Obesity shows us what is being done to people, not what people are doing to themselves…

When I have more time, I plan to write about the generally woeful state of public health in Northern Ireland. In the meantime, John Burn-Murdoch writing in the FT has some interesting views on the subject of obesity:

Over the past 50 years, no country has reversed the trend of rising obesity. It seems increasingly likely that one reason for this is that public (and policy) understanding of its drivers is woefully outdated, meaning that most proposed remedies — such as food labelling — are misguided, and many accelerants — such as stress and abundant processed foods — are unchecked.

The “individual responsibility” idea, that people gain weight due to self-destructive decisions that they can be enlightened out of, has proved false. The view that it is simply a matter of calories-in minus calories-out has also been debunked.

While people who consume plenty of calories can increase the amount of energy they expend by doing more physical activity, those who reduce their food intake in an effort to lose weight find that doing more exercise has little to no impact on calories burnt. The body compensates by cutting down on energy for other functions, making weight loss much harder than weight maintenance.

There is now a scientific consensus that whether or not someone becomes overweight is, for the most part, the result of the interplay between genetic predisposition (responsible for around half of variation in body mass index), and environmental factors.

Even putting aside genetic differences, it is only trivially true to state that those who consume more or lower-quality calories increase their risk of gaining weight or developing related health problems. The question is why people consume differently.

The evidence increasingly points to external factors. Several studies have found that chronic stress, loneliness, lack of fulfilment or negative life events are strongly associated with weight gain. Job insecurity and financial hardship are especially significant. Another found that among people with a predisposition to gain weight, lacking control over what tasks they perform in their job, and how they do them, was strongly associated with weight gain.

Obesity shows us primarily what is being done to people, not what people are doing to themselves. Increasing healthy eating and exercise are admirable goals and will improve health outcomes regardless of their impact on weight. But if any country is to reverse one of the world’s most stubborn trends, its policymakers must recognise that the solution will come not from haranguing people, but from improving the quality of their lives and their environment.


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