Who should be held responsible for the country’s soaring obesity rates?
This is a very complex issue and it is difficult to hold a specific group responsible. We know, however, that obesity stems from changes in the environment with designs to favor efficiency and reduced physical activity. There has also been a rapid increase in the consumption of convenience and restaurant foods. All sectors of the food industry have increased portion sizes over time, so that people are eating far more calories than they realize.
Important changes that have paralleled the development of the obesity epidemic include extremely high consumption of sweetened beverages. This is something that we can all avoid that can go a long way to reduce calories, and importantly, excess sugar, that may contribute to increased risk of fatty liver and diabetes. Some processed foods, including artificial flavors and artificial sweeteners, are being investigated for possible disruption of satiety signals, which may lead to greater hunger and, therefore, caloric intake and weight gain.
Which is more of a factor in the obesity epidemic: lacking self-discipline or living in an environment that promotes unhealthy behaviors?
There has been a lot of emphasis on blaming individuals for not following good health behavior, but it is not as simple as that. With the proportion of the population that is overweight or obese now in the majority, there are clearly complex factors at play. The food and exercise environment are critical, as is advertising and lack of awareness. In addition to improved understanding of the effects of foods and exercise, and attention to personal choices, individuals need healthy options that are convenient and affordable. There is much that can be done in the environment to make these easier.
Obesity rates in children have tripled since 1980. How do you recommend reversing this upward trajectory?
Obesity has finally received serious attention and there are many groups working on the problem, from research to interventions. It is, however, proving to be a very difficult problem. Much of the earlier efforts focused on weight loss, which is now a multibillion dollar industry. But it’s very difficult to lose weight and to maintain weight loss and results have been disappointing.
The focus for the future needs to be on multilevel interventions that involve everyone — the food industry, the media, medical professionals, teachers and community groups — to prevent weight gain. This involves a focus on healthy foods, with appropriate daily exercise. We need to get this into the public consciousness. Enhanced understanding of the importance of, and experience with, home cooking must be cultivated. At the same time, we need to acknowledge the need for convenience by increasing the availability of minimally processed healthy foods to make cooking easier.
At the community level, we need to increase opportunities for physical activity by enhancing parks, bike paths and building designs that favor stairs rather than elevators. There is no magic bullet and it will take efforts from all sectors, but I see momentum growing and I am optimistic that we will get there.