBA Live because it’s a lot harder to eat chips on a real court. You get healthy in a gym, but you get thin in the kitchen, or rather not in the kitchen.
even sven your observations of China are your observations and cannot be disputed but they do not comport with what is written about the Chinese response to their obesity epidemic.
It is indeed impressive that Washington DC has the third lowest adult obesity rate in the United States … but before we set them up as the model also recognize that they are the third highest in kids 10 to 17 (and middle of the pack for preschoolers).
Urbanredneck remember that adequate, even excessive, calories does not necessarily equal adequate nutrition.
I noticed this with kids in the early 90’s. They seemed to go *everywhere *with a sippy cup and a baggie of Teddy Grahams or something similar in their hands. And the kids just free-ate from the baggie all the time.
I don’t recall anyone in my generation free-eating. If we got a snack, we (or mom) would portion it out, sit down, and eat.
Some of that seems like training from back seat rear facing car seats. With toddlers up to the age of four stuck in them there’s little to keep them occupied other than snacks. About the best you can do is try to keep them healthy snacks and slow the intake rate down.
People in undeveloped countries aren’t becoming obese because they are more sedentary than they used to be. They are becoming obese because Nestle and Coke are now setting up markets in these countries, creating junk food addicts out of the populace.
Giving out “good advice” may feel satisfying … and then one can always blame the person for not taking the good advice given … but that sort of good advice is not often an effective way to accomplish change.
We want to do things that deliver results for society as a whole.
The challenge is to understand the individual behavior that results consequent to their individual biology, their personal history, and the ways in which social structures, subcultures, and our institutions interact with individual biology and psychology and personal environments. The interplay triggers behaviors that result in both obesity and metabolic obesity in normal weight. Then we can use that critical understanding of all of the biologic, the psychologic, and the sociological factors to possibly determine effective ways to alter the outcomes.
I don’t think ER doctors are in the position to consider the whole of a person’s history, biology and (sub)culture. But identifying and conveying an important aspect of the reason why someone ended up in the ER can still be useful. Many people are in denial about their weight or its health consequences.
I know that I started taking my health seriously and made big changes after a trip to the ER and spending the weekend in the hospital. Nobody told me I needed to eat less, though, I came to that conclusion all by myself. To be fair, pulmonary embolism isn’t really considered an obesity-related issue, although being overweight is one of the four risk factors.
No an ED doc actually should be shutting the … heck … up if all they are going to do is say something that is serving no purpose other than using a position of power to shame someone. Telling a morbidly obese patient who is in the ED for some minor complaint that they should eat less … that would be rude and inappropriate, likely counterproductive, even if the advice, if followed, might be “good”.
The op asked about how to solve “the obesity crisis” … being rude and inappropriate is not an effective approach. And while more effective engagement by doctors in clinical settings can be part of the solution, both to motivate/guide change and to help establish some healthier habits in kids and their families in the first place, that alone is only a very small part of what must be a larger more comprehensive solution for our society. That solution does require looking at all those factors. And even deciding if the focus is obesity per se or the behaviors and habits that are associated with obesity but which can also be associated with poor health in the non-obese.