Are We Powerless in the Fight Against Obesity?

I read an opinion piece in the New York Times, Scientists Don’t Agree on What Causes Obesity, but They Know What Doesn’t, a few times before I could figure out what bothered me about it.

First a bit of background, much or which was laid out very well in the article. Presently about 40% of Americans are obese, defined as a body mass index > 30.[i] This percentage has grown enormously over the 40 years. Here is a representative graph from the NIH:

The CDC maps of the US that follow the increasing rates of obesity in each state over the last decade are terrifying. Obesity is closely linked to many of the diseases that we struggle with in medicine. The increased risk of death from COVID in people with obesity was unexpected and striking.

The NYT article made, or alluded to, excellent points about some things that are and are not related to the rising rates of obesity. The rates are certainly related to the changes in how live and eat. We are more sedentary. This is partially due to how our anthropocene world is designed. Although much of the physiology is not understood, it seems clear that the synthesized and heavily processed food that fill our stores, often priced below fresh and unprocessed options, make it easier to gain and harder to lose weight.

Then there are the things we know are not responsible for our weight gain. We know humans have not changed. We are not metabolizing food differently and we have not lost will power. Based on the popular media I see and the catalogues that burden my mail carrier, I do not think we have gotten a whole lot more comfortable with a diversity of body types. Movie stars remain impossibly slim.

What did I struggle with about this article? It was that a political bent, one that is currently the most acceptable, completely drove the focus. We were portrayed as victims of the food industry, powerless to resist. We are forced to use UberEATS without standing from our computers, We are paralyzed by a lack of sidewalks and easy access to ride share.

Physicians, researchers, parents, and humans should be able to hold two contradictory thoughts. It has become much easier to gain weight. There are many forces, some downright pernicious, working to addict us to brilliantly engineered “edibles” that our grandparents would not recognize. Yet, we can recognize that we are not helpless. As the Times articles stated:

“No presenter argued that humans collectively lost willpower around the 1980s, when obesity rates took off, first in high-income countries‌, then in much of the rest of the world. Not a single scientist said our genes changed in that short time.”

We can simultaneously work against the forces and designs that have led us to gain weight while also working towards presently achievable healthier lifestyles. We can develop better medical and surgical treatments for obesity while not shaming people who need them. We can avoid looking at problems through a social lens that only allows us to interpret facts in one way.

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[i] In metric units: BMI = weight (kg) ÷ height2 (meters). In US units: BMI = weight (lb) ÷ height2 (inches) * 703.