War on Obesity

Pugsley and ItzlOriginally uploaded by nodigio

Eric A. Finkelstein: Why does the private sector underinvest in obesity prevention and treatment?
North Carolina Medical Journal, 67 (4):310-312.

I’m cherry-picking from an interview because I think these things are important to consider when considering the so-called “war on obesity”.

“The reason is that the costs of being thin, in terms of what they would have to forgo, have just gotten so high that people are saying “I’d rather be fat” than make the increasingly difficult sacrifices necessary to be thin.”

This comment acknowledges that it does cost a lot to be thin. He doesn’t get into all the costs that fat people endure to lose even a few pounds, but he does mention a few: farm subsidies for the eventual end products of high fructose corn syrup and soy proteins, long working hours, city zoning ordinances, and No Child Left Behind requirements. I’d like to mention a few more that he didn’t mention. It was, after all, an interview and he probably didn’t have time or opportunity to get deeply into the subject.

Some of the other cost factors in weight loss include “diet” supplements that contribute to weight gain. How is it going to help people lose weight when something advertized as “lo-cal” isn’t really low calorie or the calories are all derived from fat and/or sugar rather than real food? Food choices that are readily and affordably available to people are also not “real food”, but highly processed with many additives foods. The more processed a food is, the less healthy and nutritious it is, therefore it “requires” additives, but the added vitamins and minerals may not be ones which are digestible or can be used by the human body – not all vitamins and minerals are equal.

The food manufacturer’s propensity for displaying large portions in ads as “single portions” when in reality, their nutritional information is for much smaller portions (cereals are notorious for this – their ads generally display a 2-cup portion bowl, but a single serving is a half cup). Even worse is when they package things in “individual” portions, but if you read the labels, their “individual portions” are not “single servings” – a can of soda, for example, is 1 ½ servings, but most people assume it’s a single serving because it’s sold as an individual portion. Otis Spunkmeyer muffins, packaged individually, are actually 2 or 2 ½ servings. It’s hard to know what a single serving is when items aren’t sold in “single serving” sizes even if they are sold in individual portions – a single muffin, a single can of soda, a single can of soup (did you know that a small can of Campbell’s Chicken Noodle Soup is actually 4 servings, not one or two?). A single serving size either needs to be a realistic portion – and the nutritional information given for that realistic portion; or the manufacturers need to actually package items in single rather than individual portions. This, of course, does not apply to items which are obviously packaged in bulk for multiple portions, only those things people can reasonably assume are single or individual portions.

Restaurants also don’t help matters with their “biggie” and “super-sizing” options because economically minded people will think a 16 oz soda (which is TWO SERVINGS) costs $1.29, but a 32 oz soda (FOUR SERVINGS) is available for $1.49, so it make sense economic sense to buy the 32 oz soda. But then it’s served in an individual cup with a single straw, and we’ve been so conditioned to not share glasses that the beverage – enough for 4 people – is consumed by just one person. Did you notice that a single regular hamburger is actually 2 (or more) servings? The children’s burger is an actual single serving size – too large for a child, but the correct size for an adult. It’s no wonder people don’t know what a nutritionist’s single serving is – and nutritionists aren’t providing information on the portion size actually served.

Restaurants only consider portions in economic terms, not nutritional ones. Their portions are served based on maximizing profits, not on providing realistic portions. A lot of dieticians and nutritionists advocate eating only a portion of your restaurant meal and getting the rest to go, but it’s hard for people who’ve been raised to “clean your plate, children are starving in Africa!” to leave food on their plates. Children who’ve been forced to stay at the table until they’ve eaten all the food on their plate have been trained to leave no left-overs – and they pass their training on to their children.

It is psychologically hard for many people to only drink half (or less) of the soda they were served, to eat half (or less) of the meal they purchased. Try eating only half of a single Otis Spunkmeyer muffin. The other half goes rapidly stale unless you’re prepared with fresh wrap because the wrapping in which the muffin is sold isn’t reusable. Preserving half your take-out lunch for a future meal is also difficult unless you’re prepared with an ice chest (not all workplaces have refrigerators available, and when they do, the food isn’t always safe from being eaten by someone else) and a place to store it (some workplaces have nowhere for employees to safely store personal belongings, from coats and bags to left-overs). Rather than waste good (expensive) food, most people will simply eat it – and accept the calories and the fat the calories provide.

“I have a fairly well-paying job, but it keeps me at the computer for about 50 hours a week. The choice for me to quit my job and get one that’s more active would mean a huge drop in pay. It’s not worth it to me. Many people are in that situation”

This is certainly a huge problem in today’s society. Our jobs are located far from our homes and so many of us must commute, either in cars or on buses/trains that we get much less exercise walking to work once gave us. Ditto for schools – school buses now pick up children who live within half a mile of school instead of the 2 mile limit in effect when I was a child – so children don’t walk as far. Even those children who live inside that half mile limit are often driven to school by parents because the parents have to pass by on the way to work anyway. We work far longer hours now, too. In the 70’s the average workday was 8 hours including the lunch break, now, it’s 8 hours excluding the lunch break (during which many employers still expect the employee, especially the lower paid employees, to continue to work), extending the work day to 9 hours. Then there’s mandatory overtime and sometimes unpaid mandatory overtime. With the commute, the workday has progressed from an 8 ½ hour day to a 10 or 11 hour day – most of that spent sitting down or moving in very limited spaces. With nowhere to store lunch left-overs or real food for lunch, no time for exercise, longer work hours, and mostly only highly processed foods available in restaurants and vending machines, of course people will gain weight. They need the money to pay bills more than they need to lose weight. It’s a trade-off that many people don’t consciously make, but they nonetheless make it.

“There was an article published in the Journal of the American Medical Association that shows that today’s obese population has better cholesterol and blood pressure values than normal-weight individuals did 30 years ago.”

All this hype and media noise about how being fat makes people sicker isn’t supported by the actual medical data. Fat people are no sicker than skinny ones, and are often healthier than people who are too thin. The extremes on either end are the unhealthy people – those who are either too fat or too thin. There’s a huge middle range of weight that is acceptable and healthy, much larger than the media would have us believe.

“Look at how we subsidize farmers, encouraging corn and soy production over other vegetables and fruit. Corn is used for high-fructose corn syrup, and soy is used in hydrogenated fats. They have become the sweetener and fat of choice because they are so cheap. As a result, any product with lots of added sugars and fats will generally be cheaper in part because of government subsidies.”

Hugh crop monoculture foods at the expense of real foods may be profitable in the short run, but for long term, it destroys the environment and has a seriously negative and expensive effect on the people who have little choice but to eat these subsidized foods.

“Another example is the way we build communities. Many communities have zoning laws that prevent mixed-use buildings, so homes go up in one part of town and businesses in another, and you can’t get anywhere without driving your car. This really discourages pedestrian traffic. “

It also discourages small business owners, who often depend upon foot traffic for their appeal. The small corner grocery store is a thing of the past right now. In the entire city where I live, there is not one single grocery store. To buy any food other than high sugar, high fat convenience foods, we have to travel to another city.

Another thing the zoning laws do is discourage people from interacting with their neighbors. Not only do people work longer hours, but when they get off work at last, they have to travel great distances to shop, making their time outside of their neighborhood even longer. There’s less time to be neighborly and therefore less time spent in outdoor activities. Gardens are difficult to maintain when you have only an hour or two of usable daylight, meaning most yards are easily mowed grass – and zoning follows making many kinds of gardens illegal – from front yard victory gardens to backyard compost heaps.

Bad zoning laws therefore reduce exercise that gardening would encourage and the real food gardeners would produce.

“Or look at the No Child Left Behind Act. Many schools cut out PE because they need all the time they can [get] to teach the core classes. And kids are studying more, so there’s less time for sports or other activities. Like many well-intentioned policies, this act may be inadvertently making kids less active.”

The schools also cut out a lot of fine arts classes, which provide students with incentives to be physically active during the day. Recess has been reduced and heavily structured in the lower grades, eliminated in the upper grades, and PE is relegated to after school for those students who want to play on the school sports teams – notably track and football, although baseball and basketball still have schools fielding teams. But there’s very little in the way of non-team sports and physical games and non-structured outdoor playtime. Younger and younger children are being forced into school desks for longer periods of time to their detriment. No wonder 3 out of 4 children are not physically fit; even if they are thin, and 2 out of 3 are overweight.

I’m not in favor of monitoring and censoring what children bring in their school lunches from home, but I do fully support removing soda machines and replacing highly processed snacks in vending machines with healthier, less processed options. I’d even support removing vending machines entirely from schools.

In an entirely separate rant, I’ll address the No Child Left Behind program. Suffice it to say here that testing isn’t anywhere as important as so many people seem to think it is, especially when it is conducted to the overall detriment of both the health of the children and their education. In the years that the No Child Left Behind program has been in force, there has not been a significant improvement in our children’s education, but there has been a significant loss in their health. Removing vending machines from schools will have a positive effect on children’s health. Using real as opposed to processed foods in the school meals will also help. Giving children time to play and exercise – both structured and unstructured – will help our children. The educational aspects are a separate issue – worthy of being addressed separately. Right now, we’re concerned with their physical fitness.

“In order to be a cost-saving program, employees would have to lose enough weight, keep it off long enough and stay with the company long enough so that the reduction in health-related costs would be borne by the company. In reality, people change jobs every five years on average, so these programs are unlikely to pay off for most firms. Moreover, many of the costs of obesity occur after the age of 65, when Medicare covers the costs. Employers are likely not interested in saving these costs.”

This makes imminent sense. The only reason many companies install their underused exercise rooms is because the employees demand it as a perk, not as a health benefit. New hires are often not told about the exercise room, given a tour of it, or provided with the resources to use it effectively. It is a room full of exercise equipment, and possibly with a shower, that sits there for employees to use or not – and if the employee wants to use it, they often have to do so on their own time without spotters or help: before work, after work, or at lunch. This assumes the room is unlocked for their use at these times. It’s seen as a “perk”, not a necessity and treated as such.

The vending machine issue from schools also applies somewhat here. If vending machines offered a wider range of real foods and beverages and a smaller range of sodas and highly processed snacks, many employees would choose the healthier options. The problem here is that the “real food” offered is usually of low quality and not fresh, so people will opt for a Snickers Bar over a nicked or badly bruised apple, a soda over out-of-date juice. And if the soda is cheaper than the bottled water, they’ll choose the soda. If the bruised apple costs more than the Snickers, they’ll certainly choose the Snickers.

“People would prefer not to be fat; they just don’t want to go through all the effort it takes to be thin. But if someone can make it easier for them, there will be a huge demand, even at significant cost.”

This is mostly true. People would prefer to look good and be healthy, but they can’t afford the time and the expense our modern lifestyle demands in order to achieve these things. They have to travel to and from work, to and from the stores, and they have to spend 9 or 10 hours a day at work. If they expect to get 8 hours of sleep at night, they have a scant 3 or 4 hours a day to get in the required exercise. Remember, they will likely have to travel to and from a fitness center unless they can afford a house large enough to house the exercise equipment – and they’ll have to exercise alone if that’s the case – no spotter, no help. So, they have out of their day less than 2 hours to spend with their family or doing pleasurable things instead of the 5 or 6 hours we had in the 70’s.

Our society is set up to isolate us and reduce our health and well-being. I don’t believe it was done deliberately. There was no conspiracy behind this, merely a series of cascading effects. It all crept up on us over the last 40 years. Work hours got longer even though productivity didn’t increase that much – probably because employers hired fewer people to do the work so fewer people had to work longer hours to get the same amount of work done. Travel time increased because zoning laws prevented businesses and homes from being closer – and this was because as people gained in wealth, they created suburbs that were business-free zones. People wanted to separate their work and home lives as much as possible – even if it meant hour(s) long commutes.

There’s an interactive map (I thought I had a link to it, but I don’t) that lets you see what the population is of the major cities during business hours and after business hours, and you can quite graphically see how empty the suburbs are during the day and how empty the business districts are at night. In a healthy society, there would be very little shift in population between day and night times. People would live close to where they worked, close enough to walk or to travel only short distances.

There are many ways to make it easier for people to get healthier (not necessarily thinner, because I don’t think thin is the be-all health answer the media makes it out to be), most requiring very little effort or cost. Losing the fatty snack foods and soda vending machines is a start. Replace them with high quality minimally processed foods and beverages.

Re-zoning so people can live and work in the same neighborhood would increase community feelings and reduce commute times so people could spend more time with their families.

Flex-time and home offices so employees could work from home would also decrease commute times and give employees more leisure time.in which to attend to family needs and hobbies – which would in turn allow people to be more physically active and thus to more naturally lose (or never gain) excess weight.

Encouraging local farmers to sell locally and to grow a more diverse harvest for local consumption would also contribute to a healthier lifestyle.

Maybe instituting a half hour on-the-clock recess time at work would also help – not necessarily PE with the need to change clothes and shower, but a specific time when employees were expected to get up, move around, socialize, maybe take walks around the grounds (or inside, if the weather is bad).

If employees have met productivity goals, why not allow them to go ahead and leave for the day? Staying at work once they’ve finished is not beneficial for the company or the employee, but rewarding them with paid time off for meeting goals will inspire others to emulate those work habits.

Certainly giving school children back their recess time and removing the vending machines would help establish healthy habits early on. And even more certainly, establishing a broad “comfort zone” of health regardless of weight rather than narrow and rigid weight restrictions that don’t take into account health and well-being is a much better attitude to impart to our children and one another. When we can look at a person and see the joy and health glowing in them rather than some set weight point our society as a whole will be healthier.