The Obesity Epidemic: It’s time to stop blaming the victim

The proportion of overweight American adults remained consistent at about 1 in 3 since the 1960s. However, obesity rates have increased nearly three-fold from less than 15 percent in 1960 to nearly 40 percent today. The prevalence of diagnosed diabetes has also increased from less than 2 percent of adults in 1960 to 8 percent in 2014. High cholesterol, high blood pressure, heart attacks, and diabetes disproportionately affect those who are obese. What is responsible for this drastic increase in obesity, and will a doctor’s advice to eat less and exercise more ever make a difference?

Eating more without doing more logically leads to weight gain. Americans increased the number of calories they consume by 23 percent from 1970 to 2010. Waistlines did not increase without help from the food industry and the government. Most of the increase in food intake was in the form of refined grain products, fats, meat, and sweeteners. Food manufacturers took advantage of government subsidies introduced in the 1973 U.S. Farm bill to create calorie-dense foods that could be produced inexpensively and become more widely available.

Farmers receive subsidies for producing corn, soybeans, wheat, rice, sorghum, dairy and livestock. A large proportion of these products are converted into processed foods, refined grains and high-fat meat and dairy products. Additional unintended consequences of this policy include 1) penalties for producing “specialized crops,” including fruits and vegetables, and 2) farm and crop consolidation which increases efficiency but reduces agricultural diversity. Nearly 90 percent of U.S. farmland is used to produce three crops---corn, soy and wheat---most of which is used for animal feed or refined food products.

Subsidized food commodities are disproportionately consumed by younger, poorer, less educated and less food-secure individuals. While there is some evidence to support that these are the very groups that are also more likely to be obese, the data is inconsistent. What is consistent, however, is the role that the food industry has played in shaping the consumption patterns of all Americans.

Food producers and marketers play a key role in making the least nutritious food the most affordable, accessible and tasty through the manipulation of three key ingredients – sugar, fat and salt. This happens in the supermarket as well as in restaurants. The percent of calories Americans consume from food eaten outside of the home increased from 16 percent in 1977 to 34 percent in 2012, and much of that is attributed to fast food. Restaurant meals tend to be higher in fat, sugar and salt than home-cooked meals. The convenience, low cost and taste of fast food is too great a draw for most Americans to resist.

The food industry would like the American public to believe that proper weight can be maintained by primarily focusing on exercise, while allowing free choice to eat what we want. However, exercise places a distant second to consuming fewer calories when it comes to maintaining an ideal weight. Exercise only burns off 10 to 30 percent of the energy that we consume through food and much of our exercise comes in the form of daily activities like walking and moving around. Time at the gym has many benefits, but it won’t provide the weight management that comes from reducing calorie intake.

If obese patients receive little benefit from the healthcare system’s admonitions to lose weight, what are the public health approaches that can give Americans a better chance of reducing obesity rates? Aligning subsidies with healthier food sources would give Americans access to lower calorie food at lower prices. Taxing processed, sugar-sweetened, salted and fat-laden “junk foods” would have an impact on consumption of those foods. This was demonstrated in Mexico when an 8 percent tax on junk food and 10 percent tax on sugar-sweetened soda resulted in a 5 percent reduction in purchases.

Ultimately, an alignment between the food industry, government and healthcare system must be achieved for the United States to successfully address its obesity epidemic. Unfortunately, the trend seems to be going in the opposite direction. Not only are obesity rates increasing in the United States and other developed countries, but developing countries are increasingly faced with a double burden where overweight and under-nourished people live side-by-side. 

Progress and modernization have become synonymous with greater access to meat, fast food and refined foods that are high in fat, sugar and salt. The conversation about obesity needs to move out of the doctor’s office and into the policy arena to achieve meaningful and lasting results.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.