Our obesity epidemic is an issue of public health, not personal virtue
To Debora Burgard’s eyes, it was a beautiful sight.
"I was teaching this dance class where all of the students were women who weighed at least 200 pounds," recalls Burgard, a California-based clinical psychologist and co-author of Great Shape: The First Fitness Guide for Large Women (iUniverse.com, 2000). "Sometimes I’d just stop and marvel at what I was seeing: Here were these beautiful, fat women—not even interested in losing weight—but just being happy with the movement of their bodies and living their lives without shame or fear. To me, they were the epitome of health."
Not everyone would see it that way. In recent months, obesity has once again become the American cause celèbre, with the release of the surgeon general’s report on what’s been called an "epidemic" of weight gain in the United States. While it’s great that Burgard’s pupils are out shaking their thang, many health researchers argue that we need to do something about the causes of obesity in our society. Fat is now being labeled a serious—and costly—public health crisis linked to heart disease, diabetes, and other serious illnesses. The discussion has taken on the language of crisis.
"In 1991, when the epidemic was less intense, researchers from St. Luke’s/Roosevelt Hospital in New York estimated that obesity killed 325,000 Americans a year—eight times the number who die of AIDS, and more than the combined deaths from alcohol, drugs, firearms, and motor vehicles," write health scientists Tom Farley and Deborah Cohen in The Washington Monthly (Dec. 2001). "Soon—if it hasn’t happened already—obesity will become the number one killer in America. The cost of caring for those sickened with entirely preventable obesity-related illnesses tops $70 billion per year, about half of which is paid by government."
Dean Ornish, an alternative health authority and president and director of the Preventive Medicine Research Institute in Sausalito, California; adds "There is no question that being obese has serious health consequences. This is not a moral issue. This is a serious public health issue."
For many, the greatest cause for concern is the increasing number of overweight children. In the early 1990s the National Center for Health Statistics found that obesity in kids between 6 and 17 had doubled to 11 percent during the previous decade—and those numbers have surely risen in the past 10 years. A matching study of adults, quoted by Farley (a professor of public health at Tulane University) and Cohen (senior natural scientist at the RAND Corporation), "found that the proportion of obese adults increased by two-thirds in the 30 years from the early 1960s to the early 1990s. Telephone surveys by the Centers for Disease Control (CDC) have shown obesity rates skyrocketing another two-thirds since then."
How can this have happened during the decades when slimness, exercise, and healthy food became obsessions in American media and advertising? Those trends have been overwhelmed by the far more significant social impact of high-fat convenience foods and declining levels of physical activity, note Farley and Cohen. "The desk job, the television, the Internet, suburban housing developments and their roads to nowhere all conspire against us."
Little things can add up. A University of Minnesota study found that office workers who spend five minutes each workday e-mailing their colleagues rather than walking down the hall to chat in person gain one extra pound by the end of the year. And 20 minutes a day spent in the car rather than walking can add five pounds annually.
Part of the crisis stems from Americans’ view of fat as an issue of individual virtue, not public health. "We beat ourselves up for lack of willpower or for choosing a night at a burger joint with the kids over a trip to the gym, dramatizing personal failure even though in today’s junk-food–laden society, it’s nearly impossible to stay thin," write Farley and Cohen. Adds Marilyn Wann, a San Francisco-based zine editor, diversity trainer, and author of the book FAT!SO?: "American culture has this binge-purge mentality when it comes to food. We binge on high-calorie, high-fat items, and then purge on diets and food restrictions. It’s just like any yo-yo diet. In the end, you gain back the weight and 10 extra pounds."
Farley and Cohen make a comparison to the 19th century epidemic of cholera, which was once believed to be caused by the poor personal hygiene and intemperate drinking and eating habits of the urban poor. They had only themselves to blame, according to many social reformers of the time. But cholera turned out to be more susceptible to clean water than moral uplift; the disease rate declined after the introduction of better sewage and water-supply systems. And modern obesity, like cholera in 19th century New York and London, is more common among the poor and disenfranchised.
"It got to the point where I couldn’t ignore it any longer," says Melanie Marchand, a former corporate executive who left her job as a marketing manager to open Sisters in Shape, a Philadelphia-based organization that promotes health and fitness among African American women. She offers aerobics classes and personal training sessions for women of all races, though much of her programming focuses on fitness issues commonly encountered by African American women. At Sisters in Shape, the emphasis isn’t on weight loss, she says. The goal is "getting fit and taking care of yourself."
"Many African American women don’t make fitness a priority," Marchand explains. "Like everybody else, we are busy working, and we have families, and what gets done is the thing that’s at the top of the priority list. Then there are a lot of single moms out there, and they aren’t going to be able to get to the gym. They might not be able to afford it, either. They aren’t thinking about fitness. They’re thinking about survival. I try to explain that fitness is survival." Rather than making people ashamed that they indulge in high-fat foods and seldom exercise, Farley and Cohen recommend public policies to help us keep extra pounds off. They propose:
A reduction in working hours and commuting time might also open up opportunities in people’s schedules for exercise and for preparation of healthier home-cooked foods. And safer streets would also make a difference, especially in low-income communities. A study by the public opinion firm Yankelovich, Inc. found that one-third of Americans with incomes below $15,000 reported that they do not walk or jog in their neighborhoods for fear of crime. All these measures would make America healthier—and save billions in tax dollars that now are spent on medical conditions linked to obesity.
But can a person be fat and healthy? The two are not mutually exclusive, says Joanne Ikeda, co-director of the Center for Weight and Health at the University of California at Berkeley. Body size is not always an indicator of general health.
Wann, for instance, at 5 feet, 4 inches, and 270 pounds, fits the conventional definition of obese, but her lifestyle and exercise habits resemble those of a cheerleader. "I go to the gym all the time," she says. "I lift weights, I do deep-water aerobics, I go for long walks in the park. This is the way I am genetically programmed to look. I’m not losing weight, but I am keeping myself as happy and healthy as I can be."
"When you really study what makes a person healthy, weight is not the whole story—it’s just a small part of it," Debora Burgard explains. "The secrets to health are really very simple. They’re the things you learn in kindergarten: Eat your fruits and vegetables. Go outside and play. Make friends. It sounds boring, but that’s what it takes to stay healthy for the long term, no matter what your weight." She pauses, then chuckles. "Once we drop our collective obsession with weight, this will cease to be a heavy issue. It’s so basic it’s frightening."
"My concern is that in our increasingly mechanized society, we are forgetting about the importance of physical activity in our overall health," adds Ikeda. "Overweight is only one more visible symptom of this problem. I’m concerned that we are raising a generation of children for whom obesity will be only one element in a long list of health concerns."
Andy Steiner is a senior editor of Utne Reader.
Is the epidemic of obesity in America a personal issue or a political issue? Discuss in Caf